Search

Many countries are facing an aging population. As people live longer, surgeons face the prospect of operating on increasingly older patients. Traditional teaching is that with older age, these patients face an increased risk of mortality and morbidity, even to a level deemed too prohibitive for surgery. However, this is not always true. An active 90-year-old patient can be much fitter than an overweight, sedentary 65-year-old patient with comorbidities. Recent literature shows that frailty—an age-related cumulative decline in multiple physiological systems, is therefore a better predictor of mortality and morbidity than chronological age alone. Despite recognition of frailty as an important tool in identifying vulnerable surgical patients, many surgeons still shun objective tools. The aim of this position paper was to perform a review of the existing literature and to provide recommendations on emergency laparotomy and in frail patients. This position paper was reviewed by an international expert panel composed of 37 experts who were asked to critically revise the manuscript and position statements. The position paper was conducted according to the WSES methodology. We shall present the derived statements upon which a consensus was reached, specifying the quality of the supporting evidence and suggesting future research directions. [ABSTRACT FROM AUTHOR]

Advances in the medical field and healthcare sector during the last few decades have resulted in increased longevity. Increased lifespans have in turn led to a rapid global rise of the elderly population. However, ensuring the health and quality of life, especially in the context of chronic age-related ailments, among the growing geriatric population is a challenge. Ageing is associated with several changes in body composition including a decline in the lean body mass usually accompanied by an increase in body fat content which have a bearing on the nutrient requirements for the elderly. The nutrient requirements currently recommended for Indian adults are primarily computed using a factorial approach, that considers the cumulative loss of nutrients and is adjusted for optimal body weights and bioavailability. It is logical that physiological and metabolic changes associated with ageing influence several of these factors: body weight, lean mass, energy expenditure, nutrient retention and bioavailability and thus alter nutrient requirements compared to the adult population. Acknowledging these age-related changes, some international organizations have suggested nutrient requirements specific to the elderly. Given the contextual differences in physiology, caution needs to be exercised in adopting these guidelines for the Indian elderly. In addition, in the Indian context, there is sparse information on the diet and nutrient intakes vis-à-vis nutritional status and physiology of the elderly. This status paper highlights some of the pertinent issues related to nutritional requirements for the elderly that advocate a need for deriving nutritional requirements for the elderly in India. [ABSTRACT FROM AUTHOR]

AbstractObjectivesMethodsResults\nIMPLICATION FOR REHABILITATIONTo review the World Health Organization Disability Assessment Schedule (WHODAS2.0) application in elderly population.A review of English articles was performed using the following databases: PubMed/Medline, Scopus, Web of Science, Cochrane, Embase. Only articles assessing disability through WHODAS2.0 in elderly population (>60-years-old) were included according to PRISMA Statement.37 papers satisfied the inclusion criteria reporting 125.624 cases of elderly whose disability was assessed using WHODAS2.0 in different versions (36-items-version in 15 studies; 12-items-version in 15 papers; both versions in 3 articles; data unavailable in 4 studies). Four different aims were recognized: WHODAS 2.0 was used in 12 studies to assess the prevalence of disability, 25 studies of association between disability and environmental or medical conditions; 9 studies of validation of WHODAS and 2 studies to verify the outcome of therapies on functioning. Conclusions: WHODAS2.0 is a valid measure of disability among elderly, able to identify the relation between disability, and medical and environmental factors. Unfortunately, only few Countries apply the “bio-psycho-social” approach to social and health policies context. Therefore, it is recommended to adopt a rehabilitation perspective in every legislation. These results could serve as baseline data to monitor the application of WHODAS2.0 over the coming years.WHODAS 2.0 has been used in elderly population to assess the prevalence of disability and its association with medical and environmental factors in medical and rehabilitation contexts.Disability assessed by the WHODAS 2.0 is commonly associated with physical health impairment, depression, Alzheimer’s disease, Parkinson disease, dementia, social conditions, frailty, muscle impairment, old age, education, communication and hearing impairment.Rehabilitation professionals will benefit from the use of WHODAS 2.0 recommended by United Nations, since it will provide a uniform evaluation of functioning and performance.WHODAS 2.0 has been used in elderly population to assess the prevalence of disability and its association with medical and environmental factors in medical and rehabilitation contexts.Disability assessed by the WHODAS 2.0 is commonly associated with physical health impairment, depression, Alzheimer’s disease, Parkinson disease, dementia, social conditions, frailty, muscle impairment, old age, education, communication and hearing impairment.Rehabilitation professionals will benefit from the use of WHODAS 2.0 recommended by United Nations, since it will provide a uniform evaluation of functioning and performance. [ABSTRACT FROM AUTHOR]

Around 60% of people living with cancer are aged 65 years or older. Older cancer patients face a unique set of age-associated changes, comorbidities and circumstances that impact on their quality of life (QoL) in ways that are different from those affecting younger patients. A Task Force of the International Society of Geriatric Oncology recommends and encourages all healthcare professionals involved in cancer care to place greater focus on the QoL of older people living with cancer. This paper summarizes current thinking on the key issues of importance to addressing QoL needs of older cancer patients and makes a series of recommendations, together with practical guidance. [ABSTRACT FROM AUTHOR]

Aims: The purpose of this study was to investigate the status of self‐management behaviour and illness perceptions and to examine illness perceptions in relation to self‐management behaviour in elderly patients with chronic obstructive pulmonary disease (COPD). Methods: A cross‐sectional study was conducted, and 152 elderly COPD patients were recruited via the convenience sampling method. The COPD Self‐Management Scale and the Revised Illness Perception Questionnaire for COPD patients were used to examine self‐management behaviour and illness perceptions. Pearson correlation analysis, univariate analysis and hierarchical linear regression analysis were used to explore illness perceptions in relation to self‐management behaviour. Results: The mean overall score for self‐management behaviour was 2.90 ± 0.39. Among the subscales of self‐management behaviour, information management had the lowest score of 2.20 ± 0.76. Patients' demographic and clinical characteristics, including educational level, smoking status, type of primary caregiver, home oxygen therapy and COPD duration, were found to be significant determinants of self‐management behaviour. After controlling for these variables, several illness perception subscales, including treatment control, personal control, coherence, timeline cyclical and identity, were significantly correlated with self‐management behaviour. Conclusions: This study confirmed that elderly COPD patients' self‐management behaviour was unsatisfactory and that illness perceptions were significant determinants of self‐management behaviour. The findings may contribute to the development of self‐management interventions for elderly COPD patients. Summary statement: What is already known about this topic? Self‐management behaviour plays an essential role in managing COPD.Illness perceptions are predictors of self‐management behaviours in COPD patients, but little is known about how illness perceptions influence self‐management behaviour in elderly patients with COPD. What this paper adds? Several illness perception subscales, including treatment control, personal control, coherence, timeline cyclical and identity, were significantly correlated with self‐management behaviour.Patients' demographic and clinical characteristics, including educational level, smoking status, type of primary caregiver, home oxygen therapy and COPD duration, were found to be determinant of self‐management behaviour. The implications of this paper: The findings may contribute to developing tailored interventions that help patients establish beneficial illness perceptions to improve their self‐management behaviour. [ABSTRACT FROM AUTHOR]

Aging population is a global issue that presents a significant challenge to humanity. Declining organ function with aging can lead to gastrointestinal and nutritional shortages, eating difficulties, and other health issues. The healthy eating habits and adequate nutrition play a key role in lowering the prevalence of non-communicable diseases. As prospective food development tool for the elderly, additive manufacturing technology, commonly known as 3D printing technology, provides the advantages of personalization, customization, and digitization. However, the application of 3D printing technology to produce food for elderly has not been thoroughly examined. This paper discusses the application of 3D printing technology for the development of functional foods for elderly with eating difficulties, anorexia, malnutrition, and sensory degeneration. Also, the application of 3D printing technology in developing special medical foods that are easy to chew and swallow is discussed. Moreover, this paper analyzes the issues and future development trend of 3D printing technology in the development of functional foods and special medical foods for elderly. Overall, 3D printing technology has a wide range of applications in elderly food development. This paper provides new ideas for the future application of 3D printing technology in the development of elderly food. [ABSTRACT FROM AUTHOR]

