Fear of falling (FOF) is an important threat to autonomy. Current interventions to reduce FOF have yielded conflicting results. A possible reason for this discrepancy could be its multicausality. ...Some risk factors may not have been identified and addressed in recent studies. The last systematic review included studies until 2006.
To identify additional risk factors for FOF and to test those mentioned previously, we conducted a systematic literature review. Studies examining FOF in community-dwelling older adults between 2006 and October 2013 were screened.
Outcomes are summarized with respect to different constructs such as FOF, fall-related self-efficacy/balance confidence, and FOF-related activity restriction. Odds ratios and p values are reported. There is no clear pattern with regard to the different FOF-related constructs studied. The only parameters robustly associated across all constructs were female gender, performance-based and questionnaire-based physical function, the use of a walking aid, and, less robust, a history of falls and poor self-rated health. Conflicting results were identified for depression and anxiety, multiple drugs, and psychotropic drugs. Other potentially modifiable risk factors were only mentioned in one or two studies and warrant further investigation. Parameters with mainly negative results are also presented.
Only few risk factors identified were robustly associated across all FOF-related constructs and should be included in future studies on FOF. Some newer factors have to be tested again in different cohorts. The comprehensive overview might assist in the conceptualization of future studies.
Depressive symptoms (DS) have become a global public health problem. However, a risk prediction model for DS in the elderly population has not been established. The purpose of this study was to ...develop and validate a predictive nomogram to screen for DS in the elderly population.
A cross-sectional data of 3396 participants aged 60 and over were obtained from the China Health and Retirement Longitudinal Study 2018 (CHARLS). Participants were divided into the development and validation set. Predictive factors were selected through a single-factor analysis, and then a predictive model nomogram was established. The discrimination, calibration, and clinical validity were evaluated using the receiver operating characteristic (ROC) curves, Hosmer-Lemeshow tests, and decision curve analyses (DCA).
A total of 2379 and 1017 participants were included in the development and validation set, respectively. The analysis found that gender, residence, dyslipidemia, self-rated health, and ADL disability were risk factors for DS in older adults, and were included in the final model. This nomogram showed an acceptable predictive performance as evaluated by the area under the ROC curve with values of 0.684 (95 % confidence interval (CI): 0.663–0.706) and 0.687 (95 % CI: 0.655–0.719) in the development and validation set, respectively. The calibration curve indicated that the model was accurate, and DCA demonstrated a good clinical application value.
Five factors were selected to establish a nomogram for predicting DS in older adults. The nomogram has a good evaluation performance and can be used as a reliable tool to predict DS among older adults.
•Developed and validated a predictive nomogram to screen for depressive symptoms in the elderly.•Identified gender, residence, dyslipidemia, self-rated health, and ADL disability as risk factors.•Model demonstrated accuracy through calibration curves and good clinical application value.•Provides a tool for quick identification of at-risk elderly, aiding targeted interventions.•Significant practical value in areas with limited professional operators and resources.
Oral health influences the quality of life of older adults. Further, depression is negatively associated with oral health. However, little is known about this relationship among older adults with ...chronic health conditions. Additionally, since oral health and depression differ between genders, this study aimed to investigate the effect of transitions in depressive symptoms on oral health among older adults with chronic health conditions by gender.
We used data from the Korean Longitudinal Study of Aging (2020−2022). The study sample comprised 2836 older adults (1104 men; 1732 women). We adopted multiple linear regression to examine the association between depressive symptom transitions and oral health by gender.
The new onset depression symptoms were significantly associated with the deterioration of oral health in men (β = −5.4308) and women (β = −4.8328). Our study showed a gender-specific association between new onset depressive symptoms and particular domains of oral health. For men, the association was slightly more negative in psychosocial function (β = −2.1177) while women presented lower GOHAI scores in both the physical function domain (β = −1.8800) and the psychosocial function domain (β = −1.8801).
The data used in this study were self-reported via a survey; thus, self-report bias may be a relevant concern.
To prevent deterioration in oral health, depressive symptoms must be detected and addressed early among older adults with chronic conditions. This study underscores the importance of interventions that consider gender differences in the association between depressive symptoms and psychosocial and physical functioning.
