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Introduction: Diabetic neuropathy (DN) is one of the most complex and progressive disorders, characterized by symmetrical distal degeneration of peripheral nerves, resulting in features of pain and sensory loss. This study aimed to find out the effects of physiotherapy intervention on physical function, balance, and postural control of persons with DN. Materials and Methods: A computerized electronic search was performed using PEDro, Pubmed, CINAHL, and EMBASE with keywords including physiotherapy intervention, physical exercise, rehabilitation techniques, balance training, diabetic neuropathy, and diabetic peripheral neuropathy. The inclusion criteria consisted of studies that were randomized clinical trials, crossover trials, or controlled trials published in the English language from 2015 to 2021, identifying DN as the primary concern, and physiotherapy intervention as one of the treatment options. Results: The primary search of the database turned up an entire set of 58 studies, among which 11 studies were selected as potentially meeting the inclusion criteria. Ultimately, four studies were retained for the final results of the review. The evaluations provided evidence to suggest that physiotherapy has positive effects on subjects with diabetic peripheral neuropathy. Conclusion: After reviewing, it has been revealed that balance and strength training are applicable for improving balance, gait, and physical function in DN patients. [ABSTRACT FROM AUTHOR]

Background. Poor oral health is highly prevalent among elderlies and may impact quality of life of elderly people. In this scenario, oral health has been often linked to general health and chronic disorders, including distinct features of frailty. The aim of the present umbrella review of systematic reviews was to assess the scientific literature on the correlation between oral health related quality of life (OHRQoL) and elderly to present a multidisciplinary approach to these complex patients. Methods. We performed a literature search of the databases Pub-Med/Medline, Scopus, Web of Science, and Physiotherapy Evidence Database electronic databases. Two independent reviewers performed the literature research from the inception to 25th November 2023 and screened the studies for eligibility. Results. The search resulted in a total of 676 results eligible articles. After removal of duplicates and full-text screening, a total of 3 systematic reviews were considered to meet the inclusion criteria and were included for this review. Conclusions. Frailty is very common in elderly such as a poor oral health. In this scenario, malnutrition and bad lifestyle habits may affect not only the determinism of many systemic non-communicable diseases but also oral health quality. Taken together, the findings of this umbrella review of systematic reviews showed a strict correlation between the frailty, typical condition of ageing people, and a poor OHRQoL. Therefore, it is mandatory to implement the oral health prevention with specific protocols of oral rehabilitation to improve the OHRQoL in elderly. [ABSTRACT FROM AUTHOR]

Background and Objectives This study systematically explores the association between community green space and preventing kidney failure among middle-aged and older adults in China, using street view data. Research Design and Methods The 33 Chinese Community Health Study was used to conduct the analysis. We used street view data to assess street view green space (SVG) exposure and clearly distinguished the difference between grass (SVG-grass) and trees (SVG-tree). The normalized difference vegetation index (NDVI) was also used. Kidney failure was defined as a serum creatinine concentration of above 177 mol/L. We used multilevel logistic regression models (controlled for a series of covariates) to examine the associations between SVG and the odds of middle-aged and older adults having kidney failure. We also tested whether middle-aged and older adults from socioeconomically disadvantaged groups are likely to derive greater benefits from the effects of green space ("equigenesis"). Results The results showed that both SVG (OR = 0.353; 95% CI = 0.171–0.731) and SVG-trees (OR = 0.327; 95% CI = 0.146–0.736) were negatively associated with the likelihood of middle-aged and older adults experiencing kidney failure, but there was no significant evidence of any links between either SVG-grass (OR = 0.567; 95% CI = 0.300–1.076) or the NDVI (OR = 0.398; 95% CI = 0.237–1.058) and kidney failure. Furthermore, the moderation analysis indicated that income and educational attainment have a moderating effect on the association between green space and the improvement of kidney health, which suggests that green space has greater positive effects on the kidney health of disadvantaged groups. Discussion and Implications To reduce inequalities in relation to kidney disease through urban planning, policymakers are advised to provide more visual green space—especially trees—within the community and to focus in particular on socioeconomically disadvantaged population groups. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Community Service & Empowerment is the property of Journal of Community Service & Empowerment 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.)

