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  • 1.

    【2hr】Relationship of Prevalent Fragility Fracture in Dementia Patients: Three Years Follow up Study

    包量

    机译 痴呆症患者中普遍脆弱性裂缝的关系：三年后续研究
    摘要：Introduction: dementia increases the risk of falls by 2–3 times and cognitively impaired patients are three times more likely to have hip fracture following a fall when compared to cognitively intact individuals. However, there is not enough evidence that explores the relationship between dementia and fragility fractures. The aim of this study is to explore the relationships of prevalent fragility fracture in patients with dementia admitted with an acute illness to the hospital. Methods: the existing Health Board records were reviewed retrospectively for all patients admitted diagnosed with dementia in the year 2016. All patients were followed up for a maximum of three years. All of the the dementia patients were divided into three groups: group 1—“no fractures”; group 2—“all fractures”; group 3—“fragility fractures”. Clinical outcomes were analysed for hospital stay, discharge destination (new care home), post-discharge hip fracture data, and mortality. Results: dementia patients with a prevalent fracture were significantly older, 62% were women. A significantly higher proportion of dementia patients with prevalent fractures were care home residents and taking a significantly higher number of medications. The mean Charlson comorbidity index was similar in patients with or without fracture. Dementia patients with a prevalent fracture required a new care home and this is significantly higher when compared to those with no fracture. Mortality at one year and three year was not statistically different in patients with or without prevalent fractures. A significantly higher number (21.5%) of dementia patients with prevalent fragility fracture sustained a new hip fracture when compared to those with no prevalent osteoporotic fracture (2.9%) over the three years follow up (p < 0.0001). Conclusion: dementia patients with a prevalent fragility fracture is associated with a statistically significant higher risk of a new care home placement following acute hospital admission. This sub-group is also at risk of a new hip fracture in the next three years. Whilst clinical judgement remains crucial in the care of frail older people, it is prudent to consider medical management of osteoporosis in dementia if deemed to be beneficial following the comprehensive geriatric assessment.
  • 2.

    【2hr】Protein Intake Protein Mealtime Distribution and Seafood Consumption in Elderly Norwegians: Associations with Physical Function and Strength

    包量

    机译 老年挪威语的蛋白质摄入蛋白质餐饮时间分布和海鲜消费：具有物理功能和力量的关联
    摘要：Protein intake is considered important in the maintenance of muscle health in ageing. However, both the source and mealtime distribution of protein might affect the intake of protein and its effect on muscle protein synthesis. In this study, protein intake, mealtime distribution of protein, and seafood consumption were assessed in 92 older adults (aged 65+), and associations with physical performance (Short Physical Performance Battery (SPPB)), grip strength and gait speed were assessed in a multiple linear regression analysis. The participants had a mean age of 73 ± 8.9 years. Mean protein intake was 1.1 g/kg body weight. Protein intake was well distributed, with coefficient of variance between meals (CV meals) 0.6 ± 0.3. However, dinner had the highest protein intake. No associations were found between the nutrition factors and physical performance or strength; however, this result might have been caused by a ceiling effect in the chosen test batteries, as the mean score on SPPB was 10.3 ± 2.7, and 48.9% of the participants reached the top score of 12 points. Mean grip strength was 44.4 ± 9.4 kg (men) and 26.2 ± 6.8 kg (women). Mean gait speed was 1.0 ± 0.3 m/s. The interaction analysis suggests that there might be gender differences in the effect of seafood consumption on gait speed.
  • 3.

    【2hr】Can Comprehensive Geriatric Assessment Meet Frail Older People’s Needs? Results from the Randomized Controlled Study CGA-Swed

