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We aimed to investigate the effects of dual- and single-task training in older adults with age-related hearing loss. Intervention groups included single-, dual-task training, and control groups. The dual- and single-task trainings were held 2 days a week for 40 min for a total of 10 sessions for 5 weeks. We evaluated physical, cognitive, and auditory functions, quality-of-life, balance, concerns about falling, independence in activities of daily living, and dual-task performance. A total of 42 patients fully participated in this study. Statistically significant differences were observed in chair stand, chair sit-and-reach, global cognitive function, and delayed recall between the intervention groups and control group (p <.05). There was no statistically significant difference in quality-of-life, balance, falling concerns, independence in activities of daily living, and dual-task performance between all groups (p >.05). In conclusion, single- and dual-task training had a positive effect on physical and cognitive functioning in older adults with age-related hearing loss. [ABSTRACT FROM AUTHOR]

The aim of this systematic review, meta-analysis, and meta-regression was to examine the effects of virtual reality–based training on global cognition and executive function compared with conventional training or information-based treatment in older adults, regardless of cognitive level. A systematic literature search was conducted using four databases. A total of 31 randomized controlled trials were identified. Pooled effect sizes were calculated, the risk of bias was assessed, and evidence was graded. The primary analyses showed a small but statistically significant effect of virtual reality–based training compared with control on global cognition (Hedges' g 0.42, 95% confidence interval [0.17, 0.68], I2 = 70.1%, n = 876, 20 randomized controlled trials, low evidence) and executive function (Hedges' g 0.35, 95% confidence interval [0.06, 0.65], I2 = 68.4%, n = 810, 16 randomized controlled trials, very low evidence). Meta-regression yielded inconclusive results. Virtual reality–based training may be more effective than control in improving cognition in older adults; however, more high-quality studies are needed. [ABSTRACT FROM AUTHOR]

Knowledge of how the different types of sedentary behaviors (SB) are associated with functional limitations can guide professionals who work with older adults on better recommendations about the amount of daily time that should be encouraged in each type of SB. The objective was to estimate the associations between two SB typologies (SB television [TV] and SB computer/internet) and the presence of handgrip strength, lower limb strength, gait speed, and balance limitations in Brazilian community-dwelling older adults. This is a cross-sectional study with 1,298 community-dwelling older adults (≥60 years). SB was assessed by self-reporting daily time spent watching TV or using computer/internet (categorized into <2, 3–4, and ≥5 hr/day). Outcomes were handgrip strength, lower limb strength, gait speed, and balance limitations considering referenced cutoff points. Older adults in SB TV ≥5 hr/day had 1.75 (95% confidence interval [CI] [1.07, 2.86]) and 1.88 (95% CI [1.02, 3.46]) times more chances of handgrip strength and gait speed limitations, respectively. On the other hand, those who spent 3–4 and ≥5 hr/day in SB computer/internet had 0.45 (95% CI [0.20, 0.99]) and 0.37 (95% CI [0.15, 0.93]) had less chances of lower limb strength and balance limitations, respectively. In conclusion, functional limitations would be associated differently depending on the type of SB in the older adults sampled. [ABSTRACT FROM AUTHOR]

Background: Clinical practice suggests that older adults (i.e., ≥ 65 years of age) experience adverse drug reactions (ADRs) more often than younger patients (i.e., < 65 years of age). ADRs such as falls, extrapyramidal symptoms (EPS), metabolic disorders, sedation, and delirium are particularly worrisome and often associated with psychotropic drugs. Methods: This observational study investigated the risk for psychotropic drug-related ADRs in older (n = 99,099) and younger adults (n = 363,562) in psychiatric inpatients using data from the German pharmacovigilance program "Arzneimittelsicherheit in der Psychiatrie" (AMSP) from 1993–2016. The aim was to assess whether age influenced the risk of specific ADR types and if certain psychotropic drugs posed particular concerns. Results: The risk for ADRs did not differ between older and younger patients (relative risk 0.98, 95% confidence interval 0.92–1.05). However, older patients had a higher risk for delirium (2.35, 1.85–2.99), hyponatremia (3.74, 2.85–4.90), and orthostatic syncope (2.37, 1.72–3.26), as well as certain types of EPS, e.g., parkinsonism (1.89, 1.45–2.48) and Pisa-/metronome syndrome (3.61, 2.51–5.18). The risk for other ADRs, such as acute dystonia (0.20, 0.10–0.37), akathisia (0.47, 0.29–0.76), liver dysfunction (0.63, 0.48–0.82), weight gain (0.07, 0.04–0.14), sexual dysfunction (0.03, CI 0.00–0.25), and hyperprolactinemia/galactorrhea (0.05, 0.02–0.17) was significantly lower for older patients. Older patients treated with any type of antidepressant drug (1.33, 1.26–1.40)—especially selective serotonin reuptake inhibitors (1.57, 1.26–1.40) and selective serotonin-norepinephrine reuptake inhibitors (2.03, 1.80–2.29)—and lithium (1.74, 1.52–2.00) had a higher ADR risk than younger patients. Second-generation antipsychotic drugs had a lower (0.74, 0.71–0.77) and low-potency first-generation antipsychotic drugs a higher (1.19, 1.07–1.33) ADR risk in older patients. The risk for ADRs involving multiple drugs was higher in older patients (1.28, 1.22–1.34). ADRs in older patients were 6.4 times more likely to result in death. Conclusions: Clinicians and pharmacists should be aware of the types of ADRs and high-risk drugs across age groups and provide appropriate monitoring. Pharmacovigilance is crucial in psychiatric patients of all ages and should not be neglected, even for drugs generally considered "safe". [ABSTRACT FROM AUTHOR]

Background: The increased life expectancy and prevalence of spondylarthrosis have led to a growing frequency of spinal surgery in older people. This study aims to assess whether there is an excess mortality concerning that expected in the general population associated with surgical procedures performed in patients over 65 years old for a degenerative disease of the lumbar spine. Methods: All patients aged 65 years or older undergoing surgery at a single center between 2009 and 2019 for lumbar spine degenerative disease were included. Standardized mortality ratios (SMRs) were estimated to compare the mortality risk with the expected in the Spanish population for the same age, gender, and calendar-period. Multivariable Cox analysis was employed to determine risk factors of mortality. Results: A total of 411 procedures were analyzed. The mean age was 72.6 years old. SMR was 0.67 (CI 95% 0.54–0.84). That benefit was significant in women after gender stratification. Patients operated on between 65–84 years old had a lower mortality rate than that expected for the general population. For patients aged 85 or older, the observed mortality was not different from that expected in the general population. Multivariable Cox analysis observed an association between higher mortality and the variables age, male, and Charlson comorbidity index score. Conclusions: Compared with the general population, patients over 65 years old who underwent spinal surgery for degenerative disease of the lumbar spine experienced a reduction in mortality. This effect was particularly significant in women and patients aged 65–84 years. Age, male gender, and Charlson comorbidity index score were associated with higher mortality risk. [ABSTRACT FROM AUTHOR]

Background and purpose: Fear of falling and low physical activity become prevalent in an aged society, but their association with fall risk warrants further investigation. Methods: Our study involved 600 individuals aged 70.8–96.1 years who completed two rounds of community surveys. During the second survey, we analyzed the correlations between fall incidents and a range of factors, including age, sex, gait maneuverability, vision, comorbidity count, depressive symptoms, cognitive function, history of falls, fear of falling, and physical activity level. The chi-square test and univariate and multivariate logistic regression models were used, with further analyses either adjusted for or stratified by the full-factor combinations of fear of falling (with versus without) and low physical activity (low versus moderate-to-high). Results: Falls exhibited a prevalence rate of 13.8%. A fall risk gradient by the full-factor combinations was observed. Multivariate logistic regression modeling identified independent risk predictors for falls, including the number of comorbidities, depressive symptoms, a history of falls, and fear of falling. Fear of falling and low physical activity presented a synergistic effect to increase the fall risk by two- and one-third times (adjusted odds ratio: 2.35, 95% confidence interval: 1.12–4.91). Depressive symptoms, cognitive impairment, and a history of falls remained as significant risk predictors for older adults with both factors, those with fear of falling only, and those with neither, respectively, when the models were further stratified. Conclusion: Fear of falling and low physical activity presented likely synergism to increase the fall risk. Those older community-dwellers with both risk factors warrant fall prevention resources as a priority over those with either or neither. [ABSTRACT FROM AUTHOR]

