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This paper explores the issues of old age as they appear in the final chapter of Virginia Woolf’s The Waves (1931). Woolf recorded her own mixed feelings about growing old in her diaries: her writing, both personal and fictional, shows a keen interest in life’s different stages and their specificities. These concerns are reflected in The Waves, a novel composed of a series of soliloquies from six characters, tracing their lives from childhood into old age. The final chapter is dedicated to old age and only one character, Bernard, remains. This paper explores the role old age plays in narrative construction by investigating this chapter and showing how it offers a keener view of the general experience of old age by paying close attention to a well-characterised singular experience. The paper considers the literary representation of an individual experience of old age as it relates to broader cultural understandings of old age by looking at the symbolism of natural cycles, the impulse towards self-narration, and the mind/body duality as an issue for the ageing body. This leads to discussion of isolation and community in old age.

Sarcopenia, an age-associated loss of muscle mass and function, greatly increases the risk of fractures, falls, and death in older adults. The pathogenesis of which is mainly involves motor neuron loss, hormone imbalance, inflammatory factors, and insulin resistance, etc. Supplementing nutrients such as protein, amino acid， n-3, n-6 polyunsaturated fatty acids and vitamin and other nutrients can effectively prevent and treat the sarcopenia. This paper focuses on the pathogenesis and nutritional intervention of sarcopenia to provide a reference for the research of sarcopenia.

Objectives The paper is of a cognitive nature, it aims at diagnosing the factors of activity of the elderly and defining their anxieties and expectations related to old age and ageing. Material and methods The paper is a set of theoretical deliberations consistent with the literature of the subject and empirical deliberations collected based on generally available statistical data and own research findings. The presented research is of an exploratory nature. Results The more and more visible process of ageing societies is contributing to the growing interest in the problem of old age, particularly with regard to the social perception of old age itself and to the related complex process of ageing. This paper attempts to analyse the indicated aspects, considering seniors' attitudes towards the discussed problems. The article presents statistical data for Poland and the author's own research findings. Conclusions Contemporary old age is really varied in terms of age, sex, education level, and first of all in terms of health and independence level, thus, the way of experiencing it is very individual. However, one can indicate some trends and tendencies which accompany this process. At present, seniors prepare better and better to go through old age, more and more often they take advantage of various forms of activity, owing to which they can face the consequences of aging and experience their old age more and more consciously.

This paper explores the hypothesis that elderly people are discriminate in the face of dying, by not having access to adequate medical and mainly palliative care, due to their age. The factors proposed to be at the origin of this discrimination are three: (1) The way death is approaching and can be detected as coming soon, are not the same than in other clinical situations, due to illnesses as cancer for example. There is still a deficit of medical knowledge, about what biologically and physiologically means to become very old and dying of aging. Palliative care has not been developed for assisting people dying due to old age and remains quite inappropriate for that in their current conception. (2) Old age is a risk factor of not being as much respected in one’s autonomy as young people. Indeed, elderly are frequently considered as heteronomous and vulnerable, deserving to be protected, even against themselves and what they express. (3) Lastly, if becoming very old without getting a fatal disease can be considered as a privilege, it can indeed come with difficulties to have access to active assistance in dying. Actually, the laws that open the access to such a procedure autorize it only for people whose vital prognosis is compromised at short term because of a terminal illness fatal or for people who suffer without possibilities to be relieved, all conditions that are usually not part of the picture of dying from aging.

Hassan Adnan Bukhari Department of Surgery, Umm AL-Qura University, Makkah, Saudi ArabiaCorrespondence: Hassan Adnan Bukhari, Department of Surgery, Umm AL-Qura University, Makkah, Saudi Arabia, Tel +966 562233444, Email Hambukhari@uqu.edu.saIntroduction: Heatstroke (HS) is a severe form of heat-related illness (HRI) associated with high morbidity and mortality, representing a condition that includes long-term multiorgan dysfunction and susceptibility to further heat illness.Methods: In a systematic review searching Medline PubMed from the studies conducted between 2009 and 2020, 16 papers were identified.Results: A hallmark symptom of heat stroke is CNS dysfunction (a hallmark sign of HS) which manifests as mental status changes, including agitation, delirium, epilepsy, or coma at the time of the collapse. Acute kidney injury (AKI), gut ischemia, blood clots in the stomach and small intestine, cytoplasmic protein clumps in the spleen, and injury of skeletal muscle (rhabdomyolysis) are all characteristics of peripheral tissue damage. Severe heat stroke tends to be complicated by rhabdomyolysis, especially in patients with exertional heat stroke. Rhabdomyolysis may lead to systemic effects, including the local occurrence of compartment syndrome, hyperkalemic cardiac arrest, and/or lethal disseminated intravascular coagulopathy. Untreated heat stroke might exacerbate psychosis, lactic acidosis, consumptive coagulopathy, hematuria, pulmonary edema, renal failure, and other metabolic abnormalities. Core body temperature and level of consciousness are the most significant indicators to diagnose the severity of heat stroke and prevent unfavorable consequences. Heatstroke is a life-threatening illness if not promptly recognized and effectively treated.Discussion: This review highlighted that core body temperature and white blood cell count are significant contributing factors affecting heat stroke outcomes. Other factors contributing to the poor outcome include old age, low GCS, and prolonged hospital stay. The prevalence of both classic and exertional heatstroke can be reduced by certain simple preventive measures, such as avoiding strenuous activity in hot environments and reducing exposure to heat stress.Keywords: Hajj, heat stroke, old age, pilgrimage, white blood cells