    包量

    机译 可以综合的老年人评估符合脆弱老年人的需求吗？随机控制研究CGA-SHED的结果
    摘要：Background: The comprehensive geriatric assessment (CGA) designed to manage frail older people requiring acute medical care, is responsible for diagnostics, assessment, treatment, and planning while addressing a person’s medical, psychological, social, and functional capabilities. The aim was to investigate if CGA had an impact on frail older people’s activities of daily living (ADL) status, self-rated health, and satisfaction with hospital care. Methods: A two-armed design with frail people aged 75 or older who required an unplanned hospital admission were randomized to either the CGA ward or to an acute medical ward. Analyses were made based on the intention-to-treat principle (ITT). The primary outcome was ADL. Data were analyzed using Chi-square and odds ratio. A subgroup analysis was performed due to non-adherence and contamination. Results: One-hundred and fifty-five people participated in the study; 78 in the intervention and 77 in the control. Participants in the intervention group had a higher odds ratio of reporting having received written information and felt that care met their needs during their hospital stay. No additional statistically significant results for the primary or secondary outcomes in the ITT analysis were achieved. Conclusion: Participants felt that the care they received with the CGA ward met their needs. The lack of additional results supporting the CGA could be due to difficulties performing pragmatic intervention trials in clinical hospital settings, and because a CGA during one hospital stay is probably not enough to have long-term effects.
  • 4.

    【2hr】The Quality of Life of Older Individuals Following the World Health Organization Assessment Criteria

    包量

    机译 世界卫生组织评估标准之后老年人的生活质量
    摘要：The aim of this study was to evaluate the psychometric qualities of the WHOQOL-BREF(PT) (the questionnaire developed by the World Health Organization Quality of Life Grpup for quality of life assessment), when applied to Portuguese elderly people residing in a community setting. The psychometric qualities were assessed by confirmatory factor analysis. A hierarchical second-order model and a third model were performed, and all three models presented similar and reasonable adjustment indexes. The data analysis showed that the construct failed only regarding discriminant validity because the correlations between the first-order factors were higher, associated with lower values of average variance extracted. The psychometric qualities found in the original translation/validation of the WHOQOL-BREF(PT) were compared with those found in this study; this study found higher correlations between domains but a similar level of factor reliability. The findings of this study lead to three recommendations: (i) to compute each factor score for each participant using the factor score weights obtained from confirmatory analysis models instead of adopting a unitary weight for each item, as proposed by the authors of the original translation/validation of the WHOQOL-BREF(PT); (ii) to compute a QOL score, which is not included in the original translation/validation; and (iii) to analyze differences between individual scores for each participants, which should be done by a group of health experts.
  • 5.

    【2hr】Experience of Elderly People Regarding the Effect of Yoga/Light Exercise on Sedentary Behavior: A Longitudinal Qualitative Study in Madhya Pradesh India

    包量

    机译 关于瑜伽/轻型运动对久坐行为的影响的老年人的经验：印度Madhya Pradesh的纵向定性研究
    摘要：This study is set on the background of a randomized control trial (RCT) in which intervention was carried to observe the effects of yoga/light exercise on the improvement in health and well-being among the elderly population. A longitudinal qualitative study was conducted as part of RCT interventions to explore the experience of the elderly practicing yoga/light exercise in relation to sedentary behavior in the Ujjain district of Madhya Pradesh, India. Participants of the RCT were selected for this study. Eighteen focus group discussions were conducted—six during each phase of RCT interventions (before, during, and after). The findings regarding motivating and demotivating factors in various phases of intervention were presented in three categories: experience and perception of the effects of yoga/light exercise on sedentary behavior (1) before, (2) during, and (3) after intervention. This study explores the positive effect of yoga/light exercise on sedentary behavior and subjective well-being on the elderly population. They were recognized to have undergone changes in their physical and emotional well-being by consistently practicing yoga/light exercise. The main driving factors were periodic health check-ups and the encouragement of qualified trainers without any cost. This study concludes with the notion that these interventions should be encouraged in the community to use physical exercise as a method to better control the physical and social effects of aging.
  • 6.

    【2hr】Analysis of Vertical Micro Acceleration While Standing Reveals Age-Related Changes

    包量

    机译 垂直微加速度分析同时站立揭示与年龄相关的变化
    摘要：In this study, we investigated the fluctuation characteristics of micro vertical acceleration of center of mass (vCOMacc) in standing and examined the usefulness of vCOMacc as an aging marker for standing control abilities. Sixteen young and 18 older adults participated in this experiment. Data for vCOMacc were calculated as the vertical ground reaction force value divided by each participant’s body mass using a force plate. The COMacc frequency structure was determined using the continuous wavelet transform to analyze the relative frequency characteristics. For time domain analysis, we determined the root mean square (RMS) and maximum amplitude (MA) of the integrated power spectral density. We also analyzed the correlation between vCOMacc and lower limb muscle activity. The relative frequency band of vCOMacc was higher in older than young adults, and the time domain indicators were sufficient to distinguish the effects of aging. Regarding the relationship between vCOMacc during standing and muscle activity, a correlation was found with the soleus muscle in young adults, while it was moderately correlated with the gastrocnemius muscle in older adults. The cause of vCOM may be related to differences in muscle activity, and vCOMacc may be utilized to more easily assess the effects of aging in standing control.
  • 7.

