Abstract
Background
COVID-19 has disproportionately affected older people.
Objective
The objective of this paper to investigate whether frailty is associated with all-cause mortality in older ...hospital inpatients, with COVID-19.
Design
Cohort study.
Setting
Secondary care acute hospital.
Participants
Participants included are 677 consecutive inpatients aged 65 years and over.
Methods
Cox proportional hazards models were used to examine the association of frailty with mortality. Frailty was assessed at baseline, according to the Clinical Frailty Scale (CFS), where higher categories indicate worse frailty. Analyses were adjusted for age, sex, deprivation, ethnicity, previous admissions and acute illness severity.
Results
Six hundred and sixty-four patients were classified according to CFS. Two hundred and seventy-one died, during a mean follow-up of 34.3 days. Worse frailty at baseline was associated with increased mortality risk, even after full adjustment (P = 0.004). Patients with CFS 4 and CFS 5 had non-significant increased mortality risks, compared to those with CFS 1–3. Patients with CFS 6 had a 2.13-fold (95% CI 1.34–3.38) and those with CFS 7–9 had a 1.79-fold (95% CI 1.12–2.88) increased mortality risk, compared to those with CFS 1–3 (P = 0.001 and 0.016, respectively). Older age, male sex and acute illness severity were also associated with increased mortality risk.
Conclusions
Frailty is associated with all-cause mortality risk in older inpatients with COVID-19.
Inpatient falls among older adults are a relentless problem, and extant inpatient fall prevention research and interventions lack the older adults' perspectives and experiences of their own fall risk ...in the hospital. Theory-guided research is essential in nursing, and the purpose of this paper was to describe the process of developing a theoretical framework for a phenomenological nursing study exploring older adults' lived experiences of being at risk for falling in the hospital.
Based on philosophical nursing underpinnings, the Health Belief Model (HBM) was selected as the theoretical model. The limitations of the model led to expansion of the model with established concepts associated with accidental falls among older adults.
The HBM was selected as the guiding model due to its ability to capture a broad range of perceptions of a health threat. The HBM was expanded with the concepts of embarrassment, independence, fear of falling, dignity and positivity effect. The addition of these concepts made the theoretical framework more applicable to age-related developmental behaviours of older adult and more applicable to nursing research.
The Expanded HBM theoretical framework may guide future nursing research to develop fall prevention interventions to decrease fall rates among hospitalized older adults.
No Patient or Public Contribution.
•The presence of increased loudness and roughness in the soundscape of nursing homes may lead to elevated heart rate and an increased risk of cardiovascular health issues among the elderly ...population.•The moderate elevation of LAeq levels in the outdoor dynamic scenes within nursing homes may have a positively stimulating effect on the physiological function of older individuals.•Preference for different sound source types may have a significant effect on physiological indicators in older adults.
This research explores the impact of outdoor soundscapes at nursing homes on the physiological health of older adults. Using virtual reality, the study recreated the outdoor environments at nursing homes for 57 seniors in a lab setting, continuously monitoring physiological indicators such as skin conductance level, heart rate, low to high-frequency heart rate variability ratio, respiratory frequency, blink frequency, and pupil diameter. The comparison of these indicators with corresponding soundscapes revealed the diverse effects of different nursing home outdoor scenarios on the physiological health of older adults. Furthermore, analysis of the temporal marginal effects of these indicators highlighted the significant influence of time on the physiological responses of seniors in various soundscapes, showing fluctuations in each indicator at different times. Finally, to understand the channels of impact, the study examined how acoustic features at nursing homes affect seniors' physiological indicators. The findings suggest that increased loudness and roughness in soundscapes elevate seniors' heart rates and cardiovascular risks, while a moderate increase in LAeq and fluctuation strength in dynamic scenarios might have positive stimulative effects on the physiological functions of the older adults.
Sarcopenia and Cardiovascular Diseases Damluji, Abdulla A; Alfaraidhy, Maha; AlHajri, Noora ...