Background: There is skepticism about the benefit of surgery in elderly patients affected by traumatic brain injury (TBI) due to the negative effect of age on the outcome and surgical complications. However, there are few studies that have investigated differences in patient's outcome between surgically and conservatively managed patients after adjusting for the imbalance in preinjury characteristics and clinical and radiological features. The primary aim of this study was to evaluate the effect of early surgery on mortality and functional recovery in a cohort of older adults with acute traumatic intracranial lesions after adjustment by Propensity Score (PS) matching. Materials and methods: We conducted a retrospective cohort study on older adult patients (≥ 65 years) admitted for TBI between 2013 and 2023 to a single level 1 trauma center. Patients were categorized based on whether they underwent early surgery (< 48 h after TBI) for a space-occupying lesion evacuation. PS model was constructed based on age, frailty, comorbidities (Charlson comorbity index and American Society of Anaesthesiologists score), anticoagulants, hypoxia, shock, pupillary abnormalities and GCS motor response upon admission, midline shift, basal cistern effacement, volume of subdural and intracerebral hematomas, and limitation of life-sustaining treatment decisions.The effect of early surgery on 30-day mortality and unfavorable functional outcomes (GOSE 1–3) at 6 and 12 months were investigated after matching by paired test. Results: We identified and reviewed 301 patients who met all inclusion criteria and contained no exclusions. After matching, 62 patients (31 pairs of conservative and surgical patients) remained as the matched datasets. Our key finding was that older adult TBI patients who underwent early surgery had a statistically significant reduction in the risk of 30-day mortality (OR 0.313, 95% CI 0.114–0.853, p = 0.023) and unfaourable outcome at 12 months after TBI (OR 0.286, 95% CI 0.094–0.868, p = 0.027). Conclusions: Early surgery was associated with decreased 30-day mortality and better functional outcome at 12 months after TBI in older adults with few comorbidities and good functionality when clinically affected by acute traumatic intracranial lesions with mass effect. [ABSTRACT FROM AUTHOR]

Background: The ageing of the population is leading to an increase in the number of traumatic injuries and represents a major challenge for the future. Falls represent the leading cause of Emergency department admission in older people, with injuries ranging from minor to severe multiple injuries. Older injured patients are more likely to be undertriaged than younger patients. The aim of this study was to investigate the extent of undertriage in older patients with particular emphasis on access to trauma centres and resuscitation rooms. Methods: Retrospective observational cross-sectional study based on data prospectively collected from prehospital electronic records including all patients ≥ 18 years for whom an ambulance or helicopter was dispatched between 1 January 2018 and 31 April 2023 due to a trauma. The primary outcome, admission to the resuscitation room of the regional trauma centre with trauma team activation, was assessed by age. Multivariate logistic regression was used to control for known confounders and to test for plausible effect modifiers. Results: Emergency Medical Services treated 37,906 injured patients. Older patients ≥ 75 years represented 17,719 patients (47%). Admission to trauma centre with trauma team activation was lower in older patients, N = 121 (1%) compared to N = 599 (5%) in younger patients, p < 0.001; adjusted odds ratio: 0.33 (0.24–0.45); p < 0.001. Undertriage increased by twofold with age ≥ 75; OR: 1.81 (1.04–3.15); p value < 0.001. Undertriaged patients were older, more likely to be female, to have low energy trauma and to be located farther from the regional trauma centre. Conclusion: Older injured patients were at increased risk of undertriage and non-trauma team activation admission, especially if they were older, female, had head injury without altered consciousness and greater distance to regional trauma centre. [ABSTRACT FROM AUTHOR]

One dementia prevention strategy that is effective for older adults is frequent participation in leisure time physical activity. However, research gaps exist in our understanding of the longitudinal relationship between different levels of leisure time physical activity participation and the cognitive function of older adults with mild cognitive impairment. Thus, we investigated this relationship using Health and Retirement Study data from 2012 to 2020. Results from Repeated Measures Multivariate Analysis of Covariance indicated that both the mid (Mean Difference = −0.45) and high level (Mean Difference = −0.82) leisure time physical activity groups showed higher levels of memory function compared to the low-level leisure time physical activity group. Additionally, the mid (Mean Difference = −0.21) and high level (Mean Difference = −0.37) leisure time physical activity groups reported better working memory function, and the mid (Mean Difference = −0.02) and high level (Mean Difference = −0.02) leisure time physical activity groups showed higher levels of attention and processing speed than the low-level leisure time physical activity group. These findings suggest that older adults with mild cognitive impairment who engage either vigorously or moderately in leisure time physical activity (more than three times a week) experience improvements in cognitive function compared to those who do not. This study provides valuable insights for clinicians on the optimal level of leisure time physical activity required to mitigate cognitive decline in older adults with mild cognitive impairment. [ABSTRACT FROM AUTHOR]

Background and aim: Given the rapid technological advancements and increased usage of digital tools, understanding older people's attitudes toward technology is vital. Assessing their views can help identify barriers and facilitators to adoption. This understanding is essential for developing effective educational strategies and user-friendly technologies that enhance seniors' quality of life. Therefore, the present study aimed to psychometrically evaluate the scale for measuring attitudes—both willingness and anxiety—toward technology (TechPH) in Iranian older adults. Methods: This methodological study was conducted on 420 older individuals (aged 60 and above) in Tehran in 2024 to perform a psychometric test of the attitudes toward technology scale (TechPH). Validation was carried out using translation validity methods, including translation-back translation with bilingual experts (n = 2), face validity with a sample of the older population (n = 10), content validity with a panel of 11 experts, and construct validity through Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) (n = 420). Instrument reliability was determined through test–retest and internal consistency (Cronbach's alpha) methods with a sample of older individuals (n = 30). Data analysis was performed using SPSS version 16 and EQS 6.4 software. Results: A comparison of Persian and English translations revealed acceptable translation validity and cultural adaptability for the scale. Each item's Content Validity Index (CVI) and Content Validity Ratio (CVR) were determined, with a total average CVI of 0.95. The results of EFA indicated that the sample size was adequate, as shown by the KMO value of 0.754. Additionally, Bartlett's sphericity test demonstrated a significant correlation between the items (χ2 = 221.819, df = 15, P < 0.0001). EFA revealed that two extracted factors explained 41.002% and 18.111% of the total variance. Furthermore, CFA yielded suitable estimates based on the general fit indices of the model (RMSEA = 0.061, IFI = 0.979, GFI = 0.983, CFI = 0.978, CMIN/DF = 1.769, MFI = 0.989, AGFI = 0.942). In evaluating test–retest stability and internal consistency, the values of the Intra-class Correlation Coefficient (ICC) and Cronbach's α were 0.85 and 0.77, respectively, indicating appropriate reliability for the scale. Conclusion: P.TechPH, the first Persian version of the scale for measuring technophilia and technophobia among Iranian older people, has favorable psychometric properties. It can serve as a standard tool for assessing older people's attitudes toward technology in various studies. [ABSTRACT FROM AUTHOR]

Background: This study aims to evaluate the impact of Quebec's first hospital-at-home-inspired mobile Seniors' Clinic, the "Clinique des Ainés (CDA)", on frail older adults' returns to the Emergency Department (ED), mortality, and hospital Length Of Stay (LOS) and rehospitalizations. Methods: Design: Quasi-experimental pre-post implementation cohort study. Population: Patients aged ≥ 75 years admitted to the short-term geriatric unit after an ED consultation (control) or included by the CDA (intervention). Outcomes: return to ED (RtoED), mortality, ED & hospital LOS, and rehospitalizations. Statistical analyses: Multivariable regression modelling. Results: Overall, 891 patients were included. At the intervention site (CDA) (n = 437), RtoED were similar at 30 (17.5% & 19.5%, p = 0.58), 90 (34.4% & 37.3%, p = 0.46) and 180 days (47.2% & 54.0%, p = 0.07) in the pre and post-implementation phases. No mortality differences were found. The hospitalization LOS was significantly shorter (28.26 and 14.22 days, p < 0.01). At 90 days, rehospitalization LOS was decreased by 8.51 days (p = 0.02) and by 6.48 days at 180 days (p = 0.03). Compared to the control site (n = 454) in the post-implementation phase, RtoED was 54% at the intervention site compared to 44.1% (p = 0.02) at 180 days. The CDA had a lower adjusted probability of mortality at 90 days compared to the control site (4.8% VS 11.7%, p = 0.03). No rehospitalization LOS differences were noted. Conclusions: The Clinique des Ainés showed effectiveness in caring for frail older patients in their homes by decreasing their hospital LOS by half and 90 days mortality risk. It was a safe care trajectory without a clinically significant increase in ED returns or mortality. [ABSTRACT FROM AUTHOR]

