This review addresses conceptual and empirical research about how individual agency and motivation influences development during adulthood and old age. The major life-span approaches to individual ...agency and developmental regulation are discussed, with a focus on the motivational theory of life-span development. Developmental agency unfolds through action cycles of pursuing long-term goals for optimal development. Individuals differ in their capacity to regulate their goal engagements effectively within the age-graded structure of opportunities and constraints in their life courses. We discuss a set of research examples about specific developmental challenges, such as transition to adulthood, biological aging, illness, and societal transformation, and show how individuals, as agents in their own development, navigate change for better or worse. We conclude with suggestions for future research.
•Elderly patients may undergo neurosurgery with good outcomes.•Most common diagnoses were chronic subdural hematoma, ruptured aneurysm, meningioma.•Frailty and comorbid conditions should be ...considered in decision for surgery.•Proper patient selection and preoperative preparation are key to good outcomes.
Better living conditions and health care advancements have improved life expectancy worldwide, increasing the number of older patients who require neurosurgery. We would like to report our experience with geriatric neurosurgical patients at our institution.
This is a retrospective study on geriatric patients (aged ≥ 65 years) who underwent neurosurgery at our center between 2015 and 2022. Data on age, sex, comorbidities, pre-morbid status, type of admission, diagnosis, operation, complications, short-term outcome, hospital length of stay (LOS), and 30-day readmission were collected. Descriptive statistics and multiple regression analysis were used.
A total of 327 patients were included. The mean age was 70.4 years and 51.3 % were female. Majority (70.6 %) had at least one comorbid condition, most commonly hypertension. Most patients were admitted through emergency systems (80.1 %), with 40.4 % consulting for traumatic brain injury. The top diagnoses were chronic subdural hematoma (35.2 %), ruptured intracerebral aneurysm (15.6 %), and meningioma (10.1 %). The most common procedures were burrhole drainage of hematoma (34.8 %), brain tumor excision (16.7 %), and aneurysm clipping (14.6 %). The post-operative complication rate was 15.2 %, and mean LOS was 16.7 days. Majority of patients (86.9 %) were discharged home, and 2.8 % were readmitted within 30 days. The 30-day mortality rate was 13.1 %. Lower pre-operative GCS, certain comorbidities, and intra- and post-operative complications were significantly associated with mortality and LOS.
Advanced age alone should not be a contraindication to surgery; other factors such as frailty and comorbid conditions should also be considered. Proper patient selection and preoperative preparation are key to achieving good outcomes.
The aging of the population is becoming a global concern. With the increasing number of the elderly, the growing traffic demands are facing greater challenges. The elderly with lower movement ability ...is more vulnerable to be injured in accidents. Collaborative assistant is an effective way to prevent accidents of falling down for the elderly. In this study, we carried out a series of controlled experiments involving the elderly and the young pedestrians under different modes, including the separate, mixed and synergistic modes. The traffic efficiencies of crowds under different movement modes are compared and their movement characteristics are analyzed. Through the spatial and temporal analysis, it can be found that the primary factor hindering the traffic efficiency of the elderly crowd is the longer time headway. The mean headway distance among homogeneous pedestrians is smaller than that among heterogeneous pedestrians with larger age differences. In addition, the fundamental diagrams under different movement modes are obtained and compared. The findings contribute to a better understanding of the movement for the young assisting the old in the crowded environment. The results have practical applications in the modeling and evacuation management for the public places where the elderly gathered, such as the aged care institutions.
Despite the benefits that digital wayfinding systems offer hospital visitors and patients as well as the hospitals themselves, their actual presence in hospitals is low. This study, carried out in ...twenty hospitals, presents an evaluation of these systems. Interviews with hospital managers (with and without systems) indicate considerations and evidence-based information that are new to the literature such as reducing task complexity and overall user stress and anxiety; enhancing user control and empowerment; decreasing the amount of time medical staff must devote to providing directions to patients; and reducing rate of delayed and missed appointments. While these systems have considerable potential for assisting the elderly and those with disabilities, this potential is not being realized. Findings may benefit system planners, hospital administrators and eventually provide users with more suitable systems upon which to rely.
The incidence of postoperative delirium (POD) after maxillofacial tumors radical surgery is relatively high. There are a number of evidences showing the relationship between hypertension and ...decreased cerebral blood flow, as well as the relationship between cerebral ischemia and postoperative cognitive impairment. However, the impact of hypertension in the process of POD and related mechanisms remain unclear.
