Falls in older adults are the result of a complex interaction between intrinsic, extrinsic, and behavioral factors. Although it is difficult to separate these factors, some studies indicate that ...environmental risk factors are present in approximately 40% of falls, but there is still a gap in these real factors.
To verify the association between environmental risk factors for falls in older adult Brazilians.
Prospective cohort study, being one of the arms of a larger study “Prevalence of falls in the older adults: Intrinsic, extrinsic and behavioral factors”. The study aimed to follow up with 400 patients, both sexes, aged over 60 years and from different regions of Brazil, who had access to the online questionnaire through a link and agreed to participate in the research. The questionnaire had items related to environmental factors in older adults falls. The environmental assessment was carried out using the Home Fast Brazil self-application instrument. An analysis was performed with the Shapiro-Wilk test, which showed that the data were non-parametric, and thus the data were presented descriptively by the median and interquartile range and the environmental data with nominal variables. significance level p<0.05 was adopted.
405 individuals were evaluated, 39.5% (n=160) (p<0.446) characterized as fallers, so the sample of fallers consisted of 39% (n=113) female (p< 0.882), an aged median of 67 (63-73) years. It was observed that falls have a higher incidence with tripping 100% (n=67) (p<0.01), slipping 100% (n=43) (p<0.01), loss of balance 100%(n=37) (p< 0.01), acute pain 100% (n=2) (p<0.01), leg weakness 100% (n=2) (p<0.01), dizziness 100% (n=4) (p<0.01), knees buckled 100% (n=5) (p<0.01). Of the individuals who reported falls, the reasons were 45.83% (n=88) due to the bathroom being slippery when wet (p <0.03), even if they had adaptations in their home such as a toilet of adequate size 38.15% (n=145) (p<0.04) and grab bar in the bathroom in 47.91% (n=46) (p<0.04).
We found that the incidence of falls was due to the bathroom being slippery due to the wet floor and that most have adaptations in their homes due to the fear of falling. This makes us reflect that even with adaptations, it gives a false sense of security.
With the knowledge of environmental risk factors such as wet bathrooms, it is necessary to supervise the hygiene of these older adults.
Older adults have physical and metabolic characteristics, and there are many differences in nutritional outcomes from middle-aged adults. In addition, there are many factors that cause malnutrition ...peculiar to the older adults, which are not seen in middle-aged adults, and it is easy for them to lose weight and become malnourished. Therefore, nutritional management needs to take into account the age of each subject. Uniform nutritional management can even cause poor health outcomes. The concept of frailty, especially phenotype frailty, and sarcopenia, which have been advocated with the aging of the population and the extension of life expectancy around the world, is very important in considering the extension of healthy life expectancy. In other words, in the super-aged society, frailty and sarcopenia have been emphasized as factors of functional decline, physical dysfunction, and the need for long-term care in addition to the well-known diseases such as cardiovascular disease, malignant tumors, and infectious disease. In fact, these two conditions are strongly associated with the increased risk of new disease development, falls, fractures, disability, hospitalization and death in the older adults. These two conditions are primarily associated with malnutrition and decreased dietary protein intake, and may recover to robustness again with appropriate interventions such as nutritional therapy. Therefore, undernutrition measures are more important for prevention of frailty and sarcopenia than measures for obesity against metabolic syndrome in the older adults, especially in the late-stage older people.
Advance care planning (ACP) is a process that helps people prepare to make decisions about their future medical care.
We sought to understand who was received billed ACP visits and measure the ...association with health care utilization, cost, and mortality.
We used a randomly sampled 20 % cohort of Medicare fee-for-service (FFS) beneficiaries' files to conduct a retrospective cohort study. Beneficiaries with a billed ACP visit were matched to controls using a 2-stage propensity score matching process that included assigning a pseudo-ACP visit date for controls. Outcomes included healthcare utilization, mortality, and total medical cost per month. We used descriptive statistics for univariate analysis and fit multilevel logistic regression, multilevel linear regression, or Cox regression models.