Background: Age and sex differences in sarcopenic dysphagia are unknown. The purpose is to characterize age and sex differences in sarcopenic dysphagia. Methods: A cross‐sectional and retrospective cohort study using information from the Japanese database on sarcopenic dysphagia was performed. We investigated age and sex differences between sarcopenic dysphagia and other forms of dysphagia. We investigated whether differences in prognosis for swallowing function, as assessed by the Food Intake Level Scale, and activities of daily living (ADL), as assessed by the Barthel Index were influenced by age and sex in patients with sarcopenic dysphagia. Results: The study included 460 patients, including 229 men and 231 women, with a mean age of 81 ± 10 years. Fifty‐eight percent of the patients had sarcopenic dysphagia. Age was independently associated with sarcopenic dysphagia (odds ratio (OR): 1.056, 95% confidence interval (CI): 1.035, 1.078), although sarcopenic dysphagia could also be seen in those younger than 65 years. Sex was not independently associated with sarcopenic dysphagia. The age cut‐off for the diagnosis of sarcopenic dysphagia was 82 years in all patients (sensitivity, 0.660; specificity, 0.644), 80 years in men (sensitivity, 0.619; specificity, 0.631), and 83 years in women (sensitivity, 0.723; specificity, 0.577). Sarcopenic dysphagia showed no significant differences in the improvement of swallowing function and ADL based on age and sex. Conclusions: Sarcopenic dysphagia was most common in older adults in their 80s or older. The possibility of sarcopenic dysphagia should be considered when dysphagia is present in people 80 years of age or older. [ABSTRACT FROM AUTHOR]

Plant‐based diets reduces the risk of chronic conditions. The interaction between protein source and other macronutrients—fat (F) and carbohydrate (C)—has yet to be investigated. The aim was to assess the main and interactive effects of protein‐source (plant vs. animal) and F:C (high or low) and the transition from an Australian diet to a whole food diet on various health markers in older individuals. This single‐blinded, parallel, randomised experimental trial used a 2 × 2 factorial design to compare pro‐vegetarian (70:30 plant to animal) versus omnivorous (50:50 plant to animal) diets at 14% protein and varying fat‐to‐carbohydrate ratios (high fat ~40% vs. low fat ~30%) over 4 weeks. Study foods were provided, alcohol consumption was discouraged, and dietary intake was determined through food records. Analysis included both RCT and observational data. Changes in appetite, palatability of diets, and dietary intake were assessed. Body composition, muscle strength, function, gut microbiome, and cardiometabolic health parameters were measured. Data from 113 (of the 128 randomised) individuals aged 65–75 years were analysed. Pro‐vegetarian diets reduced diastolic blood pressure, total cholesterol and glucose levels. Moreover, the overall sample exhibited increased short‐chain fatty acids and FGF21 levels, as well as improvements in body composition, function, and cardio‐metabolic parameters irrespective of dietary treatment. Transitioning to a diet rich in fruit, vegetables, fibre, and moderate protein was associated with improved health markers in older age, with added benefits from pro‐vegetarian diets. Further research on long‐term effects is needed. [ABSTRACT FROM AUTHOR]

Purpose: This scoping review was conducted to understand the barriers, facilitators, and education and training needs of rehabilitation clinicians in their use of mainstream wireless technologies (MWT) to support people with disabilities and older adults. It was also conducted to understand the functional skills of clients that were targeted with MWT use. Materials and methods: This scoping review was reported using PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) and the Population (or Participants)/Concept/Context) framework. We searched PubMed; ProQuest to access APA PsycINFO; Web of Science Core Collection; and EBSCOhost to access Cumulated Index to Nursing and Allied Health Literature (CINAHL), Ovid MEDLINE ALL, and Education Resources Information Center (ERIC). Articles published between 2015–2022 were retrieved. Results: A total of 90 articles were included. Most interventions were apps, smartphones, and tablets; were geared toward adults; and targeted motor, cognitive and speech skills. An infographic on barriers and facilitators was generated as a decision support tool for clinicians when implementing MWT. The topic, format, timing, and source of information clinicians need are also delineated. Conclusion: MWT such as apps, smartphones and tablets are being used by rehabilitation clinicians to address motor, cognitive, and speech skills, most commonly in adults. Clinicians voice a need for more education and training. Barriers and facilitators exist at the clinician-, technology-, client-, institution-, and policy levels. IMPLICATIONS FOR REHABILITATION: A total of 90 articles from 2015–2022 were included in this scoping review Most interventions were apps, smartphones, and tablets; were geared toward adults; and targeted motor, cognitive and speech skills. An infographic was generated as a decision support tool for clinicians when implementing mainstream wireless technologies in clinical practice. Clinicians' education and training needs with regard to mainstream wireless technologies are broad. Materials on a variety of topics, in different formats, from multiple sources are needed. This review also discusses implications of findings on policy, technology development, and future research. [ABSTRACT FROM AUTHOR]

Background: Modern technologies are being applied to maintain and improve the functional performance of older adults. Fully immersive virtual reality (VR) combined with a scope of dual-task (DT) activities may effectively complement conventional physiotherapy programmes for seniors. The study aimed to compare the effectiveness of a fully immersive virtual reality (VR) environment combined with a scope of dual-task activities regarding balance in older women. Methods: Eighty women were recruited to the study protocol and, following randomisation, allocated to two equally sized groups, one pursuing conventional OTAGO exercises, the other one the VR-solutions-aided exercise programme combined with a scope of DT activities. Physiotherapy sessions spanned 6 weeks, each one lasting 60 min, three times a week, in both groups. Results: Homogeneity analysis of both study groups indicated no statistically significant differences at the first measurement point. After the intervention, both study groups achieved significantly improved scores on all tests. The VR + DT group obtained better results in dual-task gait and single-leg standing, whereas the greatest difference was observed during SLS CL (1.52 s vs. 2.33 s—difference 0.81 s 53.2% change, p = 0.001). The OTAGO group performed better in the TUG single-task gait (11.35 s vs. 12.60 s, p < 0.001) and in the Berg balance scale. Conclusions: The VR + DT training is effective in improving individual balance as well as in reducing fall risks. VR-assisted physiotherapy should complement conventional physiotherapy programmes (e.g., OTAGO). The benefits of applying VR solutions indicate that older women might well use this form of activity regularly under the guidance of a therapist or a family member. [ABSTRACT FROM AUTHOR]

Background/Objectives: Aging-related physical changes and dysfunctions in the autonomic nervous system (ANS) often lead to orthostatic hypotension (OH) in older adults. OH negatively impacts both the physical and psychological well-being of those affected. Previous studies have demonstrated that the biofeedback-based integrated program (BBIP), a multicomponent intervention focused on heart rate variability biofeedback, effectively improves OH, as well as symptoms related to ANS function. This substudy aims to examine the effects of the BBIP on psychological health outcomes among community-dwelling older adults with OH. Methods: This study employed a non-randomized controlled trial design with a convenience sampling strategy. A total of 51 older adults with OH were recruited from two senior welfare centers and randomly assigned to either the intervention group (n = 27) or the control group (n = 24). The intervention group participated in a 12-week BBIP, which included weekly biofeedback sessions and group education on lifestyle modification to alleviate OH. Telephone counseling was also provided to promote compliance. Results: The intervention group showed significant improvements in health-related quality of life, depression, anxiety, and fall efficacy after the 12-week BBIP, whereas the control group exhibited no significant changes. There was a significant reduction in the percentage of participants in the intervention group reporting problems in all five dimensions of the EQ-5D (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression). Conclusions: The BBIP was effective in improving the psychological health outcomes of older adults with OH. Future studies should explore the long-term effects of the BBIP using a larger sample size and a randomized controlled trial design. [ABSTRACT FROM AUTHOR]

The article discusses the need for a philosophical shift in the Australian residential aged care sector to better cater to the physical, social, and psychological needs of older people. It proposes reframing aged care as communities within social and ecological communities to move away from consumerist approaches. By recognizing residents as part of interconnected communities, the sector can address critical challenges identified by the Royal Commission and promote social and environmental justice. The article emphasizes the importance of relationships in shaping personhood and advocates for a holistic approach to care that considers the broader community and ecological impact. [Extracted from the article]

Background and Aims: The purpose of this study was to investigate the combined impact of variations in physical activity (PA) and sitting time (ST) on the risk of developing metabolic syndrome (MetS). Methods: This study was conducted on a cohort of adults from the general population, aged 40–69 years, who participated in the KOGES community-based cohort study over a span of 10 years. Changes in PA and ST were assessed using the results from PA questionnaires completed during baseline and follow-up surveys. The diagnosis of MetS was determined according to the criteria established by the International Diabetes Federation. To evaluate the combined effect of PA and ST changes on the incidence of MetS, we calculated hazard ratios and 95% confidence intervals using a Cox proportional hazards regression model. Result: The incidence of MetS was reduced by 39% (HR = 0.61, 95% CI = 0.46–0.82) for increased ST/increased PA and 26% (HR = 0.74, 95% CI = 0.58–0.94) for decreased ST/increased PA, compared with increased ST/decreased PA, respectively. In addition, this study confirmed that the combined impact of changes in PA and ST, based on the domain of PA, on the incidence of MetS varied. Conclusion: Changes in ST and PA are associated with the risk of developing MetS. These findings lay the groundwork for further research on the relationship between changes in PA, ST, and the occurrence of diseases. [ABSTRACT FROM AUTHOR]