    【2hr】Effects of Music Therapy on Patients with Dementia—A Systematic Review

    包量

    机译 音乐疗法对痴呆患者的影响 - 系统综述
    摘要：Dementia is an increasingly common syndrome and while pharmacotherapy is available, its potential benefit is limited, especially in non-cognitive outcomes. Non-pharmacotherapy such as music therapy is potentially associated with improved outcomes. We assessed the effects of music therapy on patients with dementia to evaluate its potential benefits on dementia. Two independent reviewers searched MEDLINE, EMBASE, CINAHL, CENTRAL, and ClinicalTrials.gov databases for clinical trials, using the keywords “music therapy” and “dementia”. Study outcomes included cognitive function, behavioral and psychological symptoms of dementia (BPSD), and quality of life. A total of 82 studies were included, of which 43 were interventional clinical trials, and 39 were systematic reviews or meta-analyses. Significant improvements in verbal fluency occurred after music therapy, with significant reductions in anxiety, depression, and apathy. There were no significant improvements in cognition or daily functioning, and the results on quality of life and agitation were ambiguous. Limitations of studies included low patient numbers, lack of standardized music therapy, and high heterogeneity in outcomes. More large-scale clinical trials would allow for clearer conclusions on the benefits of music therapy in patients with dementia.
  • 8.

    【2hr】The Potential Mediation of the Effects of Physical Activity on Cognitive Function by the Gut Microbiome

    包量

    机译 物理活性对肠道微生物组的认知功能的影响的潜在调解
    摘要：The population of older adults is growing dramatically worldwide. As older adults are at greater risk of developing disorders associated with cognitive dysfunction (i.e., dementia), healthcare costs are expected to double by 2040. Evidence suggests dementia may be slowed or prevented by lifestyle interventions, including physical activity (PA). PA is associated with improved cognitive function and may reduce risk for dementia by mitigating known risk factors (i.e., cardiovascular diseases) and/or by enhancing neurochemical processes. An emerging area of research suggests the gut microbiome may have similar neuroprotective effects. Altering the gut microbiome has been found to target physiological processes associated with dementia risk, and it influences gut-brain-microbiome axis signaling, impacting cognitive functioning. The gut microbiome can be altered by several means (i.e., disease, diet, prebiotics, probiotics), including PA. As PA and the gut microbiome independently influence cognitive function and PA changes the composition of the gut microbiome, cognitive improvement due to PA may be partially mediated by the gut microbiome. The present article provides an overview of the literature regarding the complex associations among PA, cognitive function, and the gut microbiome, as well as their underlying biological mechanisms. A comprehensive, theoretical model integrating evidence for the potential mediation is proposed.
  • 9.

    【2hr】Age-Related Male Hypogonadism and Cognitive Impairment in the Elderly: Focus on the Effects of Testosterone Replacement Therapy on Cognition

    包量

    机译 老年人与年龄相关的男性过激作用和认知障碍：专注于睾酮替代疗法对认知的影响
    摘要：Background. Epidemiological data report that male hypogonadism may play a role in cognitive impairment in elderly. However, the effect of testosterone replacement therapy (TRT) on cognitive abilities in this cluster of patients has not been well established. Methods. PubMed/MEDLINE, Google Scholar, Cochrane Library, and Web of Science were searched by using free text words and medical subject headings terms related with “male hypogonadism”, “late-onset hypogonadism”, elderly, cognition, “mild cognitive impairment”, memory, “testosterone replacement therapy” used in various combinations according to the specific clinical questions. Original articles, reviews, and randomized controlled trials written in English were selected. Results. A long-term TRT could improve specific cognitive functions, such as verbal and spatial memory, cognitive flexibility, and physical vitality. However, randomized controlled trials do not provide positive results, and in most of the cases TRT might not induce beneficial effects on cognitive function in elderly men. Discussion and conclusions. Since the lengthening of life expectancy, the prevalence rate of cognitive decline in elderly men is expected to increase remarkably over the next decade with considerable healthcare and economical concerns. Therefore, this remains a relevant clinical topic and further investigations are needed for clarifying the role of TRT especially in elderly men with hypogonadism.
  • 10.