Background: Determining social vulnerability of elderly people is a prerequisite for risk analysis in natural disasters. Understanding and comprehension of different dimensions of elderly social vulnerability by using international experiences is a must to determine and ultimately measure this phenomenon. In this study, we tried to understand the dimensions of elderly social vulnerability in natural disasters based on international experiences. Materials and Methods: An integrative review of literature was conducted to clarify the elderly social vulnerability concept in natural disasters. We used keywords such as "elderly", "social vulnerability", and "natural disasters" in texts and titles in electronic databases of Medlib Iran Medex, Magiran, SID, Irandoc, Web of Science, Google Scholar CINAHL, ProQuest, Ovid, Ageline, Scopus, Embase, and Pub Med. At last 25 articles were found issued from 1986 to 2018. Their inclusion criteria were written in Persian or English language and had search keywords in their texts, titles, or and keywords. Commentary or editor letters were excluded. Each article was examined according to subjects, definition of social vulnerability, theoretical aspects, outcomes and antecedents of social vulnerability. For analyzing, controversial content analyses was used. Results: The results of the concept analysis showed that social vulnerability is a complex, dynamic, challenging, multi-dimensional and pre-existing condition that is dependent on individual characteristics as well as economic status. It is influenced by the culture and elderly people's place of living. Conclusion: Reducing social vulnerability of older adults in natural disasters is not possible without paying enough attention to this issue and increasing their empowerment. Therefore, extensive research to identify this concept in related contexts and carry out qualitative research will be very effective in defining this concept and providing the appropriate tools for its measurement. [ABSTRACT FROM AUTHOR]

As the global trend of population ageing intensifies, the health management needs of the elderly are becoming increasingly urgent, while the existing pension system and medical resources are ill-equipped to cope with this realistic challenge. In this context, smart health wearables, as a major innovation in the field of health technology. integrate advanced technologies such as sensors, mobile technology and artificial intelligence to efficiently collect and analyze users' physiological data, provide real-time feedback on health conditions and provide early warnings, and help users realize self-health management. These products demonstrate considerable potential for application among the elderly population, offering efficient and convenient health management services that are expected to significantly enhance their quality of life and optimize the allocation of medical resources. In recent years, the rapid development of this field has triggered extensive research in the academic community. However, the majority of existing studies focus on technology development and application scenarios, and lack a systematic overview of the field and a comprehensive comparison of domestic and international studies. To address this gap, the study employed bibliometric methods to systematically review and evaluate the research conducted over the past decade on smart health wearables for the elderly, both domestically and internationally. The aim is to reveal the current research status, hotspots, and trends in this field, and to explore potential research directions, providing valuable insights for academic research, technological innovation, and practical applications. Using the CNKI and Web of Science core databases as data sources, the study selected relevant literature on elderly smart health wearables published between 2013 and 2023. A total of 339 domestic and 649 international papers were chosen, and the data were visualized using VOSviewer and CiteSpace software. First, descriptive statistical analysis was conducted on the annual publication volume, as well as the contributions of countries and institutions. Second, co-occurrence and clustering analyses of keywords were performed to identify research hotspots domestically and internationally. Additionally, keyword time-zone and burst detection were used to reveal the evolution of research frontiers. Finally, co-citation analysis was employed to present the foundational knowledge structure of international research and identify influential classic works. This study is the first to conduct a bibliometric analysis of research on elderly smart health wearables both domestically and internationally. This study has constructed knowledge maps providing a clear framework for the existing research in this field. The study reveals the current research status and trends in the field of smart health wearables for the elderly from four dimensions: spatiotemporal distribution, research hotspots, frontier evolution, and knowledge foundations. The results show that the USA and China dominate international research in this field, with particularly close academic collaboration between the two countries. Although domestic and international research have different focuses, domestic studies mainly concentrate on the integration of wearable technology and elderly care systems, while international research focuses more on technological innovation in health management and its practical applications, as well as elderly technology acceptance. Domestic research has evolved from product development and the optimization of elderly care systems to smart health management applications. Meanwhile, international research has shifted from technology development and system integration to in-depth exploration of elderly technology acceptance and adoption. Additionally, geriatric technology adoption assessment, health monitoring technology innovation, and smart health management applications form the foundational knowledge of this field. Future research should strengthen interdisciplinary collaboration between engineering and medical fields, so as to explore user experience and needs to optimize elderly-centered product design. Long-term efficacy validation is necessary to ensure the practical application of smart health wearables. These studies will drive the further development of smart health wearables for the elderly, and offer effective support in addressing the global health challenges posed by aging. [ABSTRACT FROM AUTHOR]

BACKGROUND: Gait is one of the optimal indicators of functional status in older adults. Gait parameters are associated with adverse health outcomes in older adults. OBJECTIVE: To summarize and compare the practical value of gait parameters, and to review the progress of research on spatio-temporal parameters and the risk of adverse health outcomes in older adults. METHODS: PubMed, Web of Science, and CNKI were searched for relevant literature published from January 2010 to June 2023 using the search terms of “gait speed, walking speed, step length, cadence, step frequency, step time, walking base, aged and elderly” in English and Chinese, respectively. A total of 52 papers were finally included for the systematic review. RESULTS AND CONCLUSION: Currently, researchers have focused on three basic temporal-spatial parameters, namely, step speed, step length and step frequency, to explore their association with adverse health outcomes in older adults. Reduced gait speed in older adults may increase the risk of falls, all-cause mortality, and may be an independent predictor of all-cause mortality. Older adults with slow gait speed are at higher risk of cognitive decline, and may be the preferred gait parameter in assessing cognitive impairment in older adults. Older adults with slow gait speed are more likely to have debilitating or common chronic illnesses, and are at higher risk of hospitalization and public care. Step length is positively correlated with individual height and lower limb length, but age-induced shortening of step length is not related to height or lower limb length, and shortening of step length reflects reduced physical function in older adults, and shortening of step length is a risk factor for falls and cognitive decline in older adults. Stride frequency is often used as a measure of exercise intensity, and a stride frequency of ≥ 100 steps/minute is predictive of all-cause mortality, and slowing of step frequency may lead to a higher risk of falls, hospitalization and all-cause mortality in older adults. Changes in gait parameters are closely related to the level of physical fitness in older adults, and there may be a bidirectional relationship between the two. The results of the study will provide a theoretical basis for further improving risk screening in clinical populations, refining health risk assessment in the elderly, improving health protection and promoting active health in the elderly. [ABSTRACT FROM AUTHOR]

Sepsis is a pervasive condition that affects individuals of all ages, with significant social and economic consequences. The early diagnosis of sepsis is fundamental for establishing appropriate treatment and is based on warning scores and clinical characteristics, with positive microbiological cultures being the gold standard. Research has yet to identify a single biomarker to meet this diagnostic demand. Presepsin is a molecule that has the potential as a biomarker for diagnosing sepsis. In this paper, we present a narrative review of the diagnostic and prognostic performance of presepsin in different age groups. Given its particularities, it is identified that presepsin is a potential biomarker for sepsis at all stages of life. [ABSTRACT FROM AUTHOR]