Copyright of Chinese Mental Health Journal / Zhongguo Xinli Weisheng Zazhi is the property of Chinese Mental Health Journal and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Retos: Nuevas Perspectivas de Educación Física, Deporte y Recreación is the property of Federacion Espanola de Asociaciones de Docentes de Educacion Fisica and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Older adults are at risk of adverse drug events during transition of care from hospital to community, thus optimal communication about medications at discharge is essential. Standardization of medication discharge plan (MDP) is lacking. This study aimed to (1) create a standardized MDP for older adults using consensus‐based principles, (2) create a short‐version MDP and (3) generate a practical guide. Modified Delphi was used to establish consensus on guiding principles for the MDP. Additionally, participants were asked about guiding principles deemed most essential, patient prioritization, the format and mode of transmission of the MDP. Twenty‐six guiding principles reached consensus, with 17 prioritized for a short‐version MDP. The practical guide includes explanations of the guiding principles, criteria for patient selection and recommendations on the format and mode of transmission. The results of this study will assist implementation of MDPs when older adults are discharged from hospital. [ABSTRACT FROM AUTHOR]

Background: Despite health benefits, many older adults struggle to meet physical activity guidelines, leading to stagnant activity levels. While integrating physical activity into daily routines has been proposed as a promising strategy for older adults, fit‐for‐purpose measurement tools to assess such routines are lacking. The Checklist for Habitual Physical Activity (CHaPA) was developed based on the positive deviance approach and socio‐ecological model to assess daily behaviours encouraging physical activity among adults aged 75 and older. It has been confirmed for its content and face validity. However, to ensure its broader applicability and usefulness, assessing its construct validity and reliability is necessary. Therefore, this study aims to assess the construct validity and reliability of the CHaPA and accordingly update the tool. Methods: To validate the construct validity of the CHaPA 22‐item version, we conducted item analysis and exploratory and confirmatory factor analyses. We removed inappropriate items based on predefined criteria. Then, we assessed the reliability, internal consistency, test–retest reliability, and measurement errors of the CHaPA final version. Results: Item analyses and factor analyses resulted in the deletion of 11 items. The results of confirmatory factor analysis validated the CHaPA 11‐item version with the three‐factor structure based on model fit index with χ2/degree of freedom = 1.25, comparative fit index = 0.965, Tucker‐Lewis index = 0.952, and root‐mean‐square error of approximation = 0.038. Omega coefficient (0.90) showed excellent internal consistency. Intraclass correlation coefficient (ICC) demonstrated good test–retest reliability (ICC (1, 2) = 0.77, 95% CI = 0.34–0.89, standard error of measurement = 1.75). Conclusions: We finalised the CHaPA 11‐item version as a valid and reliable instrument for assessing daily behaviours conducive to physical activity among individuals aged 75 years and older. We need to examine the methods and effectiveness of disseminating this checklist to ensure its utilisation as a resource for promoting healthy ageing and aiding older adults in maintaining active lifestyles. [ABSTRACT FROM AUTHOR]

Copyright of Zeitschrift für Gerontologie und Geriatrie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Perioperative cognitive maintenance and protection in older adults is an important patient safety imperative. In addition to foundational care, one area of growing interest is integrating cognitive prehabilitation into the surgical trajectory. This review aimed to evaluate the effectiveness and safety of cognitive prehabilitation on cognitive functional capacity and postoperative cognitive outcomes among older adults undergoing elective surgery. Methods: The MEDLINE, Embase, CENTRAL, CINAHL, PsycINFO, PEDro, CBM, CNKI, WANFANG, and VIP databases were systematically searched up to September 5, 2024, to identify randomized controlled trials published for English or Chinese. Two authors independently completed the study selection process, data extraction process and methodological quality assessment. The Patient, Intervention, Comparison, Outcome, Study design framework was used to construct the search strategy. The predefined primary outcomes of interest included the incidence of postoperative delirium (POD) and the incidence of delayed neurocognitive recovery (dNCR). The quality of the studies was evaluated by the PEDro scale. Owing to the small number of trials and clinical and methodological diversity, a narrative synthesis was undertaken in accordance with the Synthesis Without Meta-analysis guidelines. This study was conducted and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement. The certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation system. Results: Six studies were analysed. These trials involved 645 total participants, with 316 in the intervention group (mean age, 66.0–73.8  years; 38.4–77.8% male) and 329 in the comparator group (mean age, 67.5–72.6  years; 31.8–88.9% male). The effects of preoperative cognitive training on reducing the incidence of dNCR, the incidence of POD, the length of hospital stay and the incidence of postsurgical complications as well as improving postoperative global cognitive function and activities of daily living are quite uncertain. The results of this study should be interpreted with caution owing to the limited number of trials and low to very low certainty of evidence. Conclusion: Current evidence on the effectiveness and safety of cognitive prehabilitation on cognitive and noncognitive outcomes in older patients undergoing elective surgery is limited and unclear. [ABSTRACT FROM AUTHOR]

Background: Perioperative cognitive maintenance and protection in older adults is an important patient safety imperative. In addition to foundational care, one area of growing interest is integrating cognitive prehabilitation into the surgical trajectory. This review aimed to evaluate the effectiveness and safety of cognitive prehabilitation on cognitive functional capacity and postoperative cognitive outcomes among older adults undergoing elective surgery. Methods: The MEDLINE, Embase, CENTRAL, CINAHL, PsycINFO, PEDro, CBM, CNKI, WANFANG, and VIP databases were systematically searched up to September 5, 2024, to identify randomized controlled trials published for English or Chinese. Two authors independently completed the study selection process, data extraction process and methodological quality assessment. The Patient, Intervention, Comparison, Outcome, Study design framework was used to construct the search strategy. The predefined primary outcomes of interest included the incidence of postoperative delirium (POD) and the incidence of delayed neurocognitive recovery (dNCR). The quality of the studies was evaluated by the PEDro scale. Owing to the small number of trials and clinical and methodological diversity, a narrative synthesis was undertaken in accordance with the Synthesis Without Meta-analysis guidelines. This study was conducted and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement. The certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation system. Results: Six studies were analysed. These trials involved 645 total participants, with 316 in the intervention group (mean age, 66.0-73.8 years; 38.4-77.8% male) and 329 in the comparator group (mean age, 67.5-72.6 years; 31.8-88.9% male). The effects of preoperative cognitive training on reducing the incidence of dNCR, the incidence of POD, the length of hospital stay and the incidence of postsurgical complications as well as improving postoperative global cognitive function and activities of daily living are quite uncertain. The results of this study should be interpreted with caution owing to the limited number of trials and low to very low certainty of evidence. Conclusion: Current evidence on the effectiveness and safety of cognitive prehabilitation on cognitive and noncognitive outcomes in older patients undergoing elective surgery is limited and unclear. [ABSTRACT FROM AUTHOR]

Objectives: Seasonal influenza vaccination rates among the elderly in the Czech Republic are alarmingly low, making it one of the least vaccinated countries in Europe. This study explored the role of vaccine literacy and insurance coverage on vaccination status. Methods: An analytical cross-sectional study was conducted in Summer 2023 using a self-administered questionnaire covering vaccine literacy (functional, interactive, and critical skills), negative perceptions towards influenza vaccination, and the 5C model (confidence, complacency, constraints, calculation, and collective responsibility). Individuals aged 55 and older were included in the study. Mediation analyses assessed the indirect effects of insurance coverage on vaccination status. Results: Significant differences were noted in vaccination rates based on insurance coverage, chronic diseases, regular medication use, and previous COVID-19 and pneumococcal vaccinations. Vaccine literacy, especially interactive and critical skills, was higher among vaccinated individuals. Confidence and collective responsibility were significant promoters, while complacency and constraints were barriers to vaccination. Mediation analyses indicated that negative perceptions, confidence, and collective responsibility significantly mediated the relationship between insurance coverage and vaccination status. Conclusion: Enhancing vaccine literacy and addressing psychological antecedents are crucial for improving influenza vaccination rates among the elderly. Policy measures should include improving vaccine literacy, building public confidence, and addressing negative perceptions. [ABSTRACT FROM AUTHOR]