    【2hr】Age-Related Diseases and Driving Safety

    包量

    机译 年龄相关的疾病和驾驶安全
    摘要：Due to demographic changes, the number of older drivers is steadily increasing. Mobility is highly relevant for leading an independent life in the elderly. It largely depends on car driving, which is a complex task requiring a multitude of cognitive and motor skills vulnerable to age- related functional deterioration. The almost inevitable effects of senescence may be potentiated by age-related diseases, such as stroke or diabetes mellitus. Respective pharmacological treatment may cause side effects, additionally affecting driving safety. The present article reviews the impact of age-related diseases and drug treatment of these conditions on driving fitness in elderly drivers. In essence, we focus on diseases of the visual and auditory systems, diseases of the central nervous system (i.e., stroke, depression, dementia and mild cognitive disorder, and Parkinson’s disease), sleep disorders, as well as cardiovascular diseases, diabetes mellitus, musculoskeletal disorders, and frailty. We will outline the role of functional tests and the assessment of driving behavior (by a driving simulator or in real traffic), as well as the clinical interview including questions about frequency of (near) accidents, etc. in the evaluation of driving fitness of the elderly. We also address the impact of polypharmacy on driving fitness and end up with recommendations for physicians caring for older patients.
  • 11.

    【2hr】Is IDDSI an Evidence-Based Framework? A Relevant Question for the Frail Older Population

    包量

    机译 IDDSI是一个基于证据的框架吗？脆弱年龄较大的人口有关的问题
    摘要：To delay impacts of aging, optimal nutritional status is essential. Several factors can reduce food intake, such as isolation, income, and cognitive/physical decline. Additionally, chewing and swallowing difficulties, or dysphagia, often disrupt the ability to consume life-long favorite dishes. Food and liquids could require modification of texture or consistency to ensure a comfortable or safe swallow. The food industry, foodservices facilities, and caregivers need quality control benchmarks to provide adequate nourishment and meet these new feeding challenges. The International Dysphagia Diet Standardisation Initiative (IDDSI) is proposing the IDDSI framework and testing methods to describe food used in nutritional care plans to circumvent dysphagia and improve communication among caregivers. This systematic review assesses the validity and reliability of the IDDSI testing methods using the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN). Two publications presented content validity whereas 19 publications looked at construct validity or reliability for the IDDSI testing methods. One study was conducted in older adults presenting dysphagia. This review concludes that there is insufficient evidence to recommend the IDDSI testing methods. Further research, conducted with robust methodological design and reporting, is needed to develop and assess nutritious adapted food for frail older populations.
  • 12.

    【2hr】Global Cognitive Impairment Prevalence and Incidence in Community Dwelling Older Adults—A Systematic Review

    包量

    机译 全球认知患病率和社区住宅年龄较大的成年人的发病率 - 系统审查
    摘要：(1) Background: We proposed to review worldwide estimates of cognitive impairment prevalence and incidence in adults older than 50 years of age living in the community. (2) Methods: Systematic searches were performed in January 2019 using MEDLINE/PubMed. Articles were selected if they referred to cognitive impairment, prevalence, incidence, elders, and population or community-based studies. Analysis, aggregated by different methodologic features, was performed. (3) Results: Prevalence (80 studies) ranged between 5.1% and 41% with a median of 19.0% (25th percentile = 12.0%; 75th percentile = 24.90%). Incidence (11 studies) ranged from 22 to 76.8 per 1000 person-years with a median of 53.97 per 1000 person-years (25th percentile = 39.0; 75th percentile = 68.19). No statistically significant effects were found except for inclusion age. (4) Conclusion: We propose that the homogenization and clarification of the definition of what constitutes cognitive impairment are essential to refine the epidemiological understanding of this entity. The results of this review reinforce the importance of adherence to standardized cut-off scores for cognitive tests to promote study comparability.
  • 13.