The paper is focused on the issues of using direct oral anticoagulants (DOACs) in the subgroups of patients with specific characteristics. The current data on the effects of DOACs in such patients during anticoagulant therapy aimed at prevention of thromboembolic complications in both patients with atrial fibrillation (AF) and venous thromboembolic complications (VTECs) are provided. Insufficient knowledge of the DOAC effects in such populations of patients, i.e. in very old people, people with kidney disease and obese patients, that results from the small number of patients with similar characteristics included in the large-scale randomized clinical trials, is noted. The paper discusses the pharmacological features of using DOACs in patients with the listed above characteristics and possible changes in clinical efficacy and safety of DOACs used in clinical practice separately. The data on three DOACs available in Russia, apixaban, rivaroxaban and dabigatran, are provided. The data of the clinical trial analysis provided in the paper make it possible to generally assume the appropriateness of using DOACs for treatment and prevention of VTECs in patients with pronounced obesity, as well as the advantages of apixaban over other DOACs in patients with AF and concomitant obesity. The issues of using DOACs in patients with kidney disease are considered. The scarcity of evidence-based information about patients with pronounced kidney dysfunction is noted. The provided data on the effects of DOACs in very old people show the advantages of taking apixaban in this population of patients with AF, based primarily on safety indicators.

Abstract Childless older people face many challenges resulting from their lack of children that may have an impact on their subjective well-being, especially in a country where family ties are strong, and children are the main source of support. In this paper, we examine the coping strategies that childless seniors in Poland employ in order to mitigate various risks related to having no offspring. We use a qualitative approach, drawing upon in-depth interviews with 42 childless men and women aged 65 or older. We frame our analyses within the life course approach, stressing the biographical development of coping strategies over the life course. Our results corroborate previous findings, and show that the major challenges older childless people in Poland face are related to feeling lonely, and to having insufficient (practical) support and care in case of dependency. We describe the actions the respondents consciously took in response to these challenges, and examine how these actions changed over the life course. The strategies aimed at promoting healthy ageing or helping older people expand their social networks are strongly in line with the respondents’ personal predispositions and earlier lifestyles and experiences.

Although the pandemic's early months were witness to a nearly unprecedented level of public concern for the plight of the old, such attention did not lead to much sustained analysis into either the concrete experience of old age or the many ways in which a greater knowledge of aging might prove instructive for rethinking the possibilities of contemporary philosophy and social change. The present paper seeks to pursue this otherwise neglected line of inquiry by recovering a previously unexplored episode from the history of social theory in which Simone de Beauvoir and Jean Améry set themselves before the mirror of old age in order to there explore reflections as inimical to their time as our own. For what this intertextual scene of contestation so clearly demonstrates is that the aging body is itself a body of knowledge capable of transforming the very ideologies and social systems that continue to deform the lives of old and young alike.

This paper summarized the nursing management for a long-term bedridden elderly patient with nasal feeding diet complicated with various diseases. During the daily oral care, the patient swallowed the mouth care straw tip (silicone foreign body) accidentally. Given the old age and poor gastrointestinal function of the patient, targeted intervention was implemented followed by precisely locating foreign body. Comprehensive nursing measures including biochemical index monitoring, medication care and prevention of complications were carried out to ensure the successful removal of the foreign body (本文总结1例高龄、合并多种疾病且长期卧床的鼻饲饮食患者发生异物吞食事件的护理体会。老年人群胃肠功能减弱, 通过检查定位异物位置, 针对性采取消化道异物处理方式, 同时注意生化指标监测、用药以及并发症预防等细节护理, 以促进异物顺利排出体外。)

Aging persons can become involved in the criminal justice system, more commonly as victims but also as offenders. They are a growing group of interest in forensic psychiatry, due to the ageing of the population. Moreover, they are overrepresented in long-stay facilities. Forensic psychiatrists may be asked to evaluate elderly individuals whose behaviour has become problematic to their families, caregivers, or third parties. We will focus here on problematic behaviors in eldery people, particularly disinhibition, agitation and aggression, and criminal behaviour and the incarcerated eldery. Forensic psychiatric assessment with new-onset criminal behaviour require special inquiries regarding criminal responsibility or competency to stand trial. Little research is available regarding criminal behaviour in eldery persons in correctional settings. In this paper a forensic-psychiatric expert report will illustrate these topics.