We identified 183,513 beneficiaries who received any billed ACP visit and 550,539 matched controls. Of those who had a ACP visit, the mean age was 76.5 years and high-risk comorbidities were common: 16 % dementia, 10 % congestive heart failure, 10 % cancer. Beneficiaries who had an ACP visit had slightly more health care utilization than controls. Beneficiaries who had an ACP visit were more likely to die (3.1% vs. 1.0 %, p < 0.01, OR=3.0, 95 %CI 2.9–3.2) in the unadjusted and adjusted analyses compared to matched controls. Total monthly medical costs were 33 % higher among beneficiaries who had an ACP visit.
Our results suggest that ACP visits may be preferentially utilized amongst individuals with higher risk of mortality. There may be an opportunity to increase ACP visits among older adults at lower risk for mortality.
This article suggests that ACP visits are likely targeted to older adults with a higher risk of mortality than those at lower risk of mortality suggesting an opportunity to reach people before they are facing end-of-life decisions.
•Cognitive reserve could attenuate the risk of MCI associated with (pre)frailty.•Older adults with low cognitive reserve and (pre)frailty had higher risk of MCI.•Cognitive reserve could attenuate the ...risk of incident MCI.
We aimed to identify the effect of lifespan cognitive reserve and (pre)frailty on mild cognitive impairment (MCI) among older adults.
A total of 4420 older adults aged above 60 with intact cognition recruited in 2011/2012 were followed up in 2015 from the China Health and Retirement Longitudinal Study (CHARLS). The assessment of MCI was based on executive function, episodic memory, and visual-spatial ability. (Pre)frailty was assessed by the validated version of the Fried physical frailty phenotype scale. The lifespan cognitive reserve consisted of the highest educational level, occupational complexity, and participation in leisure activities. Modified Poisson regression models were used to identify the risk of MCI in relation to (pre)frailty and lifespan cognitive reserve index. We examined the interactions of (pre)frailty and lifespan cognitive reserve index on both additive and multiplicative scales.
Baseline (pre)frailty significantly increased the risk of MCI after 3–4 years of follow-up, and high cognitive reserve protected individuals from the risk of MCI. There was an additive interaction between (pre)frailty and the low lifespan cognitive reserve (the relative excess interaction risk=1.08, 95 % CI= 0.25–1,91), but no multiplicative interaction (RR=0.95, 95 % CI= 0.67–1.37). The risk of MCI was larger among older adults with comorbid (pre)frailty and low cognitive reserve than those with each condition alone.
Cognitive reserve attenuates the risk of MCI associated with (pre)frailty. This finding implicates the urgency for identifying and managing MCI among frail older adults who accumulate low cognitive reserve in the life course.
The American Geriatrics Society (AGS) Beers Criteria® (AGS Beers Criteria®) for Potentially Inappropriate Medication (PIM) Use in Older Adults are widely used by clinicians, educators, researchers, ...healthcare administrators, and regulators. Since 2011, the AGS has been the steward of the criteria and has produced updates on a 3‐year cycle. The AGS Beers Criteria® is an explicit list of PIMs that are typically best avoided by older adults in most circumstances or under specific situations, such as in certain diseases or conditions. For the 2019 update, an interdisciplinary expert panel reviewed the evidence published since the last update (2015) to determine if new criteria should be added or if existing criteria should be removed or undergo changes to their recommendation, rationale, level of evidence, or strength of recommendation. J Am Geriatr Soc 67:674–694, 2019.
See related editorial by Steinman et al. in this issue.
•Mortality among older adults with moderate to severe TBI was as high as 93 %.•Mortality had a dramatic increase for those ≥80 years old.•No factor was universally associated with increased ...mortality.•Older adults were less likely to be discharged home than younger adults.•Up to 8.4 % of older adults needed professional assistance at home.
This study examined the research on older adults with a moderate to severe traumatic brain injury (TBI), with a focus on mortality and discharge disposition.
Systematic searches were conducted in MEDLINE, CINAHL, EMBASE and PsycINFO for studies up to April 2022 in accordance with PRISMA guidelines.
64 studies, published from 1992 to 2022, met the inclusion criteria. Mortality was higher for older adults ≥60 years old than for their younger counterparts; with a dramatic increase for those ≥80 yr, with rates as high as 93 %. Similar findings were reported regarding mortality in intensive care, surgical mortality, and mortality post-hospital discharge; with an 80 % rate at 1-year post-discharge. Up to 68.4 % of older adults were discharged home; when compared to younger adults, those ≥65 years were less likely to be discharged home (50–51 %), compared to those <64 years (77 %). Older adults were also more likely to be discharged to long-term care (up to 31.6 %), skilled nursing facilities (up to 46.1 %), inpatient rehabilitation (up to 26.9 %), and palliative or hospice care (up to 58 %).