•Depressive symptoms and oral health in older adults with chronic conditions are related.•New-onset depressive symptoms and persistence of depressive symptoms are associated with poorer oral health in both genders.•New-onset depressive symptoms related to poorer psychosocial function among men•New-onset depressive symptoms related to poorer psychosocial and physical function among women
Identifying factors that impact psychological treatment outcomes in older people with common mental health problems (CMHP) has important implications for supporting healthier and longer lives. The ...aim of the present study was to synthesise the evidence on predictors of psychological treatment outcomes in older people (aged 65+). PubMed, Scopus, Web of Science and PsycINFO were searched and 3929 articles were identified and screened, with 42 studies (N = 7978, M age = 68.9, SD age = 2.85) included: depression: k = 21, anxiety: k = 11, panic disorder: k = 3, mixed anxiety & depression: k = 3, PTSD: k = 2, various CMHP: k = 2, with CBT being the most common treatment (71%). The review identified 28 factors reported as significant predictors of treatment outcome in at least one study, across different domains: psychosocial (n = 9), clinical (n = 6), treatment-related (n = 6), socio-demographic (n = 4), neurobiological (n = 3). Homework completion was the most consistent predictor of positive treatment outcome. Baseline symptom severity was the most frequently studied significant predictor and across all conditions, with higher baseline symptom severity largely linked to worse treatment outcomes. No significant effects on treatment outcome were reported for gender, income and physical comorbidities. For a large majority of factors evidence was mixed or inconclusive. Further studies are required to identify factors affecting psychological treatment outcomes, which will be important for the development of personalised treatment approaches.
•Review identified 28 predictors of psychological treatment outcomes in older adults.•High baseline symptom severity mostly associated with worse treatment outcomes.•Homework completion consistently predicted better treatment outcomes.•Gender, income and physical health consistently did not predict outcome.•Small sample sizes and heterogeneity across studies warrant future research.
Depression is common at older ages, but is under-recognized due to stigma, misperception, and under-diagnosis; its manifestations may vary by setting. Identifying older adults at risk of depression ...in the community is urgently needed for timely support and early interventions. We assessed the performance of an existing risk prediction model developed in a European setting (i.e., Depression Risk Assessment Tool (DRAT-up)), and developed a new model (i.e., EHS-Depress model) to predict 2-year risk of the onset of later life depressive symptoms in older Chinese adults.
Among 185,538 participants aged ≥65 years from Hong Kong's Elderly Health Service (EHS) cohort, 174,806 without depressive symptoms at baseline were included. Two-thirds were randomly sampled for recalibration and new model development using Cox proportional-hazards models with backward elimination. Overall predictive performance, discrimination, and calibration were assessed using the remaining.
The original DRAT-up model underestimated the risk of developing depressive symptoms in older Chinese adults; recalibrating it improved calibration. The new EHS-Depress model had better discrimination (Harrell's C statistic 0.68 and D statistic 2.74) and similarly good calibration (calibration slope 1.18 and intercept −0.002) probably due to the inclusion of more specific health measures, socio-demographics, lifestyle factors, and regular social contact as predictors.
Predictors of depressive symptoms included in our models depend on the data availability.
The EHS-Depress model predicted 2-year risk of developing depressive symptoms better than the original and recalibrated DRAT-up models. The setting-specific risk prediction model is more applicable to older Chinese adults in primary care settings.
•The EHS-Depress model can predict depressive symptoms in older Chinese adults.•Risk prediction needs predictors that reflect Chinese perceptions and experience.•Setting-specific model is applicable to primary care settings in Hong Kong, China.
Medial temporal lobe atrophy has been linked to decline in neuropsychological measures of explicit memory function. While the hippocampus has long been identified as a critical structure in learning ...and memory processes, less is known about contributions of the amygdala to these functions. We sought to investigate the relationship between amygdala volume and memory functioning in a clinical sample of older adults with and without cognitive impairment.