Molecular imaging using radiopharmaceuticals has a clear role in visualising the presence and extent of tumour at diagnosis and monitoring response to therapy. Such imaging provides prognostic and predictive information relevant to management, e.g. by quantifying active tumour mass using positron emission tomography/computed tomography (PET/CT). As these techniques require only pharmacologically inactive doses, age and potential frailty are generally not important. However, this may be different for therapy involving radionuclides because the radiation can impact normal bodily function (e.g. myelosuppression). Since the introduction of Iodine-131 as a targeted therapy in thyroid cancer, several radiopharmaceuticals have been widely used. These include antibodies and peptides targeting specific epitopes on cancer cells. Among therapeutic bone seeking agents, radium-223 ( 223 Ra) stands out as it results in survival gains in patients with castration-resistant prostate cancer and symptomatic bone metastases. The therapeutic use of radiopharmaceuticals in elderly cancer patients specifically has received little attention. In elderly prostate cancer patients, there may be advantages in radionuclides' ease of use and relative lack of toxicity compared with cytotoxic and cytostatic drugs. When using radionuclide therapies, close coordination between oncology and nuclear medicine is needed to ensure safe and effective use. Bone marrow reserve has to be considered. As most radiopharmaceuticals are cleared renally, dose adjustment may be required in the elderly. However, compared with younger patients there is less, if any, concern about adverse long-term radiation effects such as radiation-induced second cancers. Issues regarding the safety of medical staff, care givers and the wider environment can be managed by current precautions. [ABSTRACT FROM AUTHOR]

Chronic lymphocytic leukemia (CLL) mainly affects older people: the median age at diagnosis is>70 years. Elderly patients with CLL are heterogeneous with regard both to the biology of their disease and aging. Following the diagnosis of CLL in an elderly individual, careful risk assessment is essential when treatment options are evaluated. This includes not only clinical staging and evaluation of disease-specific prognostic biomarkers such as 17p deletion and TP53 mutation, but also of comorbidities, physical capacity, nutritional status, cognitive capacity, ability to perform activities of daily living and social support. Comorbidity scoring and geriatric assessment tools are helpful in achieving such multidimensional evaluation in a systematic manner. The introduction of new drugs including novel monoclonal antibodies and kinase inhibitors offers enhanced opportunities for the treatment of elderly patients with CLL. This position paper of a Task Force of the International Society of Geriatric Oncology (SIOG) reviews currently available evidence relevant to such patients. All types of elderly patient (i.e. chronological age>65-70 years) are considered, from robust (fit) to vulnerable (unfit) to the terminally ill. Among the topics covered are the following: (i) the relationship between chronological age, prognosis and survival, (ii) assessment of biological aging, (iii) biological age as a determinant of treatment feasibility and tolerance and (iv) tailoring of both first and further-line treatment to the circumstances of the individual patient. [ABSTRACT FROM AUTHOR]

Acute appendicitis is a typical surgical emergency worldwide and one of the common causes of surgical acute abdomen in the elderly. Accurately diagnosing and differentiating acute appendicitis can assist clinicians in formulating a scientific and reasonable treatment plan and providing high-quality medical services for the elderly. In this study, we validated and analyzed the different performances of various machine learning models based on the analysis of clinical data, so as to construct a simple, fast, and accurate estimation method for the diagnosis of early acute appendicitis. The dataset of this paper was obtained from the medical data of elderly patients with acute appendicitis attending the First Affiliated Hospital of Anhui University of Chinese Medicine from January 2012 to January 2022, including 196 males (60.87%) and 126 females (39.13%), including 103 (31.99%) patients with complicated appendicitis and 219 (68.01%) patients with uncomplicated appendicitis. By comparing and analyzing the prediction results of the models implemented by nine different machine learning techniques (LR, CART, RF, SVM, Bayes, KNN, NN, FDA, and GBM), we found that the GBM algorithm gave the optimal results and that sensitivity, specificity, PPV, NPV, precision, recall, F1 and brier are 0.9167, 0.9739, 0.9429, 0.9613, 0.9429, 0.9167, 0.9296, and 0.05649, respectively. The GBM model prediction results are interpreted using the SHAP technology framework. Calibration and Decision curve analysis also show that the machine learning model proposed in this paper has some clinical and economic benefits. Finally, we developed the Shiny application for complicated appendicitis diagnosis to assist clinicians in quickly and effectively recognizing patients with complicated appendicitis (CA) and uncomplicated appendicitis (UA), and to formulate a more reasonable and scientific clinical plan for acute appendicitis patient population promptly. [ABSTRACT FROM AUTHOR]

With the aging of the population, the incidence of osteoporotic fractures has risen, and the financial expenditure on health care has increased. More and more studies have concluded that rehabilitation is an indispensable part of osteoporosis treatment, but for a long time clinicians have had an insufficient degree of awareness of the rehabilitation treatment of osteoporotic fracture, and therapists have lacked standardized criteria in the process of clinical treatment. Therefore, this paper focuses on the rehabilitation treatment of osteoporotic fracture as the central theme, combing the current research status, this paper describes that the standardization of the degree of preoperative rehabilitation should be improved, the analysis of changes in visual analogue scale (VAS) scores should be strengthened in the assessment, the reasonable use of rehabilitation equipment, the application of shock wave and hydrotherapy in osteoporotic fracture should be strengthened, the application of osteoporotic fracture should be strengthened, and the treatment of osteoporotic fracture should be improved., adopt the comprehensive analysis of osteoporotic fracture and other points of view to provide reference and help for subsequent research. [ABSTRACT FROM AUTHOR]

Given the high incidence of NSCLC in the elderly, EORTC Elderly Task Force and Lung Cancer Group, and International Society of Geriatric Oncology has published in 2010 an expert's opinion paper providing recommendations for the management of elderly NSCLC patients. Since that time we believe that important data is published that require the update of our recommendations.Non-small-cell lung cancer (NSCLC) is a very common disease in the elderly population and its incidence in this particular population is expected to increase further, because of the ageing of the Western population. Despite this, limited data are available for the treatment of these patients and, therefore, the development of evidence-based treatment recommendations is challenging. In 2010, European Organization for Research and Treatment of Cancer (EORTC) took an initiative in collaboration with International Society of Geriatric Oncology (SIOG) and created an experts panel that provided an experts' opinion consensus paper for the management of elderly NSCLC patients. Since this publication, important new data are available and EORTC and SIOG recommended to update the 2010 recommendations. Besides recommendations for surgery, adjuvant chemotherapy and radiotherapy, treatment of locally advanced and metastatic disease, recommendations were expanded, to include data on patient preferences and geriatric assessment. [ABSTRACT FROM AUTHOR]

Abstract: This study investigated the effects of bending curvature of simulated e-paper displays (−10cm, plane and 10cm) and ambient illuminance (50, 500, 6000 and 12,000lx) on the visual performance of young and elderly users for simulated electronic-paper displays. In total, 24 people comprising 12 young and 12 elderly users participated in this study. Young users demonstrated significantly enhanced visual performance using the simulated electrophoretic ink (E ink) e-paper display with ambient illuminance set at 50 and 500lx; however, participants did not demonstrate significantly different visual performance using the 2 simulated e-paper displays with ambient illuminance set at 6000 and 12,000lx. The bending curvature did not exhibit significant effects on the visual performance of young participants under various ambient illuminances. The elderly participants exhibited significantly enhanced visual performance using the simulated E ink e-paper display only when ambient illuminance was set at 50lx; however, participants did not exhibit significantly different visual performance using the two simulated e-paper displays with ambient illuminance set at other levels. Elderly users exhibited significantly enhanced visual performance when the bending curvature was set at 10cm, with ambient illuminance set at 50lx. Elderly users also demonstrated significantly enhanced visual performance under bending curvature settings of 10cm and plane, with ambient illuminance set at 500lx. However, the bending curvature of the simulated e-paper did not exhibit significant effects on the visual performance of elderly participants under ambient illuminance settings of 6000 and 12,000lx. [Copyright &y& Elsevier]