Learning to use information and communication technologies (ICT) may be more difficult for older people due to decreases in fluid intelligence, generational effects, and other age-related effects. Especially older people with intellectual disabilities (ID) are at a high risk of digital exclusion. To enable all older adults to use ICT, individualized technology training may be provided. However, little is known about the ICT learning preferences among older people with ID. Based on semi-structured interviews with older adults (n = 7, mean age = 76.6 years) and older adults with ID (n = 14, mean age = 62.4 years), this paper analyzes learning strategies, preferences, and learning settings. The results from content analysis show that guided learning with personal explanations in a one-to-one setting is the most preferred learning format in both groups of older adults. While many older adults without ID additionally favor self-regulated learning (i.e., learning with manuals or videos), older adults with ID mostly rely on guided learning with personal assistance. The differences can be explained by different abilities (e.g., reading skills) and social networks (e.g., living situation, having children). Not all older adults have a family or an institutional support network to help them learn ICT and community organizations may provide additional support. Researchers and practitioners should be aware of the diverse knowledge backgrounds and competencies in the group of older adults. ICT training in old age should be ideally composed in a modular way embedding self-regulated learning formats into guided learning modules.

This paper used Our World data for coronavirus disease-2019 (COVID-19) death count, test data, stringency, and transmission count and prepared a path model for COVID-19 deaths. We augmented the model with age structure-related variables and comorbidity via non-communicable diseases for 117 countries of the world for September 23, 2021, on a cross-section basis. A broad-based global quantitative study incorporating these two prominent channels with regional variation was unavailable in the existing literature. Old age and comorbidity were identified as two prime determinants of COVID-19 mortality. The path model showed that after controlling for these factors, one SD increase in the proportion of persons above 65, above 70, or of median age raised COVID-19 mortality by more than 0.12 SDs for 117 countries. The regional intensity of death is alarmingly high in South America, Europe, and North America compared with Oceania. After controlling for regions, the figure was raised to 0.213, which was even higher. For old age, the incremental coefficient was the highest for South America (0.564), and Europe (0.314), which were substantially higher than in Oceania. The comorbidity channel via non-communicable diseases illustrated that one SD increase in non-communicable disease intensity increased COVID-19 mortality by 0.132 for the whole sample. The regional figure for the non-communicable disease was 0.594 for South America and 0.358 for Europe compared with the benchmark region Oceania. The results were statistically significant at a 10% level of significance or above. This suggested that we should prioritize vaccinations for the elderly and people with comorbidity via non-communicable diseases like heart disease, cancer, chronic respiratory disease, and diabetes. Further attention should be given to South America and Europe, which are the worst affected regions of the world.

This paper explores the composite of elderly immigrants, self-appointed helpers (selvudpegede hjælpere) and care managers (visitatorer) in Danish municipalities. Free elderly care is a common good in the Danish welfare state. Instead of using the homecare service provided by the municipality, many elderly citizens with a Muslim immigrant background prefer to have a family member contracted as their self-appointed helper. The self-appointed helper is often a spouse, daughter or daughter-in-law, who ends up having the dual role as both a caring, loving family member and a professional care worker. Due to the special setup with self-appointed helpers working in their private homes, it is difficult for the care managers to follow standard rules and procedures. Instead, it seems to be a public secret that there is a gap between what we are supposed to do (according to the law) and what we actually do. We suggest seeing this gap as a silence agreement, where care managers, self-appointed helpers and elderly citizens refrain from asking all the critical questions (regarding the provision of care, the quality of care, working conditions, etc.) that no one wants to know the answers to. However, when the silence agreement from time to time breaks down, the relationship between the self-appointed helper and the care manager is haunted by a widespread phantasm where Muslim immigrants are cast as welfare scroungers. Basically, we argue that care managers and self-appointed helpers share a silent agreement but when it is neglected or violated, the latter end up in a vulnerable and marginalized position. The dynamic highlights the ambiguous intimate belonging of Muslim immigrant families and questions to what extent they were seen as legitimate subjects under the state in the first place.