A serial clinical sample of older adults that underwent neuropsychological assessment at an outpatient neurology clinic was selected for retrospective chart review. Patients were included in the study if they completed a comprehensive neuropsychological assessment within six months of a structural magnetic resonance imaging scan. Regional brain volumes were quantified using Neuroreader® software. Associations between bilateral hippocampal and amygdala volumes and memory scores, derived from immediate and delayed recall conditions of a verbal story learning task and a visual design reconstruction task, were examined using mixed-effects general linear models, controlling for total intracranial volume, scanner model, age, sex and education. Partial correlation coefficients, adjusted for these covariates, were calculated to estimate the strength of the association between volumes and memory scores.
A total of 68 (39 F, 29 M) participants were included in the analyses, with a mean (SD) adjusted age of 80.1 (6.0) and educational level of 15.9 (2.5) years. Controlling for age, sex, education, and total intracranial volume, greater amygdala volumes were associated with better verbal and visual memory performance, with effect sizes comparable to hippocampal volume. No significant lateralized effects were observed. Partial correlation coefficients ranged from 0.47 to 0.33 (p<.001).
These findings contribute to a growing body of knowledge identifying the amygdala as a target for further research in memory functioning. This highlights the importance of considering the broader functioning of the limbic system in which multiple subcortical structures contribute to memory processes and decline in older adults.
The COVID-19 pandemic has led to an increase in the digitalisation of services that poses the risk of digital exclusion, especially among older adults. We examined the predictors of Internet use for ...services and its increase or decrease among a longitudinal population-based sample of 1426 older adults from Finland aged between 70 and 100 years, gathered in 2017 and 2020. High education and high income positively predicted the use of the Internet for services, and age, deteriorated health and deteriorated memory negatively. High age, low education and a change to living alone predicted a decrease in use. High education predicted the increased Internet use due to COVID-19. Thus, it seems that those older adults who have low education level are very old, whose health or memory has deteriorated and those who have changed to living alone are particularly in danger of digital exclusion. Actions targeted to these people are needed.
Malnutrition in older adults can decrease quality of life and increase risk of morbidities and mortality. Accurate and timely identification of malnutrition, as well as subsequent implementation of ...effective interventions, are essential to decrease poor outcomes associated with malnutrition in older adults. The Academy of Nutrition and Dietetics Evidence Analysis Center conducted a systematic review of the literature to develop an evidence-based nutrition practice guideline for the prevention and treatment of malnutrition in older adults. The objective of this guideline was to provide evidence-based recommendations to identify, prevent, or treat protein-energy malnutrition in older adults (mean age ≥65 years) living in long-term care and community settings. This guideline provides 11 nutrition recommendations to inform shared decision making among dietitians, members of the health care team, family members or caregivers, and older adults living in long-term care or the community to prevent or treat malnutrition. Topics include dietitian effectiveness, nutrition assessment tools, oral nutrition supplements, food fortification, and home-delivered and congregate meals. Guideline implementation should include consideration of the importance of comprehensive individualized nutrition care for older adults. Future research is needed to address gaps that were identified related to the validity, reliability, and feasibility of nutrition assessment tools, as well as the effectiveness of dietitian interventions on outcomes of interest in older adults living in long-term care and the community.
The older population is growing and with this growth there is a parallel rise in the operations performed on this vulnerable group. The perioperative pain management strategy for older adults is ...unique and requires a team-based approach for provision of high-quality surgical care.
Literature search was performed using PubMed in addition to review of relevant protocols and guidelines from geriatric, surgical, and anesthesia societies. Systematic reviews and meta-analyses, randomized trials, observational studies, and society guidelines were summarized in this review.
The optimal approach to a pain management strategy for older adults undergoing surgery involves addressing all phases of perioperative care. For example, preoperative assessment of a patient's cognitive function and presence of chronic pain may impact the pain management plan. Consideration should be also given to intraoperative strategies to improve pain control and minimize both the dose and side effects from opioids (e.g. regional anesthetic techniques). Postoperative pain control (e.g. under or over treatment of pain) may impact the development of elderly-specific complications such as postoperative delirium and functional decline. Finally, pain management does not stop after the older adult patient leaves the hospital. Both discharge planning and post-operative clinic follow-up provide important opportunities for collaboration and intervention.
An opioid-sparing pain management strategy for older adults can be accomplished with a comprehensive and collaborative interdisciplinary strategy addressing all phases of perioperative care.
PDF
