Objectives
Symptoms of insomnia are highly prevalent in the elderly. A significant number of pharmacological and non‐pharmacological interventions exist, but, up‐to‐date, their comparative efficacy ...and safety has not been sufficiently assessed.
Methods
We integrated the randomized evidence from every available treatment for insomnia in the elderly (>65 years) by performing a network meta‐analysis. Several electronic databases were searched up to May 25, 2019. The two primary outcomes were total sleep time and sleep quality. Data for other 6 efficacy and 8 safety outcomes were also analyzed.
Results
Fifty‐three RCTs with 6832 participants (75 years old on average) were included, 43 of which examined the efficacy of one or more drugs. Ten RCTs examined the efficacy of non‐pharmacological interventions and were evaluated only with pairwise meta‐analyses because they were disconnected from the network. The overall confidence in the evidence was very low primarily due to the small amount of data per comparison and their sparse connectedness. Several benzodiazepines, antidepressants, and z‐drugs performed better in both primary outcomes, but few comparisons had data from more than one trial. The limited evidence on non‐pharmacological interventions suggested that acupressure, auricular acupuncture, mindfulness‐based stress reduction program, and tart cherry juice were better than their control interventions. Regarding safety, no clear differences were detected among interventions due to large uncertainty.
Conclusions
Insufficient evidence exists on which intervention is more efficacious for elderly patients with insomnia. More RCTs, with longer duration, making more direct interventions among active treatments and presenting more outcomes are urgently needed.
STUDY OBJECTIVES: We examined and compared cross-sectional and longitudinal associations between self-reported sleep disturbances and various cognitive domains in five separate Nordic European ...longitudinal aging studies (baseline N=5631, Mean age=77.7, Mean follow-up=4.16 years).
METHODS: Comparable sleep parameters across studies included reduced sleep duration/quality, insomnia symptoms (sleep latency, waking up at night and early awakenings), short and long sleep duration, and daytime napping. The cognitive domains were episodic memory, verbal fluency, perceptual speed, executive functioning, and global cognition (aggregated measure). A series of mixed linear models were run separately in each study and then compared to assess the level and rate of change in cognitive functioning across each sleep disturbance parameter. Models were adjusted for age, sex, education, hypnotic usage, depressive symptoms, lifestyle factors, cardiovascular and metabolic conditions. By using a coordinated analytic approach, comparable construct-level measurements were generated and results from identical statistical models were qualitatively compared across studies.
RESULTS: While the pattern of statistically significant results varied across studies, subjective sleep disturbances were consistently associated with worse cognition and steeper cognitive decline. Insomnia symptoms were associated with poorer episodic memory and participants sleeping less or more than 7-8 hours had a steeper decline in perceptual speed. Additionally, daytime napping (>2 hours) was cross-sectionally and longitudinally associated with all examined cognitive domains. Most observed associations were study-specific (except for daytime napping) and a majority of association estimates remained significant after adjusting for covariates.
CONCLUSION: This rigorous multicentre investigation further supports the importance of sleep disturbance, including insomnia, long and short sleep duration, and daytime napping on baseline cognitive functioning and rate of change among older adults. These sleep factors may be targeted in future lifestyle interventions to reduce cognitive decline.
•Old age and SCI induced distinct profiles of plasma EVs cargo contents.•SCI-disrupted plasma EVs induced glial activation and neuronal apoptosis in vitro.•In vivo, SCI-derived EVs are sufficient to ...impair neurological function in intact mice.•Plasma EVs from young animals had rejuvenating effects on naïve aged mice.•In vivo, disrupted circulating EVs cargoes contributed to brain dysfunction after SCI.