Circulation (New York, N.Y.),
05/2023, Letnik:
147, Številka:
20
Journal Article
Recenzirano
Odprti dostop
Sarcopenia is the loss of muscle strength, mass, and function, which is often exacerbated by chronic comorbidities including cardiovascular diseases, chronic kidney disease, and cancer. Sarcopenia is ...associated with faster progression of cardiovascular diseases and higher risk of mortality, falls, and reduced quality of life, particularly among older adults. Although the pathophysiologic mechanisms are complex, the broad underlying cause of sarcopenia includes an imbalance between anabolic and catabolic muscle homeostasis with or without neuronal degeneration. The intrinsic molecular mechanisms of aging, chronic illness, malnutrition, and immobility are associated with the development of sarcopenia. Screening and testing for sarcopenia may be particularly important among those with chronic disease states. Early recognition of sarcopenia is important because it can provide an opportunity for interventions to reverse or delay the progression of muscle disorder, which may ultimately impact cardiovascular outcomes. Relying on body mass index is not useful for screening because many patients will have sarcopenic obesity, a particularly important phenotype among older cardiac patients. In this review, we aimed to: (1) provide a definition of sarcopenia within the context of muscle wasting disorders; (2) summarize the associations between sarcopenia and different cardiovascular diseases; (3) highlight an approach for a diagnostic evaluation; (4) discuss management strategies for sarcopenia; and (5) outline key gaps in knowledge with implications for the future of the field.
There is an emerging imperative to design walkable communities catering to older adults, particularly given the context of an increasingly aging population. However, studies of how older citizens ...perceive walkability remain scarce. Therefore, this study aims to identify the factors that influence walking behaviours and perceived walkability among senior citizens, whilst also illuminating the associations between them.
A quantitative analysis was conducted on 200 older individuals living in Ealing, London, an area with a large proportion of senior citizens. Utilising the self-developed Neighbourhood Environment Walkability Scale for Older Adults (NEWS-OA), based on the abbreviated version of NEWS, both linear and logistic regression models were employed to decode the data.
Our results show that NEWS-OA is appropriate for assessing perceived walkability among senior citizens and reveal concerns regarding traffic safety. Communities with high walkability are likely to encourage an extended distance, duration, and frequency of walks. However, socioeconomic status (SES) was found to have a less pronounced effect on walking frequency and distance. The study further demonstrates that perceptions of safety were lower among older adults with a high SES. We found that positive perceptions of all the variables tested, except Aesthetics, encouraged walking. Furthermore, the study reveals the crucial influence of these perceptions on older adults’ inclination to walk for various purposes, such as the role of perceived safety in terms of social interaction.
This study offers insights that can be used to make London a more age-friendly and walkable city. It can also serve as a reference for other cities to enhance inclusiveness.
•Older adults in London have significant concerns about traffic safety.•Age and gender have different effects on walking behaviours and perceptions of walking behaviours.•The impact of SES on walking behaviours is less pronounced than on walkability.•Most perceptions of walking are positively correlated with walking behaviours.
The population aging is a growing problem worldwide. Walking is one of the most important ways of self-management of health for older adults, determined by many factors, such as neighborhood ...environment (NE) and socio-economic attributes. Although the previous studies have typically predicted elderly walking behavior through NE, they are limited by the methodological system and data collection, resulting in low prediction accuracy. To this end, this study incorporates residents' subjective perceptions of the environment and objective neighborhood environmental attributes into the evaluation system, uses human-machine adversarial framework and machine learning methods to predict elderly walking behavior, and assesses the nonlinear effects of each factor. The results show that (1) combining subjective and objective factors, the prediction accuracy of elderly walking behavior has been effectively improved based on human-machine adversarial framework and machine learning methods. (2) The nonlinear and threshold effects of environmental and perceptual factors on the walking time of the elderly were revealed. (3) The neighborhood attributes were incorporated into the walking behavior prediction, and were found to be of comparable importance to the influence of the NE on the behavior of the elderly. These results provide more reliable qualitative and quantitative auxiliary suggestions for planners.
•The accuracy of prediction has effectively improved on elderly walking behavior.•It is found that the influence of NE attributes on the behavior of the old adults is as important as that of the NE.•The property management fee and housing price ranked highly in relative importance in neighborhood attributes.•Two subjective perception factors, wealthy and boring, have a higher degree of influence on the behavior of the elderly.
Physical activity provides substantial health benefits. Older adults are less physically active than the rest of the population, and interventions that promote physical activity are needed. In this ...meta-analysis, we investigate how different wearable activity trackers (pedometers and accelerometers) may impact physical activity levels in older adults.