Life review therapy is a form of psychotherapy framework which involves the guided reflection of life events throughout a patient's life journey. Patients are encouraged to actively recall and analyze important life events, both negative and positive. Through this process, patients may be able to come to terms with, or even resolve negative events such as conflicts and regrets. The aim of this study is to gain an understanding of the current knowledge of the use of life review therapy in older adults, and to identify areas for future research. A systematic literature search was conducted across CINAHL, Medline, PsycInfo, Embase and Scopus. Papers were screened and selected using predetermined inclusion and exclusion criteria using Covidence and exported into Excel. Data analysis was conducted to synthesise thematic analyses. One hundred and thirty‐one articles from 1974 to 2023 were included in this study and were used to develop four themes: life satisfaction and self‐esteem, depression and depressive symptoms, institutional care and cognitive decline, and post‐traumatic stress disorder (PTSD) and trauma. Life review has some benefit in older adults in certain groups and situations, although the extent and duration of effectiveness of this benefit is unclear. Life review unlikely improves self‐esteem. However, in the short term, life review appears to improve life satisfaction, depression or depressive symptoms, and PTSD symptoms in the elderly. Life review may be a useful therapeutic tool for older adults with cognitive decline for as long as the intervention continues. Areas for future research are explored. [ABSTRACT FROM AUTHOR]

High-grade gliomas are the most prevalent neurooncological desease in adults, their incidence increases with age, peaking in the seventh decade. This paper aims to address how to select patients for surgical resection by identifying pre-surgical predictors of 12-month mortality in newly diagnosed HGG patients aged ≥ 75 years. A prognostic score will be proposed to guide surgical decisions based on expected survival. Retrospective observational single-center cohort study was carried out at the "Città della Salute e della Scienza-Molinette" University Hospital in Turin, Italy. All consecutive patients aged ≥ 75 years newly diagnosed with HGG were included, regardless of whether they underwent surgical resection. Clinical, radiological, histological and molecular data were collected.Variables potentially available at the time of diagnosis were considered to develop a multivariable logistic regression predictive model, with 12-months overall survival as the dependent variable. 102 patients aged 75 years or older received a new diagnosis of high-grade glioma, of whom 68 underwent surgical resection. Patients undergoing surgery were slightly younger (76.9 vs 79.0 years, p = 0.007) and had better performance status (median KPS 80 vs 70). Most tumors undergoing surgery were localized in cortical or subcortical non-motor areas (p < 0.001) and less frequently deep-seated (p = 0.023) or multifocal (p < 0.001). A predictive model, the DAK-75 score, was developed: the AUROC of the final model was 0.822 (95% CI 0.741–0.902). The score includes clinical presentation, tumor location, and KPS, ranging from 0 to 20, categorizing risk scores into low-risk and high-risk groups (< or > 8). Higher scores corresponded to fewer surgical patients and higher one-year mortality rates (92.2% vs 47.1%, p < 0.001). DAK-75 score may represent a valuable tool in the decision-making process for neurosurgical intervention in elderly patients diagnosed with HGG. Further studies are needed to externally and prospectively validate the scoring system. [ABSTRACT FROM AUTHOR]

This article adopts data from the Chinese General Social Survey (CGSS) 2021 to establish a structural equation model to investigate the influence of lifestyle on the subjective well-being of older adults. The results show that lifestyle positively impacts the subjective well-being of the older adults, meaning those with a richer lifestyle get higher subjective well-being. Health status plays a positive mediating role in the relationship between lifestyle and subjective well-being, in which lifestyle can enhance the subjective well-being of older adults by improving their health status. In the first half of the mediation effect, class identity has a significant negative moderating effect, which indicates that the upper class, the weaker the influence of older adults' lifestyles on their health status. This paper proposes to focus on improving the lifestyle of older adults, enhancing the pension and medical service systems, and promoting the well-being of older adults. [ABSTRACT FROM AUTHOR]

Purpose: Frailty is common in surgical patients and is closely associated with postoperative outcomes. Aims: This study employed bibliometric methods to summarize and analyze research related to frailty and surgery, comprehensively analyzing the research structure and providing visualized maps. Methods: This study analyzed the volume of publications, countries, institutions, authors, journals, references, and keywords related to perioperative frailty in the Web of Science Core Collection from 1978 to 2024. Visual bibliometric analyses were conducted from multiple perspectives, including collaboration networks, citation analysis, and keyword clustering. Results: From 1978 to 2024, 21,879 authors from 95 countries and regions published 4,119 papers on perioperative frailty in 973 journals worldwide. The United States has the most publications, while Italy has the highest degree of international collaboration. The University of California System has the highest number of publications. The University of Kansas Medical Center is the institution with the highest centrality. The top nine authors in terms of publication volume are all from the USA. Bowers Christian A. is the most prolific author. The Journal of Vascular Surgery is the journal with the most publications. Current research directions include preoperative risk assessment of frailty, the relationship between frailty and postoperative complications, elderly frailty, and the relationship between frailty and sarcopenia. Research hotspots include risk stratification, postoperative delirium, the elderly, and sarcopenia. Conclusion: This study has identified the research hotspots and trends in perioperative frailty. Our findings will enable researchers to understand this field's knowledge structure better and identify future research directions. [ABSTRACT FROM AUTHOR]

Aim: The aim of this concept analysis is to seek clarity as to what end‐of‐life conversations involve by developing a clear working definition and using model cases to conceptualise the defining attributes of an end‐of‐life conversations with the older person. Design: Walker and Avant's eight step approach to Concept Analysis. Data Sources: Four databases were searched, including PubMed, CINAHL, PsycINFO, and Scopus. A total of 339 publications were identified with 30 papers meeting the inclusion criteria and put forward for the final conceptual analysis. Results: The defining attributes associated with end‐of life conversations included (1) an ongoing process of older person empowerment, (2) discussion's concerning values and preferences concerning end‐of‐life issues, and (3) maintaining an open dialogue between all concerned individuals. Antecedents were associated with the older person is their readiness to talk openly about death and dying. Consequences were identified as having a better understanding of what death and dying may mean to the older person in a more specific manner. Conclusions: End‐of‐life conversations are vital in understanding an individual's values and preferences at the end of life, and yet, the concept of the end‐of‐life conversation has not been well defined in the literature. End‐of‐life conversations with the older person encompass ongoing discussions and maintaining open dialogue around end‐of‐life care while developing strategies to promote individual empowerment in making informed choices. Using a conceptual model, aides in addressing aspects of end‐of‐life conversations and an acknowledgment of the dynamic process of end‐of‐life conversations. [ABSTRACT FROM AUTHOR]

Many researchers have studied the role of air pollutants on cognitive function, changes in brain structure, and occurrence of dementia. Due to the wide range of studies and often contradictory results, the present systematic review was conducted to try and clarify the relationship between air pollutants and dementia. To identify studies for this review, a systematic search was conducted in Scopus, PubMed, and Web of Science databases (without historical restrictions) until May 22, 2023. The PECO statement was created to clarify the research question, and articles that did not meet the criteria of this statement were excluded. In this review, animal studies, laboratory studies, books, review articles, conference papers and letters to the editors were avoided. Also, studies focused on the effect of air pollutants on cellular and biochemical changes (without investigating dementia) were also excluded. A quality assessment was done according to the type of design of each article, using the checklist developed by the Joanna Briggs Institute (JBI). Finally, selected studies were reviewed and discussed in terms of Alzheimer's dementia and non-Alzheimer's dementia. We identified 14,924 articles through a systematic search in databases, and after comprehensive reviews, 53 articles were found to be eligible for inclusion in the current systematic review. The results showed that chronic exposure to higher levels of air pollutants was associated with adverse effects on cognitive abilities and the presence of dementia. Studies strongly supported the negative effects of PM2.5 and then NO2 on the brain and the development of neurodegenerative disorders in old age. Because the onset of brain structural changes due to dementia begins decades before the onset of disease symptoms, and that exposure to air pollution is considered a modifiable risk factor, taking preventive measures to reduce air pollution and introducing behavioral interventions to reduce people's exposure to pollutants is advisable. [ABSTRACT FROM AUTHOR]