Aged individuals with spinal cord injury (SCI) are prevalent with increased mortality and worse outcomes. SCI can cause secondary brain neuroinflammation and neurodegeneration. However, the mechanisms contributing to SCI-induced brain dysfunction are poorly understood. Cell-to-cell signaling through extracellular vesicles (EVs) has emerged as a critical mediator of neuroinflammation, including at a distance through circulation. We have previously shown that SCI in young adult (YA) male mice leads to robust changes in plasma EV count and microRNAs (miRs) content. Here, our goal was to investigate the impact of old age on EVs and brain after SCI. At 24 h post-injury, there was no difference in particle count or size distribution between YA and aged mice. However, aged animals increased expression of EV marker CD63 with SCI. Using the Fireplex® miRs assay, Proteomics, and mass spectrometry-based Lipidomics, circulating EVs analysis identified distinct profiles of miRs, proteins, and lipid components in old and injury animals. In vitro, plasma EVs from aged SCI mice, at a lower concentration comparable to those of YA SCI mice, induced the secretion of pro-inflammatory cytokines and neuronal apoptosis. Systemic administration of plasma EVs from SCI animals was sufficient to impair general physical function and neurological function in intact animals, which is associated with pro-inflammatory changes in the brain. Furthermore, plasma EVs from young animals had rejuvenating effects on naïve aged mice. Collectively, these studies identify the critical changes in circulating EVs cargoes after SCI and in aged animals and support a potential EV-mediated mechanism for SCI-induced brain changes.
How does major policy change come about? This article identifies and rectifies weaknesses in the conceptualization of innovative policy change in the Advocacy Coalition Framework. In a case study of ...policy belief change preceding an innovative reform in the German subsystem of old‐age security, important new aspects of major policy change are carved out. In particular, the analysis traces a transition from one single hegemonic advocacy coalition to another stable coalition, with a transition phase between the two equilibria. The transition phase is characterized (i) by a bipolarization of policy beliefs in the subsystem and (ii) by state actors with shifting coalition memberships due to policy learning across coalitions or due to executive turnover. Apparently, there are subsystems with specific characteristics (presumably redistributive rather than regulative subsystems) in which one hegemonic coalition is the default, or the “normal state.” In these subsystems, polarization and shifting coalition memberships seem to interact to produce coalition turnover and major policy change. The case study is based on discourse network analysis, a combination of qualitative content analysis and social network analysis, which provides an intertemporal measurement of advocacy coalition realignment at the level of policy beliefs in a subsystem.
Introduction and objective Stroke most often affects elderly people. It often causes lasting brain damage and results in disability. Despite considerable progress in prevention, diagnosis,treatment ...and rehabilitation, patients with the diagnosis of stroke are burdened with a high risk of health problems and social alienation. The aim of the study was presentation of the principles of patient rehabilitation as a multidisciplinary process, and difficulties in rehabilitation of elderly patients who had undergone stroke. Review methods A review and analysis of medical literature published in 2016–2020 on rehabilitation of the elderly after stroke was performed with particular emphasis on the medical and social aspects of the rehabilitation process. Abbreviated description of the state of knowledge The aim of rehabilitation of patients after stroke is the prevention of complications arising from temporary immobilization, and reduction of dysfunctions connected with the size and location of the focus of stroke. It is important to restore verbal communication of the patient with the environment, and improve motor functions. Systematic and individually adjusted rehabilitation is the chance for faster restoration of patient’s efficiency and living in society. An elderly person after stroke needs special care during the rehabilitation process because of symptoms and complications resulting from illness and systemic changes which take place due to ageing. Summary Rehabilitation after stroke should begin on admission to hospital. Progress in rehabilitation significantly increases patient’s motivation to exercise, and exerts a beneficial effect on the rehabilitation process. Multiple repeating of exercises and motivation of the patient are the factors which, to a great extent, restore patient’s efficiency, and enable the return to life in society.
Acute pancreatitis caused by acute hepatitis A is extremely rare, with only a small number of cases in young adults having been reported. This paper presents a 74-year-old female patient with an ...acute abdomen, which proved to be acute pancreatitis with acute hepatitis A. A survey of acute viral hepatitis A as a root cause of pancreatitis should be considered when clinicians encounter patients with acute pancreatitis without any known etiology of pancreatitis.