Background: Exercise is effective in preventing frailty status in older adults, but the effect of an exercise program based on Wellness Motivation Theory (WMT) on the frailty status, self-efficacy for exercise, and quality of life for older adults with pre-frailty remains unclear. Our objective was to examine the efficacy of a multicomponent exercise program based on WMT on frailty status, self-efficacy, and quality of life among pre-frail older adults. Methods: This was a randomized controlled trial of pre-frail older adults aged from 60 years to 85 years. Participants in the intervention group performed exercise three times a week for 24 weeks, once at a community health service station instructed by two researchers and two times at home. Participants in the control group were given one-time advice on physical activity. The assessor was the only one blinded. The primary outcome was the reversal rate of pre-frailty. The secondary outcomes included self-efficacy and quality of life. Results: One hundred and forty-four participants were randomized into two groups (n = 72 in the intervention group and n = 72 in the control group) and analyzed. After 24 weeks, the proportion of pre-frailty was significantly lower in the intervention group than in control (31.8% versus 74.6%, P < 0.001). The absolute risk reduction was 42.8% [95% CI, 25.1–57.1]. In the 8th week and the 24th week, the frailty score of the intervention group was significantly lower than that of the control group. There were significant improvements in self-efficacy at week 2, week 8, and week 24. In weeks 8 and 24, participants in the intervention group reported a higher quality of life than the control group. There were no exercise-related injuries or falls among the participants. Conclusions: The exercise intervention based on WMT for pre-frail older adults could reverse pre-frailty, increase self-efficacy for exercise, and improve the quality of life in older Chinese. Study registration details: This study was registered in www.ClinicalTrials.gov on the 25th of July, 2024, with the identifier NCT06519695. Reporting method: The Consolidated Standards of Reporting Trials (CONSORT) checklist was used in this study for properly reporting how the randomized trial was conducted. [ABSTRACT FROM AUTHOR]

Background: Overweight and obesity are global health concerns, especially significant for older adults at higher risk for chronic diseases. The transition to retirement, altering daily routines, highlights the need for adequate weight management support. Since obesity is a challenging topic in healthcare and socioeconomic inequalities exist in access and utilization, we examined how retired individuals with obesity and low or high education describe their experiences of unmet needs, mismatches, and successes within the healthcare service system for weight management. Methods: This qualitative interview study is part of the Helsinki Health Study. The participants (N = 20, with a body mass index of at least 30 kg/m2) were selected from a cohort of retired former employees of the City of Helsinki. Half of the interviewees had low education, and the other half had high education. Women and men were equally represented. The interviews were conducted in 2023 and the data were analyzed using inductive thematic analysis. Results: Three main themes were formed: Deficiencies in engaged care, Services are mismatched with needs, and Facilitating conditions for individual successes. The first main theme had two sub-themes: Condescending attitude and Ignoring weight during the appointment. The second main theme had one sub-theme: Inadequate personnel resources. The third main theme had one sub-theme: Individual opportunities to acquire information and treatment. Educational differences were most clearly reflected in the sub-themes. Participants with low education more often described experiencing a condescending attitude towards them when seeking care and had had difficulties in obtaining time for appointments due to inadequate resources. Participants with high education described broader experiences related to individual opportunities to acquire information and treatment within the healthcare service system than participants with low education. Conclusions: The participants in this study highlighted the importance of respectful engagement with the subject of their weight and felt that these kinds of interaction skills should still be developed in healthcare personnel. The participants articulated a need for approaches that are tailored to their unique circumstances. According to the participants, long-term group intervention, provided with peer support and supported by a multidisciplinary team, could sustain their weight management. [ABSTRACT FROM AUTHOR]

Background: Advancing age is associated with an increase in mortality among patients with acute respiratory distress syndrome (ARDS) due to coronavirus disease 2019 (COVID-19). This study aimed to determine risk factors for in-hospital mortality in patients over 60 years old with COVID-19-related ARDS (C-ARDS). Methods: This was an observational, analytical, retrospective study conducted on a cohort that included all patients aged 60 years or older diagnosed with COVID-ARDSwho were admitted to a high-complexity hospital in Bogotá, Colombia, between March 2020 and July 2021. Results: A total of 1563 patients were included in the analysis, with a median age of 73 years (interquartile range [IQR]: 67–80) and 811 deaths (51.8%). Independent risk factors for in-hospital mortality were identified as follows: patients aged 71–80 [OR 1.87 (95% CI 1.33–2.64)], age > 80 [OR 8.74 (95% CI 5.34–14.31)], lactate dehydrogenase (LDH) [OR 1.009 (95% CI 1.003–1.0015)], severe C-ARDS [OR 2.16 (95% CI 1.50–3.11)], use of invasive mechanical ventilation (IMV) [OR 12.94 (95% CI 9.52–17.60)], and use of steroids [OR 1.49 (95% CI 1.09–2.03)]. In patients over 80 years of age (n = 388), the primary risk factor associated with in-hospital mortality was the use of IMV (n = 76) [OR 6.26 (95% CI 2.67–14.69)], resulting in an in-hospital mortality rate of 89.4% (n = 68) when this therapy was implemented. Conclusions: The primary risk factors for in-hospital mortality in patients older than 60 years were age, the use of IMV, the severity of C-ARDS, use of steroids and elevated LDH values. Among patients older than 80 years, the main risk factor for in-hospital mortality was the use of IMV. In cases of C-ARDS in older patients, the decision to initiate IMV should always be individualized; therefore, the use of alternative oxygen delivery systems as the first-line approach can be considered. [ABSTRACT FROM AUTHOR]

Background: Sarcopenia represents a constant threat to the health of older adults, and accurate risk perception is essential for disease prevention and control. However, current methodologies lack rigorously validated instruments to assess the perceived risk of sarcopenia among this group. Thus, this study aimed to develop and validate a sarcopenia disease risk perception scale for older adults. Design: The study was conducted in two phases: development of the initial scale and its psychometric evaluation. A STROBE checklist was employed. Methods: Based on the two-factor model of risk perception theory and the health belief model, the initial draft of the scale was created through literature review, expert consultations, and a preliminary survey with a small sample. Then, we used a cross-sectional study methodology to conveniently select 438 Chinese older adults. Item analysis, exploratory factor analysis (EFA), and confirmatory factor analysis (CFA) were used to refine and validate the scale items. Internal consistency and external consistency were assessed to confirm the scale's reliability. Results: These evaluations established the scale's framework: content validity, item analysis, and EFA. The two factors extracted from the initial analysis explained 62.250% of the observation variance. The CFA confirmed a good fit for the model, demonstrating the scale's robust reliability and validity. The finalized scale includes 15 items and two dimensions: perceived susceptibility (eight items) and perceived severity (seven items). Conclusion: The Sarcopenia Disease Risk Perception Scale for Older Adults is reliable and valid, making it appropriate for assessing the risk perception level in the target population. [ABSTRACT FROM AUTHOR]

The aim of this study was to examine the effects of free swimming (FS), aquatic resistance training (ART), and their combination (FS&ART) on the body composition, blood pressure, and physical fitness of older adults. The study employed a randomized controlled design, comparing three experimental groups with a control group. Eighty volunteers aged between sixty and seventy years (age: 66.2 ± 2.3 years; body mass index: 25.8 ± 4.3 kg/m²) participated in the 16-week intervention, consisting of two weekly sessions. Assessments were conducted at baseline and post-intervention, including anthropometric measurements, blood pressure readings, and the Senior Fitness Test. Significant differences were found between groups in post-intervention considering the chair stand test (p = 0.017; ES = 0.125), arm curl test (p = 0.029; ES = 0.111), 8-foot up and go test (p = 0.042; ES = 0.102), and walk test − 6 min (p = 0.005; ES = 0.156). Specifically, both ART (+ 20.1%; p < 0.05) and FS&ART (+ 19.5%; p < 0.05) showed significantly greater improvements in the chair stand test compared to the control group. Similarly, ART (+ 23.1%; p < 0.05) and FS&ART (+ 18.7%; p < 0.05) performed better than the control group. FS&ART also exhibited a significant improvement over the control group in the 8-foot up-and-go test (+ 14.6%; p < 0.05). In the 6-minute walk test, FS (+ 19.4%; p < 0.05) and FS&ART (+ 15.9%; p < 0.05) both significantly outperformed the control group. This study found that FS improves cardiovascular endurance, while ART enhances muscular strength and endurance in older adults, with combined benefits for agility, suggesting integration of combined modalities into community wellness initiatives for enhanced physical fitness and health outcomes. [ABSTRACT FROM AUTHOR]

Background: The unprecedented pandemic situation of COVID-19 has had a negative impact on the mental health of many people, especially among the "old-old" older adults who are aged 75 or older. Therefore, the aim of this study is to investigate the changes in depression among "old-old" older adults before and after the onset of COVID-19, and the extent to which depression affects suicidal ideations. Method: The 12th to 16th Korea Welfare Panel Study(KoWePS) conducted from 2017 to 2021 was used for analysis. For this study, 771 older individuals with complete data to estimate the degree of change of depression were selected as the final analysis subjects. Result: A Growth Mixture Modeling(GMM) analysis was conducted, resulting in the classification of two groups: an increasing group and a decreasing group. The study findings showed that "old-old" older individuals with high levels of depression, specifically those in the decreasing group, may be more susceptible to suicidal ideation. Despite this steep change slope, the decreasing group still exhibited a higher level of depression in 2021 compared to the increasing group. As per characteristics, the decreasing group, which showed a higher prevalence of suicidal ideation, had a higher proportion of women and individuals with lower levels of education, those living alone, and a lower household income compared to the increasing group. Conclusion: It is important to note that although the study emphasized the need to prioritize intervention for the decreasing group with consistently high levels of depression, the majority of individuals belong to the increasing group, which exhibited a gradual increase in depression levels over time. Therefore, intervention plans should be developed concurrently for both groups. Also, it is crucial to implement proactive efforts targeting groups with understandings of these characteristics when establishing preventative measures for depression and suicidal ideation among "old-old" older adults. [ABSTRACT FROM AUTHOR]