Background: Parkinson's disease (PD) has an impact on speech production, manifesting in various ways including alterations in voice quality, challenges in articulating sounds and a decrease in speech rate. Numerous investigations have been conducted to ascertain the oral‐diadochokinesis (O‐DDK) rate in individuals with PD. However, the existing literature lacks exploration of such O‐DDK rates in Malaysia and does not provide consistent evidence regarding the advantage of real‐word repetition. Aims: To explore the effect of gender, stimuli type and PD status and their interactions on the O‐DDK rates among Malaysian‐Malay speakers. Methods & Procedures: O‐DDK performance of 62 participants (29 individuals with PD and 33 healthy elderly) using a non‐word ('pataka'), a Malay real‐word ('patahkan') and an English real‐word ('buttercake') was audio recorded. The number of syllables produced in 8 s was counted. A hierarchical linear modelling was performed to investigate the effects of stimuli type (non‐word, Malay real‐word, English real‐word), PD status (yes, no), gender (male, female) and their interactions on the O‐DDK rate. The model accounted for participants' age as well as the nesting of repeated measurements within participants, thereby providing unbiased estimates of the effects. Outcomes & Results: The stimuli effect was significant (p < 0.0001). Malay real‐word showed the lowest O‐DDK rate (5.03 ± 0.11 syllables/s), followed by English real‐word (5.25 ± 0.11 syllables/s) and non‐word (5.42 ± 0.11 syllables/s). Individuals with PD showed a significantly lower O‐DDK rate compared to healthy elderly (4.73 ± 0.15 syllables/s vs. 5.74 ± 0.14 syllables/s, adjusted p < 0.001). A subsequent analysis indicated that the O‐DDK rate declined in a quadratic pattern. However, neither gender nor age effects were observed. Additionally, no significant two‐way interactions were found between stimuli type, PD status and gender (all p > 0.05). Therefore, the choice of stimuli type has no or only limited effect considering the use of O‐DDK tests in clinical practice for diagnostic purposes. Conclusions & Implications: The observed slowness in O‐DDK among individuals with PD can be attributed to the impact of the movement disorder, specifically bradykinesia, on the physiological aspects of speech production. Speech‐language pathologists can gain insights into the impact of PD on speech production and tailor appropriate intervention strategies to address the specific needs of individuals with PD according to disease stages. WHAT THIS PAPER ADDS: What is already known on this subject: The observed slowness in O‐DDK rates among individuals with PD may stem from the movement disorder's effects on the physiological aspects of speech production, particularly bradykinesia. However, there is a lack of consistent evidence regarding the influence of real‐word repetition and how O‐DDK rates vary across different PD stages. What this study adds to existing knowledge: The O‐DDK rates decline in a quadratic pattern as the PD progresses. The research provides insights into the advantage of real‐word repetition in assessing O‐DDK rates, with Malay real‐word showing the lowest O‐DDK rate, followed by English real‐word and non‐word. What are the potential or actual clinical implications of this work?: Speech‐language pathologists can better understand the evolving nature of speech motor impairments as PD progresses. This insight enables them to design targeted intervention strategies that are sensitive to the specific needs and challenges associated with each PD stage. This finding can guide clinicians in selecting appropriate assessment tools for evaluating speech motor function in PD patients. [ABSTRACT FROM AUTHOR]

Objective As society becomes more interconnected with technology, it is important to examine how traditional "paper and pencil" administered neuropsychological tests can be utilized in digital electronic forms (e.g. computers, touch screen tablets, and smartphones). Literature has shown somewhat mixed outcomes for the validity of computerized tests. Gathering data electronically has been found to reduce human error in both test administration and in data collection itself. Digitizing carries benefits in the research field where electronic administration may make it possible to gather data on a larger scale numerically and geographically. However, in some conversions to digital versions of a task, changes may be made to the stimuli and procedure that might seemingly be benign, but could activate different cognitive responses, potentially compromising construct validity. This study examined the comparability of paper and electronic forms of the Stroop task, which is used widely and has been previously validated in paper form. Method Electronic Stroop tests were examined for concurrent validity with a paper version. Two touch-screen based apps were examined: BrainBaseline for the iPad and EncephalApp for smartphone. Young and older adults (n = 58) completed paper and an electronic version of the Stroop. Results Correlation analyses revealed a significant, but modest relationship between paper Stroop and the BrainBaseline version (r =.54; p =.001), while the EncephalApp correlation was non-significant (r =.44; p =.18). Conclusions These results need to be verified in a larger sample, but the implication is that some paper and electronic versions of cognitive tests are not necessarily interchangeable, and caution should be used. [ABSTRACT FROM AUTHOR]

As a result of an increasing life expectancy, the incidence of cancer cases diagnosed in the older population is rising. Indeed, cancer incidence is 11-fold higher in persons over the age of 65 than in younger ones. Despite this high incidence of cancer in older patients, solid data regarding the most appropriate approach and best treatment for older cancer patients are still lacking, mostly due to under-representation of these patients in prospective clinical trials. The clinical behaviour of common malignant diseases, e.g. breast, ovarian and lung cancers, lymphomas and acute leukaemias, may be different in older patients because of intrinsic variation of the neoplastic cells and the ability of the tumour host to support neoplastic growth. The decision to treat or not these patients should be based on patients’ functional age rather than the chronological age. Assessment of patients’ functional age includes the evaluation of health, functional status, nutrition, cognition and the psychosocial and economic context. The purpose of this paper is to focus on the influence of age on cancer presentation and cancer management in older cancer patients and to provide suggestions on clinical trial development and methodology in this population. [Copyright &y& Elsevier]

Although several studies have described dual-tasking ability in normal aging, Mild Cognitive Impairment and Alzheimer's disease, no normative data for dual-task performance exist. Dual-tasking ability of 436 healthy individuals, aged 16–88 years, was assessed using a new paper-and-pencil dual-task paradigm. In this study, no age effect was detected, providing strong evidence that age does not affect dual-tasking abilities. Psychometric data for this new assessment are presented, which may enable clinicians and researchers to use this paradigm as a means of examining attentional control in dual-tasking. [ABSTRACT FROM PUBLISHER]

Abstract: Treatments currently recommended for metastatic renal cell cancer (mRCC) have not been evaluated specifically in elderly patients. Here we consider what may be learned by analysing according to age the efficacy and toxicity data from key phase III trials of the targeted agents sorafenib (Nexavar), sunitinib (Sutent), temsirolimus (Torisel), and bevacizumab (Avastin), and from a study of expanded access to sunitinib and sorafenib. This paper represents the first systematic review of the role of targeted agents specifically in the elderly population. Retrospective subgroup analyses of clinical trial data cannot be considered definitive. However, they suggest in general that the progression-free and overall survival benefits seen in mRCC patients aged 65 years and over are similar to those in the younger age group. The frequency of major toxicities in elderly patients treated with targeted agents is no greater than in younger patients, although such toxicities may have greater impact on the quality of life. That said, no meaningful data are available for patients over 85 years. To confirm and extend these conclusions, prospective studies should be undertaken in the elderly to determine whether recommendations made for the wider mRCC population apply equally to this group of patients in whom comorbidities, comedication and the greater impact of low-grade toxicity may influence the efficacy and tolerability of treatment. Such studies are increasingly needed, given the growing number of elderly people and their rising life expectancy. Meanwhile, when considering the most appropriate drug to use in a particular patient, the toxicity profiles of the individual targeted agents – and any implications for specific comorbid conditions – should be taken into account. [Copyright &y& Elsevier]

Background: In China, the healthcare financing structure involves multiple parties, including the government, society and individuals. Medicare Fund is an important way for the Government and society to reduce the burden of individual medical costs. However, with the aging of the population, the demand of Medicare Fund is increasing. Therefore, it is necessary to explore the sustainability of the healthcare financing structure in the context of population ageing. Objective: The purpose of this paper is to organize the characteristics of population ageing as well as healthcare financing in China. On this basis, it analyzes the impact mechanism of population ageing on healthcare financing and the sustainability of existing healthcare financing. Methods: This paper mainly adopts the method of literature research and inductive summarization. Extracting data from Health Statistics Yearbook of China and Labor and Social Security Statistics Yearbook of China. Collected about 60 pieces of relevant literature at home and abroad. Results: China has already entered a deeply ageing society. Unlike developed countries in the world, China's population ageing has distinctive feature of ageing before being rich. A healthcare financing scheme established by China, composing of the government, society, and individuals, is reasonable. However, under the pressure of population ageing, China's current healthcare financing scheme will face enormous challenges. Scholars are generally pessimistic about the sustainability of China's healthcare financing scheme. Conclusions: Population ageing will increase the expenditure and reduce the income of the Medicare Fund. This will further affect the sustainability of the healthcare financing structure. As a consequence, the state should pay particular attention to this issue and take action to ensure that the Fund continues to operate steadily. [ABSTRACT FROM AUTHOR]