This study included 98 elderly patients who underwent maxillofacial tumors radical surgery in our hospital, from June 2020 to December 2020. We collected the general condition of patients and related research factors before surgery, and also collected related intraoperative factors. After that, we would follow up the patients for POD evaluation.
The incidence of POD in the hypertension group was 41%, compared with 12% in the nonhypertension group (
P
< 0.05). The incidence of POD in the irregular medication group was 62%, compared with 26% in the regular medication group (
P
< 0.05). Both hypertension (OR = 2.45, 95% CI = 1.11–5.72) and irregular medication use (OR = 2.35, 95% CI = 0.87–5.69) were independent risk factors for POD after this type of surgery in elderly patients.
Hypertension and medication use regularity are closely related to POD. This may be related to the delayed postoperative response caused by intraoperative cerebral ischemia.
•This study was underpinned by a nationally representative dataset in China.•The LSTM+ML model can successfully capture high-dimensional and time-series information of risk factors for depression in ...elderly.•The decision support system based on the predictive model of this research may be very valuable for doctors, nurses and community medical providers for early discovery and intervention of depression.
Early detection of potential depression among elderly people is conducive for timely preventive intervention and clinical care to improve quality of life. Therefore, depression prediction considering sequential progression patterns in elderly needs to be further explored.
We selected 1,538 elderly people from Chinese Longitudinal Healthy Longevity Study (CLHLS) wave 3–7 survey. Long short-term memory (LSTM) and six machine learning (ML) models were used to predict different depression risk factors and the depression risks in the elderly population in the next two years. Receiver operating curve (ROC) and decision curve analysis (DCA) were used to evaluate the prediction accuracy of the reference model and ML models.
The area under the ROC curve (AUC) values of logistic regression with lasso regularisation (AUC=0.629, p-value=0.020) was the highest among ML models. DCA results showed that the net benefit of six ML models was similar (threshold: 0.00-0.10), the net benefit of lasso regression was the largest (threshold: 0.10-0.17 and 0.22-0.25), and the net benefit of DNN was the largest (threshold: 0.17–0.22 and 0.25–0.40). In two ML models, activities of daily living (ADL)/ instrumental ADL (IADL), self-rated health, marital status, arthritis, and number of cohabiting were the most important predictors for elderly with depression.
The retrospective waves used in the LSTM model need to be further increased.
The decision support system based on the proposed LSTM+ML model may be very valuable for doctors, nurses and community medical providers for early diagnosis and intervention.
60% of patients diagnosed with lung cancer are older than 65 years and are at risk for substandard treatment due to a reluctance to recommend surgery. Pneumonectomy remains a high risk procedure ...especially in elderly patients. Nevertheless, the impact of age and neoadjuvant treatment on outcomes after pneumonectomy is still not well described.
We performed a multicentric retrospective study, analyzing outcomes of patients older than 70 years who underwent pneumonectomy for central primary lung malignancy between January 2009 and June 2019 in 7 thoracic surgery departments: Lucerne and Bern (Switzerland), Hamilton (Canada), Alicante (Spain), Monza (Italy), London (UK), Leuven (Belgium). Survival was estimated with Kaplan-Meier, and differences in survival were determined by log-rank analysis. We investigated pre- and post-operative prognostic factors using Cox proportional hazards regression model; multivariable analysis was performed only with variables, which were statistically significant at the invariable analysis.
A total of 136 patients were included in the study. Mean age was 73.8 years (SD 3.6). 24 patients (17.6%) had an induction treatment (chemotherapy alone in 15 patients and chemo-radiation in 9). Mean length of stay (LOS) was 12.6 days (SD 10.39) and 74 patients (54.4%) had experienced a post-operative complication: 29 (21.3%) had a pulmonary complication, 33 (24.3%) had a cardiac complication and in 12 cases (8.8%) patients experienced both cardiac and pulmonary complications. 16 patients were readmitted median LOS 13.7 days (range, 2
39 days) and of those 14 (10.3%) required redo surgery. Median overall survival (OS) of the entire cohort was 38 months (95% CI: 29.9
46.1 months); in-hospital mortality was 1.5%, 30-day mortality rate was 3.7%, while 90-day mortality was 8.8% accounting for 5 and 12 patients respectively. Patients receiving neo-adjuvant therapy did not experience a higher incidence of postoperative complications (P=0.633), did not have a longer postoperative course (P=0.588), nor did they have an increased mortality rate (P=0.863).
Age should not be considered an absolute contraindication for pneumonectomy in elderly patients even after neoadjuvant treatment. It has become apparent that especially in these patients, a patient-tailored approach with a careful selection should be used to define the risk-benefit balance.
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