Given their vulnerability, optimizing outcomes for older adults with moderate-severe TBI across the healthcare continuum is critical.
Mobile banking has become increasingly important to society; however, not all members of society adopt and/or use it as much as others: older adults, the disabled and lower-income families remain ...behind in their use and adoption of this service. This finding helped us recognise a research gap and led us to form our primary aim: to understand and explain the factors that influence the adoption, use and diffusion of mobile banking among one of those groups in particular, older adults, in the UK. To form a theoretical understanding, this paper presents a comprehensive review of the surrounding literature in the area and proposes a conceptual framework that can be used for future research. The implications of this research for academia and businesses are also provided in this paper.
Social isolation and loneliness are associated with increased mortality and higher health care spending in older adults. Hearing loss is a common condition in older adults and impairs communication ...and social interactions. The objective of this review is to summarize the current state of the literature exploring the association between hearing loss and social isolation and/or loneliness.
PubMed, Embase, CINAHL Plus, PsycINFO, and the Cochrane Library.
Articles were screened for inclusion by 2 independent reviewers, with a third reviewer for adjudication. English-language studies of older adults with hearing loss that used a validated measure of social isolation or loneliness were included. A modified Newcastle-Ottawa Scale was used to assess the quality of the studies included in the review.
Of the 2495 identified studies, 14 were included in the review. Most of the studies (12/14) were cross-sectional. Despite the heterogeneity of assessment methods for hearing status (self-report or objective audiometry), loneliness, and social isolation, most multivariable-adjusted studies found that hearing loss was associated with higher risk of loneliness and social isolation. Several studies found an effect modification of gender such that among women, hearing loss was more strongly associated with loneliness and social isolation than among men.
Our findings that hearing loss is associated with loneliness and social isolation have important implications for the cognitive and psychosocial health of older adults. Future studies should investigate whether treating hearing loss can decrease loneliness and social isolation in older adults.
Research on digital inequality tends to collapse people above a certain age into one “older adults” category, seemingly assuming that this is one homogeneous group when it comes to internet uses. ...Drawing on national survey data of adults in the United States, this article examines the online skills and behaviour of this group. Findings reveal diversity among older adults in internet skills and uses. Those with higher education and higher income have higher-level Web-use skills. While those of higher socioeconomic status are also more likely to use the internet for diverse types of activities from which they may benefit, once controlling for skills, these differences are less pronounced.
Evidence on the association between single nucleotide polymorphisms (SNPs) in the vitamin D receptor (VDR) and depressive symptoms is inconclusive.
The primary aim of the study was to investigate the ...association between SNPs in the VDR gene and depressive symptoms.
In a sample of older adults from the Longitudinal Ageing Study Amsterdam (n = 922), depressive symptoms were assessed using the Centre for Epidemiological Studies Depression scale (CES-D scale) at baseline and after 3, 6, and 10 y of follow-up. Blood samples for SNP and serum 25-hydroxyvitamin D3 (25(OH)D3) determination were obtained at baseline. The association between 13 SNPs in the VDR gene and the course of depressive symptoms were evaluated using linear mixed models. The interaction between SNPs and serum 25(OH)D3 in relation to depressive symptoms was evaluated using multiple linear regression.
No SNPs were associated with the course of depressive symptoms. Significant interactions between serum 25(OH)D3 and SNPs in the VDR gene were found. Stratified analysis revealed that within the GG genotype strata, 10 nmol/L higher serum 25(OH)D3 was associated with 0.27 (95% CI: −0.50, −0.04) and 0.23 (95% CI: −0.48, 0.02) lower scores on the CES-D scale for Cdx-2 and 1b-G-886A, respectively. This association was not found in persons having the GA or AA genotype.
No SNPs are associated with the course of depressive symptoms. Stratified analysis shows that the effect of serum 25(OH)D3 concentrations on depressive symptoms is different among genotypes of Cdx-2 and 1b-G-886A. Future research should elucidate on the function of Cdx-2 and 1b-G-886A to describe their effect.
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