Background: Comorbidities and risk factors likely to complicate treatment are common in elderly cancer patients. Anthracyclines remain the cornerstone of first-line therapy for non-Hodgkin’s lymphoma (NHL) and metastatic and early breast cancer but can cause congestive heart failure. Elderly patients are at increased risk of this event and measures to reduce it should be considered.Methods: A committee of experts in breast cancer and NHL met under the auspices of the International Society for Geriatric Oncology to review the literature and make recommendations, based on level of evidence, for the assessment, treatment and monitoring of elderly patients requiring anthracyclines.Results and recommendations: Use of anthracycline-based chemotherapy illustrates many of the dilemmas facing elderly cancer patients. Age in itself should not prevent access to potentially curative treatment or treatment that prolongs life or improves its quality. The risk of cardiotoxicity with conventional anthracyclines is increased by the following factors: an existing or history of heart failure or cardiac dysfunction; hypertension, diabetes and coronary artery disease; older age (independent of comorbidities and performance status); prior treatment with anthracyclines; higher cumulative dose of anthracyclines and short infusion duration. The fact that cumulative and irreversible cardiotoxicity is likely to be greater in this population than among younger patients calls for effective pretreatment screening for risk factors, rigorous monitoring of cardiac function and early intervention. Use of liposomal anthracycline formulations, prolonging the infusion time for conventional anthracyclines and cardioprotective measures should be considered. However, when treatment is being given with curative intent, care should be taken to ensure reduced cardiotoxicity is not achieved at the expense of efficacy. [ABSTRACT FROM AUTHOR]

Although no randomized studies have demonstrated a positive impact of therapeutic drug monitoring (TDM) on clinical outcome in epilepsy, evidence from nonrandomized studies and everyday clinical experience does indicate that measuring serum concentrations of old and new generation antiepileptic drugs (AEDs) can have a valuable role in guiding patient management provided that concentrations are measured with a clear indication and are interpreted critically, taking into account the whole clinical context. Situations in which AED measurements are most likely to be of benefit include (1) when a person has attained the desired clinical outcome, to establish an individual therapeutic concentration which can be used at subsequent times to assess potential causes for a change in drug response; (2) as an aid in the diagnosis of clinical toxicity; (3) to assess compliance, particularly in patients with uncontrolled seizures or breakthrough seizures; (4) to guide dosage adjustment in situations associated with increased pharmacokinetic variability (e.g., children, the elderly, patients with associated diseases, drug formulation changes); (5) when a potentially important pharmacokinetic change is anticipated (e.g., in pregnancy, or when an interacting drug is added or removed); (6) to guide dose adjustments for AEDs with dose-dependent pharmacokinetics, particularly phenytoin. [ABSTRACT FROM AUTHOR]

The hip fracture causes significant disabilities in many elderly people. Many studies around the world have identified various risk factors for the hip fracture. The aim of this study was to systematically investigate the risk factors of hip fractures. This study is a systematic review of risk factors for hip fractures. All published papers in English and Persian languages on patients in Iran and other countries between 2002 - 2022 were examined. The search strategy used keywords matching the mesh, including : predictors, hip fracture, and disability. Articles were selected from international databases (PubMed, Proquest,Web of Sience, Scopus, Google scholar and Persian(Sid,Magiran), and the Newcastle Ottawa Scale was used to assess the risk of bias. The study has identified several factors that were significantly correlated with the risk of hip fracture, including age, cigarette and alcohol consumption, visual and hearing problems, low BMI levels, history of falling, weakness, and diseases such as stroke, cardiovascular disease, high blood pressure, arthritis, diabetes, dementia, Alzheimer's, Parkinson's, liver and kidney diseases, bone density, osteoporosis, vertebral fracture, and hyperthyroidism. However, the study did not find any significant correlations between the consumption of calcium and vitamin D, history of fractures, cognitive disorders, schizophrenia, and household income, and the risk of hip fracture. The results of this study reveal the determining role of some risk factors in hip fracture in older persons. Therefore, it is recommended that health policy makers provide the possibility of early intervention for some changeable factors. [ABSTRACT FROM AUTHOR]

Aims: To describe the development and report the first‐stage validation of a digital version of the digit symbol substitution test (DSST), for assessment of cognitive function in older people with diabetes. Materials and Methods: A multidisciplinary team of experts was convened to conceptualize and build a digital version of the DSST and develop a machine‐learning (ML) algorithm to analyse the inputs. One hundred individuals with type 2 diabetes (aged ≥ 60 years) were invited to participate in a one‐time meeting in which both the digital and the pencil‐and‐paper (P&P) versions of the DSST were administered. Information pertaining to demographics, laboratory measurements, and diabetes indices was collected. The correlation between the digital and P&P versions of the test was determined. Additionally, as part of the validation process, the performance of the digital version in people with and without known risk factors for cognitive impairment was analysed. Results: The ML model yielded an overall accuracy of 89.1%. A strong correlation was found between the P&P and digital versions (r = 0.76, p < 0.001) of the DSST, as well as between the ML model and the manual reading of the digital DSST (r = 0.99, p < 0.001). Conclusions: This study describes the development of and provides first‐stage validation data for a newly developed digital cognitive assessment tool that may be used for screening and surveillance of cognitive function in older people with diabetes. More studies are needed to further validate this tool, especially when self‐administered and in different clinical settings. [ABSTRACT FROM AUTHOR]

Dementia is a highly prevalent condition with devastating clinical and socioeconomic sequela. It is expected to triple in prevalence by 2050. No treatment is currently known to be effective. Symptomatic late-onset dementia and predementia (SLODP) affects 95% of patients with the syndrome. In contrast to trials of pharmacological prevention, no treatment is suggested to remediate or cure these symptomatic patients. SLODP but not young onset dementia is intensely associated with multimorbidity (MUM), including brain-perturbating conditions (BPCs). Recent studies showed that MUM/BPCs have a major role in the pathogenesis of SLODP. Fortunately, most MUM/BPCs are medically treatable, and thus, their treatment may modify and improve SLODP, relieving suffering and reducing its clinical and socioeconomic threats. Regrettably, the complex system features of SLODP impede the diagnosis and treatment of the potentially remediable conditions (PRCs) associated with them, mainly due to failure of pattern recognition and a flawed diagnostic workup. We suggest incorporating two SLODP-specific conceptual themes into the diagnostic workup: MUM/BPC and multilevel phenomenological themes. By doing so, we were able to improve the diagnostic accuracy of SLODP components and optimize detecting and favorably treating PRCs. These revolutionary concepts and their implications for remediability and other parameters are discussed in the paper. [ABSTRACT FROM AUTHOR]

This comprehensive review paper is based on an extensive analysis of 33 articles published in various reputable research journals. These articles present the most recent empirical evidence on the association between well-being and ageing under the treatment methods. The research was conducted by surfing search engines and databases, including Scopus, PubMed Central, Google Scholar, ProQuest, and Jstor. The article was themed according to the mental health, quality of life, activities of daily living, cognitive decline, social interaction, and social support of Parkinson's patients. [ABSTRACT FROM AUTHOR]