    【2hr】Associations between Pet Ownership and Frailty: A Systematic Review

    包量

    机译 宠物所有权和脆弱之间的协会：系统审查
    摘要：Frailty is defined as a state of increased vulnerability due to age-related decline in reserve and function across multiple physiological systems. Increasing physical activity level is considered to be a measure to counteract frailty. Some studies have indicated that pet owners are more engaged in physical activity than non-owners. We conducted a systematic review regarding associations between pet ownerships and frailty among community-dwelling older adults and critically assessed the findings. PubMed was searched in April 2020 according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines for cross-sectional or prospective studies examining associations between pet ownership and frailty in community-dwelling older adults with a mean age of 60 or above. A supplementary search was done using Google Scholar. Identified articles were reviewed by two investigators independently and assessed for methodological quality. The search identified 48 studies, among which three studies (two cross-sectional and one prospective) were included in this review. These studies suggested that pet ownership may be associated with a lower risk of frailty. This systematic review found only a limited amount of relevant research. More research is needed to establish the link between pet ownership and frailty as well as healthy aging and well-being.
  • 14.

    【2hr】Nutrients and Pathways that Regulate Health Span and Life Span

    包量

    机译 调节健康跨度和寿命的营养和途径
    摘要：Both life span and health span are influenced by genetic, environmental and lifestyle factors. With the genetic influence on human life span estimated to be about 20–25%, epigenetic changes play an important role in modulating individual health status and aging. Thus, a main part of life expectance and healthy aging is determined by dietary habits and nutritional factors. Excessive or restricted food consumption have direct effects on health status. Moreover, some dietary interventions including a reduced intake of dietary calories without malnutrition, or a restriction of specific dietary component may promote health benefits and decrease the incidence of aging-related comorbidities, thus representing intriguing potential approaches to improve healthy aging. However, the relationship between nutrition, health and aging is still not fully understood as well as the mechanisms by which nutrients and nutritional status may affect health span and longevity in model organisms. The broad effect of different nutritional conditions on health span and longevity occurs through multiple mechanisms that involve evolutionary conserved nutrient-sensing pathways in tissues and organs. These pathways interacting each other include the evolutionary conserved key regulators mammalian target of rapamycin, AMP-activated protein kinase, insulin/insulin-like growth factor 1 pathway and sirtuins. In this review we provide a summary of the main molecular mechanisms by which different nutritional conditions, i.e., specific nutrient abundance or restriction, may affect health span and life span.
  • 15.

    【2hr】Revision of Acetabular Component with a Debonded Porous Coating in an Elderly Patient

    包量

    机译 在老年患者中使用脱粘多孔涂层修改髋臼成分
    摘要：Debonding of the porous coating from the acetabular component of a total hip endoprosthesis is a rare complication. Revision total hip arthroplasty for an unstable acetabular component with a debonded porous coating strongly fixed to the bone can be challenging, especially in elderly patients of poor overall health. In such patients, revision procedures should be as simple and safe as possible. We present our technique of solving that problem in a case of an 82-year-old female with bad general condition and unstable acetabular component of hip endoprosthesis. Because of extremely deficient bone stock, a well-fixed porous coating was left in acetabulum to serve as a “cage“, allowing cemented acetabular component placement. This procedure can reduce the risk of intraoperative bone fracture, blood loss, and duration of surgery, which is important in elderly patients with poor overall health.
  • 16.

    【2hr】Responding to COVID-19: Lessons Learned from a Senior Living and Social Service Organization

    包量

    机译 回应Covid-19：从高级生活和社会服务组织中吸取的经验教训
    摘要：This case study analyzes one senior living and social service organization’s coronavirus (COVID-19) crisis response. We conducted interviews with n = 14 department managers to explore the organization’s pivot to remote work and service provision. We used the Pearson and Mitroff Crisis Management Framework to organize themes. A pre-existing culture of teamwork, willingness to adapt and adopt new approaches, and responsiveness to new policies and procedures facilitated the COVID-19 crisis response. However, low levels of digital literacy among staff, decreased job satisfaction due to no face-to-face interaction between care recipient and service provider, and lack of proactive policies for crisis response, which decreased the speed of enacting remote service provision, were obstacles in effective crisis response. Lessons learned from this case study highlight the need for pre-emptive policy creation on remote service provision and work from home policies, as well as training considerations for senior living and social service organizations.
  • 17.