Background: Perioperative cognitive maintenance and protection in older adults is an important patient safety imperative. In addition to foundational care, one area of growing interest is integrating cognitive prehabilitation into the surgical trajectory. This review aimed to evaluate the effectiveness and safety of cognitive prehabilitation on cognitive functional capacity and postoperative cognitive outcomes among older adults undergoing elective surgery. Methods: The MEDLINE, Embase, CENTRAL, CINAHL, PsycINFO, PEDro, CBM, CNKI, WANFANG, and VIP databases were systematically searched up to September 5, 2024, to identify randomized controlled trials published for English or Chinese. Two authors independently completed the study selection process, data extraction process and methodological quality assessment. The Patient, Intervention, Comparison, Outcome, Study design framework was used to construct the search strategy. The predefined primary outcomes of interest included the incidence of postoperative delirium (POD) and the incidence of delayed neurocognitive recovery (dNCR). The quality of the studies was evaluated by the PEDro scale. Owing to the small number of trials and clinical and methodological diversity, a narrative synthesis was undertaken in accordance with the Synthesis Without Meta-analysis guidelines. This study was conducted and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement. The certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation system. Results: Six studies were analysed. These trials involved 645 total participants, with 316 in the intervention group (mean age, 66.0-73.8 years; 38.4-77.8% male) and 329 in the comparator group (mean age, 67.5-72.6 years; 31.8-88.9% male). The effects of preoperative cognitive training on reducing the incidence of dNCR, the incidence of POD, the length of hospital stay and the incidence of postsurgical complications as well as improving postoperative global cognitive function and activities of daily living are quite uncertain. The results of this study should be interpreted with caution owing to the limited number of trials and low to very low certainty of evidence. Conclusion: Current evidence on the effectiveness and safety of cognitive prehabilitation on cognitive and noncognitive outcomes in older patients undergoing elective surgery is limited and unclear. Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=277191, Identifier CRD42021277191. [ABSTRACT FROM AUTHOR]

Objectives: To investigate whether the likelihood of hospital‐acquired complications for older people in Australia differs by whether they have dementia. Study design: Matched cohort study. Setting, participants: People aged 60 years or older with dementia who were admitted to five public hospitals in the South Western Sydney Local Health District, New South Wales, 1 January 2010 to 31 December 2020, and people without dementia admitted during the same period, matched by age, sex, number of medical conditions, and presence of selected specific medical conditions, emergency admission status, history of falls, and admission from a nursing home. Main outcome measures: Hospital‐acquired complications (falls, pressure injuries, delirium, pneumonia, venous thromboembolism, new incontinence, malnutrition, in‐hospital death), by dementia status. Results: A total of 217 459 people aged 60 years or older were admitted to the five hospitals during the study period. The mean age of the 11 393 patients with dementia (83 years; standard deviation [SD], 7.5 years) was higher than that of the 206 065 patients without dementia (73 years; SD, 8.9 years), and the proportion of women slightly larger (55% v 50%). Median hospital length of stay was longer for people with dementia (nine days; interquartile range [IQR], 4–19 days) than for people without dementia (three days; IQR, 1–9 days), and the number of in‐hospital deaths higher (768, 7% v 584, 5%). After propensity score‐based matching, the risks of falls (odds ratio [OR], 4.7; 95% confidence interval [CI], 3.8–5.7), pressure injury (OR, 1.4; 95% CI, 1.1–1.8), delirium (OR, 2.4; 95% CI, 2.0–3.0), and pneumonia (OR, 1.3; 95% CI, 1.01–1.7) were higher for people with dementia than for those without dementia; differences between the two groups in the risks of venous thromboembolism, malnutrition, and incontinence were not statistically significant. Conclusions: Given the greater risk of many hospital‐acquired complications for people with dementia, targeted models of person‐centred care are needed to ensure the best outcomes for these patients. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Modern Medicine & Health is the property of Journal of Modern Medicine & Health and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: The ageing of the population is leading to an increase in the number of traumatic injuries and represents a major challenge for the future. Falls represent the leading cause of Emergency department admission in older people, with injuries ranging from minor to severe multiple injuries. Older injured patients are more likely to be undertriaged than younger patients. The aim of this study was to investigate the extent of undertriage in older patients with particular emphasis on access to trauma centres and resuscitation rooms. Methods: Retrospective observational cross-sectional study based on data prospectively collected from prehospital electronic records including all patients ≥ 18 years for whom an ambulance or helicopter was dispatched between 1 January 2018 and 31 April 2023 due to a trauma. The primary outcome, admission to the resuscitation room of the regional trauma centre with trauma team activation, was assessed by age. Multivariate logistic regression was used to control for known confounders and to test for plausible effect modifiers. Results: Emergency Medical Services treated 37,906 injured patients. Older patients ≥ 75 years represented 17,719 patients (47%). Admission to trauma centre with trauma team activation was lower in older patients, N = 121 (1%) compared to N = 599 (5%) in younger patients, p < 0.001; adjusted odds ratio: 0.33 (0.24–0.45); p < 0.001. Undertriage increased by twofold with age ≥ 75; OR: 1.81 (1.04–3.15); p value < 0.001. Undertriaged patients were older, more likely to be female, to have low energy trauma and to be located farther from the regional trauma centre. Conclusion: Older injured patients were at increased risk of undertriage and non-trauma team activation admission, especially if they were older, female, had head injury without altered consciousness and greater distance to regional trauma centre. [ABSTRACT FROM AUTHOR]

Introduction: Surgical treatment of distal femoral fractures (DFFs) in osteoporotic bone is challenging despite improvements in hardware and surgical techniques. The occurrence and degree of secondary displacement during healing after bridging plate fixation are still unknown. This study aimed to assess the occurrence and degree of secondary displacement in healing DFFs in elderly patients and correlate the secondary displacement to body mass index, bone density, and weight-bearing regimen. Patients and Methods: The study involved 32 patients, 65 years or older, with a DFF of AO/OTA types 33 A2-3, B1-2, C1-2, and 32(c) A-C,1-3, including peri-prosthetic fractures with stable implants. Twenty-seven patients had at least 8 weeks of follow-up, and 21 patients had a complete 1-year follow-up. Minimally invasive surgery was performed using a distal anatomical femoral plate as a long bridge-plating construct. Secondary displacement was assessed with computed tomography of the entire femur postoperatively and at 8, 16, and 52 weeks. Femoral length, coronal angulation (varus/valgus), and subsidence as the change in distance between the distal joint surface and a specified locking screw were measured. Results: There was a statistically significant mean femoral shortening at 52 weeks of 4.7 mm (SD 3.9, (95% CI 2.9–6.5), P < 0.001) mainly by subsidence of the distal fragment. Most patients experienced limited coronal angulation. There was no correlation between body mass index or bone density and secondary displacement. At the 1-year follow-up, no patient needed revision surgery for non-union or plate breakage. Restricted weight-bearing for 8 weeks did not prevent secondary displacements or adverse events such as cut-outs. Conclusion: Modern dynamic plate osteosynthesis could not prevent commonly occurring fracture subsidence in DFF in an elderly cohort. Restricted weight-bearing for 8 weeks did not prevent secondary displacements or mechanical adverse events. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to describe the experiences of critically ill elderly patients (CIEPs) who were treated using the high-flow nasal cannula (HFNC) after extubation. Design/methodology/approach: A descriptive phenomenological approach was conducted to interview eleven CIEPs using face-to-face semi-unstructured interviews. Participants were selected through purposive sampling. Data were analyzed using Giorgi's method. Findings: Experiences of CIEPs included their fears of failure, getting comfortable and uncomfortable, as well as asking for assistance. Fears of failure were described as involving worsening symptoms related to their diseases and failure of HFNC leading to the need for reintubation. While receiving HFNC, their breathing was comfortable, and they were free from intubation. However, they were uncomfortable because of the sensation of burning in the nasal passages. Additionally, they asked for assistance from nurses in managing their symptoms, and the alarms of HFNC oxygen therapy devices resulted in fears of HFNC failure. Originality/value: The paper indicates that CIEPs experienced physical and psychological impacts from HFNC oxygen therapy (e.g. burning sensation in the nose and fear of failure). Although they had comfortable breathing, being uncomfortable also occurred. Therefore, health-care professionals should support what CIEPs need and develop a program or guidelines for managing the complications of HFNC – neither burning noses nor psychological issues enhance the comfort of CIEPs – by considering age-related changes. [ABSTRACT FROM AUTHOR]