Mild cognitive impairment impacts a sizable segment of the older population, and often evolves into dementia within a few years. At this stage, subjects may benefit from non-pharmacological therapies that can delay or stop the progression of the mild cognitive impairment into dementia and are crucial for improvement in the subject's quality of life, while also being easily accessible and safe for use. Many research studies have shown that a variety of exercises, including cognitive training, have the potential to enhance or optimize cognitive function and general well-being. Recently, many authors have suggested video games as a promising approach for cognitive training and neurorehabilitation in older people, thanks to their increasing motivation and training effects through immersion in stimulating environments. Under this premise, our narrative review's objective is to discuss and summarize the body of existing material on the role of video games in improving cognitive performance, daily life activities, and depression symptoms in older individuals with different levels of cognitive decline. From the papers reviewed, it emerged that older subjects trained with video games showed a significant improvement in cognitive functions, sleep quality, and psychiatric symptoms, positioning video games as an intriguing and useful tool. [ABSTRACT FROM AUTHOR]

Alongside a marked increase in the population of older New Zealanders has been an increase in tooth retention: more and more older adults now have at least some of their own teeth. Understanding their oral health demands consideration of their journey along the life course. The common clinical oral conditions – dental caries ('tooth decay') and periodontitis ('gum disease') – are both chronic and cumulative, and highly socially patterned in their occurrence, being more prevalent and severe in those of lower socio-economic position. Those who have ended up with 'good oral health' in old age are those who have had the wherewithal to adapt successfully to their oral disease burden as it has accumulated over the years. In this paper, I consider the utility of the life course approach for interpreting and understanding data, and I apply its principles to a number of important observations on older people's oral health. [ABSTRACT FROM AUTHOR]

An elderly person is someone who has reached the age of 60 years and over, men or women who have decreased ability to adapt and are unable to meet their own daily needs. The elderly have the potential to experience anemia due to changes in the characteristics of the elderly, comorbidities, decreased nutritional absorption. Anemia is a condition where the levels of hemoglobin (Hb) or red blood cells (erythrocytes) decrease. Hemoglobin acts as a transporter of oxygen (O2) from the lungs throughout the body and exchanges it with carbohydrate dioxide (CO2) from the tissues to be excreted through the lungs. Iron (Fe) is needed in hemopoesis (blood formation), namely in the synthesis of hemoglobin. This study aims to look at the relationship between iron (serum iron) and hemoglobin levels as a potential for iron deficiency anemia in the elderly in Taman District, District. Sidoarjo. This scientific paper research uses primary data, descriptive analytical observational methods. The number of respondents was 25 people. This research uses the Pearson correlation test to see the level of relationship between SI and Hb. Conclusion: The results of the study show that there is a strong relationship between SI and Hb with p=0.000 and r=0.649. The average hemoglobin level was 10.52 g/dl with normal results of 12% and low results of 88%. The average serum iron value was 91.68 µg/dl with normal results of 92% and low 8%. Elderly people with low hemoglobin levels do not necessarily have low serum iron. Low Hb values without being influenced by a decrease in SI can be caused by deficiencies of other nutrients and chronic diseases (inflammation). [ABSTRACT FROM AUTHOR]

A total of 110 patients, aged 64 years or over, with de novo acute myeloid leukaemia (AML) and white blood cell counts <50 × 109/l were treated with 3 d of cytarabine 1 g/m2 twice daily, mitoxantrone 12 mg/m2 and etoposide 200 mg/m2, randomized with or without the addition of granulocyte-macrophage colony-stimulating factor (GM-CSF) 200 μg/m2. The primary aim was to evaluate the effect of GM-CSF on the remission rate. Secondary aims included comparison of duration of remission, survival and infectious complications and the impact of maintenance therapy with thioguanine. Complete remission (CR) was achieved by 64% of patients without GM-CSF, and by 65% of patients who received GM-CSF, the median remission duration was 13 vs. 6 months, the median overall survival (OS) was 14 vs. 9 months, the mean time to neutrophil recovery was 25 vs. 17 d ( P = 0·03) and the number of positive blood cultures was 46 vs. 39 ( P = 0·05) respectively. The impact of thioguanine remains unanswered since only 30 patients remained in CR after consolidation therapy. We conclude that induction therapy is feasible with acceptable toxicity in elderly patients with AML, albeit with a high relapse rate and short OS. GM-CSF prior to, and in combination with, induction treatment reduced the time to neutrophil recovery and the number of neutropenic septicaemia cases but did not improve the OS of AML in the elderly. [ABSTRACT FROM AUTHOR]

A quadripartite concept, the Good Life for older people, was developed by the American psychologist M. P. Lawton and forms the theoretical framework of this study. Ninety Swedish and 93 Polish subjects, aged ≥ 60 years who had reported locomotor disturbances in selected samples from the two countries, took part in the study. Interviews were performed using the Philadelphia Geriatric Center Multilevel Assessment Instrument (PGCMAI) and functional testing was done using the Standardized Practical Equipment (SPE). The Polish elderly scored lower in most domains of the PGCMAI, which meant a worse life situation according to the Good Life model. On the SPE, scoring was lower in the Polish group, mainly on items related to balance and mobility. There was a logic convergent validity between the PGCMAI and the SPE in the whole group. The somewhat more complicated life situation for the Polish elderly has to be further analysed. [ABSTRACT FROM AUTHOR]

In this consensus paper, the Belgian Bone Club aims to provide a state of the art on the epidemiology, diagnosis, and management of osteoporosis in frail individuals, including patients with anorexia nervosa, patients on dialysis, cancer patients, persons with sarcopenia, and the oldest old. All these conditions may indeed induce bone loss that is superimposed on physiological bone loss and often remains under-recognized and under-treated. This is of particular concern because of the major burden of osteoporotic fractures in terms of morbidity, mortality, and economic cost. Therefore, there is an urgent need to appreciate bone loss associated with these conditions, as this may improve diagnosis and management of bone loss and fracture risk in clinical practice. [ABSTRACT FROM AUTHOR]

Multidisciplinary management of worsening heart failure (HF) in the elderly improves survival. To ensure patients have access to adequate care, the current HF and French health authority guidelines advise establishing a clearly defined HF patient pathway. This pathway involves coordinating multiple disciplines to manage decompensating HF. Yet, recent registry data indicate that insufficient numbers of patients receive specialised cardiology care, which increases the risk of rehospitalisation and mortality. The patient pathway in France involves three key stages: presentation with decompensated HF, stabilisation within a hospital setting and transitional care back out into the community. In each of these three phases, HF diagnosis, severity and precipitating factors need to be promptly identified and managed. This is particularly pertinent in older, frail patients who may present with atypical symptoms or coexisting comorbidities and for whom geriatric evaluation may be needed or specific geriatric syndrome management implemented. In the transition phase, multi-professional post-discharge management must be coordinated with community health care professionals. When the patient is discharged, HF medication must be optimised, and patients educated about self-care and monitoring symptoms. This review provides practical guidance to clinicians managing worsening HF in the elderly. [ABSTRACT FROM AUTHOR]

Along with the degree of population ageing, the proportion of the elderly is increasing in patients with type 2 diabetes mellitus ( T2DM) year by year. Elderly patients with T2DM are prone to drug-related problems (DRPs) due to complications or comorbidities, a large and complex number of medications, and low medication compliance, which poses a severe challenge to medication management in the elderly with T2DM. Drug Therapy Management (MTM) is a kind of pharmaceutical care project, which is widely used in many countries in the treatment of chronic diseases. The core mission of MTM is to promote the correct use of medicines by patients, prevent medication errors, enhance the effectiveness of treatment, and reduce the waste of healthcare costs. This paper introduces MTM and DRPs in the elderly with T2DM, then summarizes and evaluates the construction and application of MTM service system in the elderly with T2DM, which probably provides suggestions and references for the development of MTM service in the elderly with chronic diseases in China. [ABSTRACT FROM AUTHOR]