    【2hr】Looking for the Little Things: A Multi-Disciplinary Approach to Medicines Monitoring for Older People Using the ADRe Resource

    包量

    机译 寻找小事：使用Adre资源的老年人的药物监测多学科方法
    摘要：Advances in medicines have increased the effectiveness of treatments and the social and cultural authority of doctors. However, as prescribing has become the dominant modality of treatment, the “pharmaceuticalization” of medical practice has often resulted in treatment “at a distance”, with doctors having limited contact with patients. Older and poorer people, who are socially distanced from medical prescribers, suffer more adverse drug reactions (ADRs) than the general population. A team approach to checking patients systematically for ADRs, as detailed in manufacturers’ literature, can minimise medication errors, but regular review is rare. This paper explains the benefits of medicines monitoring to protect older patients from iatrogenic harm, such as over-sedation, falls, or drug-induced Parkinsonism. We show how multidisciplinary initiatives to optimise prescribing can be supported by using a recognised resource—the adverse drug reaction profile (ADRe). The profile identifies and documents patients’ signs and symptoms of putative ADRs. Better monitoring allows professionals to adjust prescribing and respond to identified problems with agility. Implementation of systematic monitoring will require changes to the regulatory regime and better inter-professional cooperation. Providing carers, nurses and pharmacists with a structured system to monitor patients would democratise relevant medical knowledge and help address ageism and the socio-economic health divide.
  • 18.

    【2hr】Frailty Assessment in Clinical Practice: Opportunity in the Midst of a Pandemic

    包量

    机译 临床实践中的脆弱评估：大流行中的机会
    摘要：Emerging evidence from studies of older adults hospitalised with COVID-19 suggests that there is a high prevalence of frailty in this patient group. We reflect on the measurement of frailty in older patients hospitalized as an emergency and the translation of frailty from a research to a clinical concept. We consider whether, despite the contemporary challenges in the care of older adults as a result of COVID-19, there are opportunities for care quality improvement during a pandemic.
  • 19.

    【2hr】New Variations on the Theme of Multidimensional Geriatric Assessment

    包量

    机译 多维老年评估主题的新变化
    摘要：Geriatric assessment—broadly defined—has become foundational to systems of care for frail elderly people at risk for functional decline, death, intensification of services, and long-term institutionalization. Its key feature is the ascertainment of multiple dimensions of health and health risks: not only medical, but functional, cognitive, psychological, and socioeconomic factors. This multidimensionality is key to systematic screening and targeting using technologies to uncover frail, at-risk elderly people in their neighborhoods, homes, and at various other service contact points, for more intensive evaluation, i.e., “comprehensive geriatric assessment”, a multidisciplinary diagnostic and treatment process that identifies medical, psychosocial, and functional limitations of a frail older person to develop a coordinated plan to maximize overall health with aging [1].
  • 20.

    【2hr】The Impact of Urinary Incontinence on Quality of Life: A Cross-Sectional Study in the Metropolitan City of Naples

    包量

    机译 尿失禁对生命质量的影响：十万城市的横断面研究
    摘要：Urinary incontinence is a hygienic and psychosocial problem that often brings people to restrict their social life and to experience depression. The main aim of this study was to evaluate the impact of urinary incontinence on quality of life among residents of the Metropolitan City of Naples, Italy, using a newly designed multidimensional questionnaire. The secondary objective was to find which variables affect the quality of life and symptom severity in these patients. To do so, a sample composed of twenty-eight patients was recruited in a multicentre cross-sectional study. Most of the participants had a mild impairment (60%) concerning social life and self-perception, especially those whose education was above the primary level (p = 0.036) and those who followed a pelvic floor rehabilitation program (p = 0.002). Overflow urinary incontinence was associated with a greater deterioration in the aspirational and occupational domain (p = 0.044). Symptom severity was worse in those who had comorbidities (p = 0.038), who had a high body mass index (p = 0.008) or who used diuretics (p = 0.007). In conclusion, our results suggest that there is a significant impairment of quality of life in patients who have only primary education and who follow a pelvic floor rehabilitation program.
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