Purpose: Our objective was to evaluate the cost-utility of a health and social care integration programme for frail older adults in Buenos Aires, Argentina. Design/methodology/approach: Based on a study of the programme's effectiveness, a Markov model was conducted to assess its cost-utility. The active intervention was the health and social care integration programme, and the control was the best standard of care so far. The setting was the patients' home of residence. A third-party payer perspective and a lifelong time horizon were adopted. All transition probabilities, quality-adjusted life years (QALYs) and costs were estimated from the effectiveness study. A discount rate of 3.5% was applied to costs and benefits. Costs are expressed in international dollars (Int$), calculated according to the International Monetary Fund's purchasing power parity rate. Different sensitivity analyses were performed. The model was built in Excel 365. Construct validity, verification during model construction and internal consistency of the results were assessed. Findings: The programme had an average cost of Int$18,768.22/QALY, and the control Int$42,609.68/QALY. In the incremental analysis, the programme saved Int$26,436.10 and gained 0.81 QALYs over the control. In the sensitivity analyses, in 99.96% of cases, the programme was less costly and more effective. Practical implications: The cost savings can facilitate the scalability. Originality/value: The health and social care integration programme for frail older adults was more effective and less costly than the best standard of care to date. This study contributes to the scarce evidence on the efficiency of integrated care strategies for frail older persons. [ABSTRACT FROM AUTHOR]

Background: Globally, population aging is a widespread phenomenon. However, Korea is experiencing this demographic shift at the fastest rate globally. As the number of older adults increases, the local primary healthcare system has become increasingly important in supporting them to maintain their lives within the community. Current Concepts: The integrated medical support project is systematic and comprehensive, focusing on services provided by primary care providers. The project requires a tailored implementation plan specific to the community for long-term operations. Therefore, providers need to explore roles and collaborative measures to establish a sustainable system of primary care-centered supportive care for elderly patients. Discussion and Conclusion: Local governments must identify patients, establish a cooperative system, manage and entrust patient information and communications technology (ICT), educate ICT users, and secure a budget to integrate and provide medical care in the community effectively. The local medical association should establish and operate a medical and healthcare support center, coordinate a consultative body between medical institutions, and implement a 24-hour patient response system. The proposed medical and healthcare support center will facilitate cooperation and comprehensive evaluation during home visits by primary care doctors. This center can also connect patients needing care by collaborating with local care-related organizations. In addition to providing home-visit services, primary care institutions must establish a system for conducting comprehensive patient evaluations with medical care support teams. Additionally, the recommendation is to incorporate elements beyond home-visit treatment fees to facilitate the systematic and intensive management of patients. [ABSTRACT FROM AUTHOR]

Objective Conventional total knee arthroplasty (TKA) rehabilitation has little impact on sedentary lifestyles that have negative long-term health consequences. The purpose of this trial was to determine the effect of telehealth-based physical activity behavior change intervention on physical activity and functional outcomes following TKA. Methods This study was a 2-arm, parallel randomized controlled superiority trial at a regional Veterans Affairs medical center. The participants were 92 US military veterans (mean age = 65.7 [SD =7.8] y) undergoing unilateral TKA. The Physical Activity Behavior Change (PABC) intervention included telehealth-based self-management training (10 30-minute sessions) delivered over 12 weeks. The control intervention included telehealth-based health education sessions that matched PABC frequency and duration. Both groups participated in standardized conventional outpatient rehabilitation. Physical activity, measured as average daily step count, was the primary outcome. Secondary outcomes were Life-Space Assessment questionnaire, 30-Second Chair-Stand test, Timed "Up & Go" Test, 6-Minute Walk Test, Western Ontario and McMaster Universities Osteoarthritis Index, and Veterans RAND 12-Item Health Survey. The Self Efficacy for Exercise scale and daily time spent in different postures (sitting/lying, standing, stepping) were exploratory variables. Outcomes were measured at baseline (before surgery), mid-intervention (8 weeks after surgery), after the intervention (14 weeks after surgery; primary endpoint), and follow-up (38 weeks after surgery). Results The PABC group had an estimated 931 (95% CI = 42–1819) more daily steps than the control group from baseline to 14 weeks, though a between-group effect was not sustained at 38 weeks. There were no group differences in secondary outcomes. Participants included only military veterans using Veterans Health Administration services. The intervention targeted self-management and did not include peer support. Conclusion The PABC intervention improved physical activity for veterans recovering from unilateral TKA at 14 weeks after surgery, though the effect was not sustained at 38 weeks. Physical function improved with rehabilitation but was not different between groups, indicating that physical function was not a primary driver of physical activity behavior. Impact Conventional TKA rehabilitation has a negligible effect on free-living physical activity, which is relevant to long-term health outcomes. This trial identified telehealth physical activity self-management as effective in addressing activity behaviors, separate from conventional rehabilitation strategies. [ABSTRACT FROM AUTHOR]

Background: Polydoctoring can increase the risk of care fragmentation among patients with multimorbidity, but its impact on health outcomes remains unclear. Aim: To determine the effects of polydoctoring, as measured by the regularly visited facilities (RVF) indicator, on patient outcomes among older individuals with multimorbidity. Design & setting: Data from the ongoing prospective cohort study, Kawasaki Aging and Wellbeing Project (KAWP), was utilised in this study. Among the 1026 KAWP participants aged 85-89 years, those with two or more chronic conditions were enrolled in this study. Method: Care fragmentation and polydoctoring was evaluated using the RVF, which is a new indicator that measures the number of medical facilities consistently involved in a patient's care. Based on RVF, mortality was analysed using the Cox proportional hazards model, with adjustments for age, sex, frailty, and number of comorbidities. Results: A significant reduction in mortality rates was observed in participants with an RVF of =3 and 2-4 comorbidities (hazard ratio [HR] 0.43, 95% confidence interval [CI] = 0.18 to 0.99, P value = 0.048). However, no significant difference in mortality based on RVF was observed for those with =5 comorbidities. Notably, individuals with =5 comorbidities and an RVF of 0 had a significantly higher HR for death (HR 2.68, 95% CI = 1.05 to 6.84, P value = 0.039). Conclusion: In older patients with multimorbidity, polydoctoring may reduce mortality in patients with =4 coexisting conditions, but it does not significantly impact mortality in those with =5 conditions. These findings provide insights for healthcare decision making in managing older patients with multimorbidity. [ABSTRACT FROM AUTHOR]

Background/Aim: This study evaluated the cumulative incidence of pancreatic cancer and worrisome features (WFs) in patients with pancreatic cysts (PCs) clinically considered as branch-duct intrapapillary mucinous neoplasm (BD-IPMN). Methods: Data from 177 patients followed for BD-IPMN were retrospectively analyzed. Suspected BD-IPMN was defined as PCs with confirmed communication with the main pancreatic duct (MPD) via imaging studies, while presumed BD-IPMN referred to PCs lacking clear MPD communication. Results: Among the patients, 30.5% were categorized as suspected BD-IPMN. The median age at diagnosis was 64 years, with a median cyst size of 13 mm. At diagnosis, 19 patients (10.7%) exhibited WFs, and none of the patients had high-risk stigmata. Over a follow-up period of 70.5 months, pancreatic cancer developed in three patients, resulting in a cumulative incidence of 4.0% (95% confidence interval [CI], 0.98 to 10.76%) at 96 months. For the 158 patients without initial WFs, the cumulative incidence of WFs was 5.1% (95% CI, 2.37 to 9.28%) at 24 months and 11.2% (95% CI, 6.34 to 17.53%) at 96 months. The development of WFs was lower in the presumed BD-IPMN group (p=0.102) and among patients aged under 75 (p=0.463), though these differences were not statistically significant. Notably, the incidence of WFs plateaued after two years in the elderly cohort. Conclusions: The cumulative incidence of pancreatic cancer and WFs in patients with low-risk PCs was notably low. Furthermore, discontinuing surveillance may be considered for elderly patients, especially those with no changes within the first two years of observation. [ABSTRACT FROM AUTHOR]

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Background/Objectives: Despite the importance of resistance exercise in older adults, factors associated with participation remain unclear, especially regarding sex differences. This study investigated sociodemographic, behavioral, and comorbidity factors associated with insufficient resistance exercise participation among community-dwelling older adults in Korea, with analyses stratified by sex. Methods: Nationally representative cross-sectional data from 8671 participants aged ≥65 years (3758 men and 4913 women; mean age 72.8) were analyzed using the 6th-8th Korea National Health and Nutrition Examination Surveys (2014–2019). Complex-sample multivariable logistic regression identified factors associated with insufficient resistance exercise overall and by sex. Results: Women had a higher prevalence of insufficient resistance exercise than men (91.27% vs. 71.04%, p < 0.001). Older age groups, particularly those aged ≥80 years (OR: 2.39; 95% CI: 1.86–3.07), and those with lower education (OR: 1.56; 95% CI: 1.33–1.82), rural residence (OR: 1.89; 95% CI: 1.49–2.38), low household income, (OR: 1.45; 95% CI: 1.13–1.88), insufficient aerobic exercise (OR: 1.68; 95% CI: 1.46–1.94), current smoking (OR: 1.70; 95% CI: 1.26–2.29), and diabetes (OR: 1.28; 95% CI: 1.09–1.51) were independently associated with a higher likelihood of insufficient resistance exercise. The association of household income, current smoking, hypertension, and diabetes with resistance exercise adherence showed differences in sex-stratified analyses. Conclusions: Multiple sociodemographic, behavioral, and comorbid factors are linked to resistance exercise adherence among older Koreans. Tailored, sex-specific interventions are needed to promote resistance exercise in this population, informing public health strategies and further research on effective approaches for diverse older adults. [ABSTRACT FROM AUTHOR]