Background. Kyphosis is a prevalent condition in older women that can significantly impact their mobility. Various therapeutic approaches and modalities can be used to treat hyperkyphosis. Cervicothoracic fascia stretching reduces kyphotic angle, decreases cervical pain, and improves various dimensions of thoracic mobility. Purpose of the study. The aim of this study is to evaluate the effect of the cervicothoracic fascia stretch on the thoracic mobility of older women. Subjects and methods. Sixty older women with non-specific neck discomfort, whose ages ranged from 60 to 70, were recruited from the outpatient clinics at Heliopolis University. The recruited patients were randomly divided into two groups of equal numbers of subjects: Group A included 30 patients who underwent cervicothoracic fascia stretching, and 30 patients were included in Group B who underwent diaphragmatic breathing exercises three times a week for four weeks. The neck pain was assessed utilizing the Neck Pain and Disability Scale (NPAD), while thoracic kyphosis was assessed utilizing a flexion curve ruler. Moreover, thoracic circumference excursion was measured using tape, while transverse and latero-lateral dimensions of the thorax were assessed using a chest depth caliper. Results. The comparison between pre- and post-study results showed a significant enhancement in all measured variables, including neck pain, thoracic circumference, chest width dimension, chest depth dimension, and kyphotic angle in both groups. Our findings indicated a statistically significant decrease in neck pain and kyphotic angle. Conversely, there was a statistically significant increase in thoracic circumference and chest width dimension for the cervicothoracic stretch group after treatment. Conclusions. Both interventions, such as intrathoracic fascia stretch and diaphragmatic breathing exercises exhibited extraordinary effectiveness in the management of reduced thoracic mobility and neck pain in older women with better results in favor of cervicothoracic stretch. [ABSTRACT FROM AUTHOR]

Exploring the adoption intention of smart senior care services can help improve the actual adoption rate. Taking a questionnaire survey of 1600 households in Anhui Province as an example, structural equation modeling was used to study the adoption intention and influencing factors of smart senior care services. The results show that subjective norms, perceived usefulness and perceived ease of use are the key factors influencing the adoption intention of smart senior care services. Further, age has an impact on perceived usefulness and adoption intention, education has an impact on perceived ease of use and adoption intention, and monthly household income has an impact on perceived usefulness and adoption intention. This paper broadens the existing technology acceptance model (TAM) theory and provides some basis for the development of economics. The findings will be beneficial to the government in formulating more precise policies on elderly services to properly address the challenges of aging. [ABSTRACT FROM AUTHOR]

Respiratory syncytial virus (RSV) is increasingly recognized as being implicated in acute illness in older adults, with a significant weight in hospitalizations for respiratory illness and death. By means of a best-evidence review, this paper aims to investigate whether RSV can be considered a forgotten pathogen in older patients, looking at trends in the literature volume and exploring possible epidemiological and clinical features underlying the focus given to it. We then present an assessment of its disease burden and present and future strategies for its reduction, particularly in light of the recent availability of new vaccines. [ABSTRACT FROM AUTHOR]

A tablet app, based on the Pain Assessment Checklist for Seniors with Limited Ability to Communicate-II (PACSLAC-II), has been shown to have clinical utility and unique advantages. We aimed to replicate and extend the previous validation of the app through the implementation and evaluation of a new community platform involving a quality indicator (QI) monitoring feature and a resource community portal (CP) that work in conjunction with an updated version of the app. We employed a mixed-methods multiple-baseline design across 11 long-term care (LTC) units. Units were randomly assigned to conditions which varied in number of app features available. Data included unit-level QIs as well as questionnaires and semi-structured interviews with health professionals. Following use of the app, we found improvements in unit-level QIs regardless of availability of the QI/CP features. During interviews, participants expressed a preference for the app over a paper version of the PACSLAC-II due to reasons such as the app's ability to summarize information. Utilization of the community portal websites was unrelated to staff questionnaire-assessed stress/burnout. Despite the positive effects on the care of residents, the COVID-19 pandemic presented challenges and interfered with the long-term maintenance of the QI results. [ABSTRACT FROM AUTHOR]

Background: There is limited research on the experiences of access to medicines for non-communicable diseases (NCDs) in health facilities among older persons in Uganda. This paper explores the perspectives of older persons and healthcare providers concerning older persons' access to essential medicines in Uganda. Methods: It is based on qualitative data from three districts of Hoima, Kiboga, and Busia in Uganda. Data collection methods included seven (07) focus group discussions (FGDs) and eighteen (18) in-depth interviews with older persons. Nine (9) key informant interviews with healthcare providers were conducted. Deductive and inductive thematic analysis (using Health Access Livelihood Framework) was used to analyze the barriers and facilitators of access to healthcare using QSR International NVivo software. Results: The key facilitators and barriers to access to healthcare included both health system and individual-level factors. The facilitators of access to essential medicines included family or social support, earning some income or Social Assistance Grants for Empowerment (SAGE) money, and knowing a healthcare provider at a health facility. The health system barriers included the unavailability of specialized personnel, equipment, and essential medicines for non-communicable diseases, frequent stock-outs, financial challenges, long waiting times, high costs for medicines for NCDs, and long distances to health facilities. Conclusion: Access to essential medicines for NCDs is a critical challenge for older persons in Uganda. The Ministry of Health should make essential drugs for NCDS to be readily available and train geriatricians to provide specialized healthcare for older persons to reduce health inequities in old age. Social support systems need to be strengthened to enable older persons to access healthcare. [ABSTRACT FROM AUTHOR]

The current study aimed to explore the protective factors and underlying mechanisms associated with loneliness and psychological distress among older Chinese adults within the framework of a longitudinal design. This investigation specifically focused on the mediating role of attitudes toward own aging (ATOA) in the relationship between social support and the experience of loneliness and psychological distress (comprising depression, anxiety, and stress) amidst the backdrop of the COVID-19 pandemic. A cohort of 345 elderly individuals (mean age = 83.84 years, standard deviation = 8.49 years; 55.1% females) participated in this research endeavor. The participants were required to complete self-report instruments measuring their perceived levels of social support at Time 1 (T1), attitudes towards own aging, ATOA at Time 2 (T2), and their experiences of loneliness, and psychological distress (including depression, anxiety, and stress) at T1 and Time 3 (T3). The data collection timeline encompassed baseline data collection at T1 in September 2020, a subsequent six-month follow-up at T2 in March 2021, and a one-year follow up at T3 in September 2021. The findings of this investigation unveiled a negative predictive relationship between social support at T1 and psychological distress (encompassing depression, anxiety, and stress) at T3. Furthermore, it was discerned that ATOA at T2 acted as a mediating mechanism, elucidating the longitudinal association between social support at T1 and the manifestation of loneliness and psychological distress (including depression, anxiety, and stress) at T3. The discussion section of this paper delves into an exploration of the limitations and implications inherent in these conclusions, particularly concerning their relevance to potential intervention strategies. [ABSTRACT FROM AUTHOR]

Background: Older people living in long-term care facilities represent a particularly vulnerable segment of the population, who disproportionately bear the burden of infectious diseases, as recently highlighted by the COVID-19 pandemic. Summary: Older long-term care residents typically cumulate several risk factors for infection and experience serious life-threatening outcomes once infected. These common infections are often compounded by the collective living environment, where it is more difficult to contain the spread of infection. Moreover, the staff may represent an additional reservoir of potential infection and mode of transmission. In this paper, we review the burden of infectious respiratory diseases in residents in long-term care and discuss the potential gains from higher vaccine coverage in this older and most vulnerable population but also from higher vaccine coverage among the facility staff. We highlight the compelling need to integrate specific vaccine recommendations for residents of long-term care into national vaccination schedules, as well as the need to include vaccination campaigns in routine protocols for infection control. Surveillance, reporting, hygiene, and individual protective measures remain key aspects in basic infection control, both in ordinary times and during epidemics. Key Message: Vaccination of residents in long-term care facilities against respiratory diseases including influenza, pneumococcal disease, pertussis, and COVID is a simple, inexpensive, and effective means to reduce the burden of infection in this segment of the population. [ABSTRACT FROM AUTHOR]