We searched MEDLINE, Embase and CINAHL for randomized controlled trials including participants that were ≥65 years, using wearable activity trackers with the intent of increasing physical activity. Studies whose comparator groups were engaged in active or inactive interventions, such as continued a physical therapy program or goal-setting counseling, were not excluded simply for implementing co-interventions. We used random-effects models to produce standardized mean differences (SMDs) for physical activity outcomes. Heterogeneity was measured using I2.
Nine studies met the eligibility criteria: Four using accelerometers, four using pedometers, and one comparing accelerometers and pedometers, for a total number of 939 participants. Using pooled data, we found a statistically significant effect of using accelerometers (SMD = 0.43 (95%CI 0.19–0.68), I2 = 1.6%, p = 0.298), but not by using pedometers (SMD = 0.17 (95%CI −0.08–0.43), I2 = 37.7%, p = 0.174) for increasing physical activity levels.
In this study, we found that accelerometers, alone or in combination with other co-interventions, increased physical activity in older adults however pedometers were not found to increase physical activity. The high risk of bias found in most studies limits these findings. High quality studies that isolate the effects of accelerometers on physical activity changes are needed.
•Interventions that promote physical activity are needed for the less active older adult population.•Accelerometers, alone or in combination with co-interventions, increased physical activity in older adults.•High quality studies that isolate the effects of accelerometers on physical activity changes are needed.
Aging-related cognitive decline and cognitive impairment greatly impacts older adults' daily life. The worldwide ageing of the population and associated wave of dementia urgently calls for prevention ...strategies to reduce the risk of cognitive decline. Physical activity (PA) is known to improve cognitive function at older age through processes of neuroplasticity. Yet, emerging studies suggest that larger cognitive gains may be induced when PA interventions are combined with cognitive activity (CA). This meta-analysis evaluates these potential synergistic effects by comparing cognitive effects following combined PA + CA interventions to PA interventions (PA only), CA interventions (CA only) and control groups.
Pubmed, Embase, PsycInfo, CINAHL and Sportdiscus were searched for English peer-reviewed papers until April 2018. Data were extracted on cognition and factors potentially influencing the cognitive effects: mode of PA + CA combination (sequential or simultaneous), session frequency and duration, intervention length and study quality. Differences between older adults with and without mild cognitive impairments were also explored.
Forty-one studies were included. Relative to the control group, combined PA + CA intervention showed significantly larger gains in cognition (g = 0.316; 95% CI 0.188-0.443; p < .001). Studies that compared combined PA + CA with PA only, showed small but significantly greater cognitive improvement in favor of combined interventions (g = 0.160; 95% CI 0.041-0.279; p = .008). No significant difference was found between combined PA + CA and CA only interventions. Furthermore, cognitive effects tended to be more pronounced for studies using simultaneous designs (g = 0.385; 95%CI 0.214-0.555; p < .001) versus sequential designs (g = 0.114; 95%CI -0.102- 0.331, p = .301). Effects were not moderated by session frequency, session duration, intervention length or study quality. Also, no differences in effects were found between older adults with and without mild cognitive impairments.
Findings of the current meta-analysis suggest that PA programs for older adults could integrate challenging cognitive exercises to improve cognitive health. Combined PA + CA programs should be promoted as a modality for preventing as well as treating cognitive decline in older adults. Sufficient cognitive challenge seems more important to obtain cognitive effects than high doses of intervention sessions.
Background: Visually impaired people have challenges with outdoor mobility, which underscores the need for orientation and mobility rehabilitation training (OMRT). However, awareness and uptake of ...OMRT among blind people remain very low in Nigeria. The study investigated the association of demographic, physical, and visual impairment-related variables with awareness and uptake of orientation and mobility rehabilitation training (OMRT) in Nigeria
Methods: A cross-sectional survey of 361 visually impaired people aged 60 years and over, with best-corrected visual acuity ≤ 20/80 (0.6 LogMAR). The Timed Up and Go (TUG) test was used to assess the risks of falling. Multiple logistic regression was used to analyse predictors of awareness and uptake of OMRT
Results: Only 26.88% of those who were aware of OMRT reported accessing Orientation and mobility rehabilitation training (OMRT). The duration of visual impairment (p=0.016), awareness of the cause of Low Vision (p=0.043), and being at the risk of falls (p < 0.001), were significantly associated with taking-up OMRT.
Conclusion: Prolonged delays in referrals for OMRT are a potential cause of apathy towards the uptake of OMRT.
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