The surgical treatment of geriatric acetabular fractures is becoming increasingly important due to a demographic change in age. While acetabular fractures used to occur more frequently in younger patients, they are currently more prevalent in geriatric patients. This change has also led to an increase in the frequency of anterior and combined anterior acetabular fractures. Surgery for geriatric acetabular fractures is very challenging, and surgeons need years of experience to be able to deal with the advantages and disadvantages of pelvic surgery. This is why a high level of surgical expertise is required. The aim of this article is to provide an insight into the topic of geriatric acetabular fractures with a critical narrative review of the current literature and a focus on minimally invasive surgical treatment using the modified Stoppa approach without patients' own assessment. The modified Stoppa approach offers excellent visibility of the anterior structures of the acetabulum and can address the quadrilateral surface effectively. Pelvic surgery, in particular acetabular surgery, offers patients many advantages, such as rapid mobilization and the quick relief of pain symptoms. Total hip arthroplasty is currently being discussed as an alternative with good results for certain types of acetabular fractures in older patients, though it requires clarification of studies and recommendations. [ABSTRACT FROM AUTHOR]

Background: The hospital discharge process poses significant safety risks for older patients due to complexities in communication and coordination among stakeholders, leading to potential drug‐related problems post‐discharge. Adopting a person‐centred care (PCC) approach in medication communication by healthcare professionals (HCPs) is crucial to ensure positive health outcomes. This study aimed to explore the practice of PCC in medication communication between older patients and HCPs during the hospital discharge process. Methods: We conducted a qualitative study using non‐participatory direct observations of patient–HCP consultations during hospital discharge, followed by semi‐structured interviews with observed patients and, when applicable, their informal caregivers. Data collection occurred from October 2020 to May 2021 at two Swedish hospitals. We gathered data using an observational form and audio‐recorded all consultations and interviews. The data were analysed thematically using the systematic text condensation method. Results: Twenty patients were included (median age: 81 years [range: 65–94]; 9 female) in observations and 13 of them participated in interviews. Two patients were accompanied by an informal caregiver during the interviews. Three main themes were identified: (1) The impact of traditional authoritarian structures, depicts power dynamics between patients and their HCPs, showing how traditional structures influence the practice of PCC in medication communication during hospital discharge; (2) Consultation timing and mode not on patients' terms, describes suboptimal times and settings for consultations, along with the use of complex language that hinders effective communication; and (3) Discrepancy in expectations of self‐care ability, illustrates a mismatch between the self‐care guidance provided by HCPs during hospital discharge and the actual needs and preferences of patients and informal caregivers. Conclusion: Medication communication between older patients and HCPs during hospital discharge is frequently inconsistent with the practice of PCC. Not only must HCPs improve their communication strategies, but patients and their informal caregivers should also be better prepared for discharge communication and encouraged to participate in their care. This involvement would give them relevant knowledge and tailor communication to their individual needs, preventing problems in managing their medications after discharge. Patient or Public Contribution: An advisory group of six patients and/or informal caregiver contributors provided input on the study design, edited the consent forms, and helped develop the interview guide. [ABSTRACT FROM AUTHOR]

Background. Adequate physical activity is essential to healthy aging. This study aimed to examine the construct validity of the Persian version of the Physical Activity Scale for the Elderly (PASE) among community-dwelling adults, which would be used as a screening tool at the Neyshabur longitudinal study on the aging (NELSA) Center. Methods. This cross-sectional study was conducted in Neyshabur, Iran, as a pilot phase at the NELSA center between May and January 2019. The sampling method was a stratified random method. For explanatory factor analysis (EFA) and confirmatory factor analysis (CFA), 300 and 650 community-dwelling adults aged 50 and older were selected, respectively. EFA was used with the principal component extraction method, and Varimax rotation and CFA were performed with the maximum likelihood estimation method. Results. Of the 950 participants, 445 (46.8%) were male, and 505 (53.2%) were female. The mean age of participants was 63 ± 8.6 years. The mean physical activity score was 89.7 ± 70.7. According to the percentage of variance explained in EFA, all five extracted factors explained 62.7% of the total variance. The results of CFA showed that all item- scale relationships were significant (P < 0.05), except for household activity (Q8) and leisure time activity (Q2) (P > 0.05). The values of the fit indices showed that the model fits well with the data. Conclusion. The EFA and CFA confirmed the construct validity of the Persian version of PASE. This questionnaire is suitable for measuring the physical activity level of older Persian adults. Practical Implications. The Persian version of PASE is suitable for measuring the physical activity level of older Persian adults. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the vocal fold histological characteristics during different postnatal periods in rats, especially older rats. Methods: Sprague–Dawley rats aged 4 days, 4 and 12 weeks, and 12 and 24 months were used for the experiment. Five larynges were obtained for each age and cut into 5‐μm consecutive sections. The expression of Ki‐67 was assessed using immunohistochemistry to examine cell proliferation. Elastic van Gieson staining was used to detect the collagen and elastin concentrations. The cell type was determined using multicolor immunofluorescence. Results: Ki‐67 was not expressed in the macula flava (MF) of 12‐week‐, 12‐month‐, and 24‐month‐old adults. Collagen fibers in the lamina propria (LP) increased with age. The elastic fiber concentrations in the LP decreased significantly at 24 months (p <.01) but remained stable in the MF. All posterior MF cells showed strong glial fibrillary acidic protein and vimentin‐positive reactions with weaker expressions of CD68 and α‐smooth muscle actin (α‐SMA). The myofibroblasts (α‐SMA‐positive) and macrophages (CD68‐positive) in the LP of the 24‐month‐old rats were significantly the highest (p <.01). Conclusion: The extracellular matrix in the LP increases with age, presenting as an increase in collagen with the loss of elastin, which may be due to myofibroblast proliferation. Moreover, the cellular properties or extracellular matrix components of the mature MF in rats are comparable to those in humans. [ABSTRACT FROM AUTHOR]

Introduction: Occupational balance has been investigated in different populations but less in stroke survivors. Previous studies have focussed on occupational balance among stroke survivors of working age (15–64 years of age), showing they did not perceive they had occupational balance. There is, therefore, a lack of knowledge of how older stroke survivors perceive their occupational balance. The aims of this study were to describe occupational balance in community‐dwelling stroke survivors 65 years or older and to investigate if there were any associations between their perceived stroke impact and occupational balance. Methods: A cross‐sectional study was performed with 58 stroke survivors, with a median age of 75 years at stroke onset and a median time since stroke onset of 11 months. The participants were recruited from a local stroke register and answered questionnaires on occupational balance and stroke impact. Data were analysed with descriptive statistics, correlations and logistic regression. Results: The participants had a median score of 29 (min 12 to max 33), indicating a very high occupational balance, a low stroke impact, and a good recovery (median 82.5; min 0 to max 100). An association between participation and occupational balance (OR 1.13; 95% CI 1.04–1.23) was found. Conclusion: The stroke survivors perceived a low stroke impact and a high occupational balance. It is possible that older community‐dwelling stroke survivors, of whom many have retired, juggle less occupations leaving them with more time to engage in those occupations they want to, leading to a better occupational balance. PLAIN LANGUAGE SUMMARY: People who have a stroke can experience difficulties with managing everyday activities, including performance of a specific task but also to have a balance between activities that are needed and those that are enjoyed. Previous studies have showed that stroke survivors in working age did not perceive they had a balance in their daily activities, but similar studies in older stroke survivors were lacking. This study therefore described balance in daily activities in 58 community‐dwelling stroke survivors 65 years or older. The participants answered questionnaires on balance in daily activities and what impact the stroke had in their life. The results showed that they had a very high balance in daily activities and a low stroke impact and perceived a good stroke recovery. Our conclusion is that because many of the older community‐dwelling stroke survivors are retired, they therefore have more time to spend on activities they want to engage in. Since they can decide themselves how their time will be spent, this can explain why they experience a better balance in daily activities. Future studies should include a larger number of participants. Still, we believe that since this is a new research area, the results are interesting for researchers and clinicians in this field. [ABSTRACT FROM AUTHOR]