Despite the lower prevalence of severe mood disorders in the elderly as compared to younger adults, late-life depression and bipolar disorder (BD) are more strongly associated with negative outcomes ...related to the presence of medical comorbidities, cognitive deficits, and increased suicide risk and overall mortality. The mechanisms that contribute to these associations are probably multifactorial, involving pathological factors related directly and indirectly to the disease itself, ranging from biological to psychosocial factors. Most of the accumulated knowledge on the nature of these associations derives from naturalistic and observational studies, and controlled data are still scarce. Nonetheless, there has clearly been a recent growth of the scientific interest on late-life BD and geriatric depression. In the present study, we review the most relevant studies on prevalence, clinical presentation, and cognitive/functional impact of mood disorders in elderly. Several clinical-epidemiological studies were dedicated to the study of the prevalence of mood disorders in old age in distinct settings; however, fewer studies investigated the underlying neurobiological findings and treatment specificities in late-life depression and BD. In the present study, we further discuss the implications of these findings on the management of mood disorders in older adults.
The COVID-19 pandemic, due to its disproportionated higher morbidity and mortality rates in the older age, has been considered to be a "geropandemic." Several studies, however, have found that older ...age is associated with lower psychological distress in relation to the COVID-19 outbreak and related lockdown measures.
To explore the role of Resilience as a mediator between stressful COVID-19 related life events and depressive and, anxiety symptoms and perceived stress, and to ascertain the role of age as a moderator of the mediator's effect.
An on-line survey was spread through social networks during the first lockdown in Italy. Depressive and anxiety symptoms and perceived stress were measured using the Italian version of the Patient Health Questionnaire-9 (PHQ-9), the Generalized Anxiety Disorder Questionnaire-7 (GAD-7) and the Perceived Stress Scale (PSS). Resilience was measured using the Italian version of the Resilience Scale for Adults (RSA). Stressful COVID-19 related life events were explored using a checklist of events derived from the International Adjustment Disorder Questionnaire (IADQ). After a preliminary panel of linear regressions, mediation was tested using Structural Equation Modeling and inspecting the bootstrapped indirect effects. Afterwards, age was introduced as a mediator of the indirect effect in a moderated mediation analysis.
Twenty one thousand three hundred and thirty four subjects completed the questionnaire, 17,178 (80.52%) were female, 748 (3.5%) were >60 years old. In the whole sample, the presence of any stressful event was associated with depressive and anxiety symptoms and perceived stress. Resilience mediated the effects of stressful COVID-19-related events on depressive and anxiety symptoms and perceived stress. The moderated mediation analysis revealed that age moderated the mediation effect of Resilience between the presence of a stressful event and the selected outcomes.
Taken together, our results show that age moderates the mediating effect of Resilience in the relationship between COVID-19-related stressful events and depressive and anxiety symptoms and perceived stress. Older adults' Resilience was less influenced by stressful events, and this could be one of the reasons accounting for the better mental health outcomes observed in the older age.
This volume represents the beginning of a 'cross pollination' of different social scientific disciplines, bridging the boundaries between national and disciplinary epistemic communities in the worlds ...of European welfare markets. It maps the common ground and uncovers new research directions for the future study of actors, policies and institutions shaping the growth and dynamics of European welfare markets. The book defines welfare markets as politically shaped, regulated and state supported markets that provide social goods and services through the competitive activities of non-state actors. The chapters focus on what happens after states have initiated welfare markets, with equal weight given to the analysis of the agency of state actors and non-state actors in the contraction, stabilisation, and disruption of welfare markets. By focusing the analysis on two cases of welfare markets, private pensions and home-based domestic/care work, the contributions explore and compare the dynamics of different types of markets. The research will be of use to sociologists and scholars of social policy interested in the social dimension of welfare markets, political scientists and political economists, as well as diverse epistemic communities across the social sciences.
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