Context • Adequate intestinal preparation is the key to colonoscopies. The population of older adults in China is developing rapidly, and their incidence of intestinal lesions is relatively high. The failure rate of intestinal preparation of these older adults is high. Objective • The study intended to develop and implement an evidence-based practice program, based on the best evidence available and combined with information about an endoscopy center’s clinical situation, to improve the qualified rate and quality of the intestinal preparation of older patients and to reduce the waste of medical resources. Design • Using the method of evidence-based nursing, the research team performed a literature search for the relevant guidelines for intestinal preparation for colonoscopies, developed a program using evidence-based practices, and conducted a prospective study using the indicators developed. Setting • The study took place at the Center for Digestive Endoscopy at Shanxi Provincial People’s Hospital, a Grade-3A hospital, in Taiyuan City, Shanxi Province, China. Participants • Participants were 120 older adults who underwent a colonoscopy between July and September 2021 and 60 older patients who did so between October and December 2021. The patients from July through September became the baseline group, and the patients from October through October became the postintervention group. Outcome Measures • Set up an evidence-based practice group that included an evidence-based expert group and a review team, with members from the Center for Digestive Endoscopy. The practice group: (1) performed a literature review and developed the review’s content; (2) conducted a baseline review of the endoscopy center’s nursing procedures; (3) analyzed the promoting and hindering factors based on the review’s results; (3) conducted a study with older adult patients that compared the changes between baseline and postintervention in the qualified rate of intestinal-preparation cleanliness, dietary restrictions during intestinal preparation, and the compliance rate for medications and exercise; and (4) measured patients’ incidence of adverse reactions and the nurses’ implementation rate of intestinal-preparation education. Results • The postintervention group’s qualified rate of intestinal cleanliness, at 48 participants (80%), was significantly higher than that of the baseline group, at 35 participants (58.3%), with P = .010. For the intestinal preparation, the postintervention group’s compliance with dietary restrictions, use of medications, and performance of exercise was significantly higher than that of the baseline group (all P<.001). The postintervention group’s incidence of adverse reactions, such as abdominal distension, was significantly lower (P < .05), while the incidence of abdominal pain, headache, dizziness, and other adverse reactions were significantly different between the groups (P > .05). At baseline, the implementation rate by nursing staff in the endoscopic center for the baseline group was less than 50% for four indicators, but the implementation rate for the postintervention group for those indicators was significantly higher (P<.05). Conclusions • The best evidence for methods of intestinal preparation effectively reduced the adverse reactions of older patients and improved their compliance and the cleanliness of the intestinal preparation. The management of intestinal preparation using an evidence-based nursing practice can effectively standardize the process of intestinal preparation before colonoscopies and improve the cleanliness of and patients’ compliance with intestinal preparation. [ABSTRACT FROM AUTHOR]

Context • Because the early symptoms of primary hepatocellular carcinoma (PHC) aren’t significant, it’s difficult to diagnose it by routine inspection clinically, and if the lesion’s diameter is small, less than 2.0 cm, false negatives can occur in pathological examinations. Researchers need to actively search for more diagnostic methods. Objective • The study intended to detect and analyze the value of plasma Septin9 gene methylation for the diagnosis and therapeutic monitoring of PHC in older adults. Design • The research team performed a prospective controlled study. Setting • The study took place at the First Hospital of Qiqihar, an Affiliated Qiqihar Hospital at Southern Medical University in Qiqihar, China. Participants • Participants were 32 patients with PHC and 28 with cholangiocarcinoma (CCA) who had been admitted to the hospital between January 2021 and July 2022 and 40 healthy individuals. Groups • The research team divided participants into three groups: (1) patients with PHC, the PHC group; (2) patients with CCA, the CCA group; and (3) healthy individuals, the control group. Outcome Measures • The research team: (1) determined the positive expression rate of Septin9 gene methylation; (2) measured liver function indicators—alanine aminotransferase (ALT), aspartate aminotransferase (AST), serum total bilirubin (TBIL), direct bilirubin (DBIL), alkaline phosphatase (ALP), γ-glutamyl transpeptidase (GGT), albumin (ALB); and (3) measured tumor markers—alpha-fetoprotein (AFP), carbohydrate antigen (CA) 199, CA125, and CA153. The team also: (1) established a binary logistic regression model based on levels of GGT and plasma Septin9 gene methylation to analyze risk factors and diagnosis accuracy, (2) created a receiver operating characteristic (ROC) curve to analyze diagnostic values; and (3) during followup, analyzed the negative conversion rate of Septin9 gene methylation in participants. Results • The positive expression rate of Septin9 methylation in the PHC group was significantly lower than that that of the CCA group and significantly higher than that of the control group (P<.05). The PHC group’s ALT, AST, TBIL, DBIL, ALP, and GGT were significantly higher than those of the control group but significantly lower than those of the CCA group (all P < .05). PHC group’s ALB was significantly lower than that of the control group (P<.05). The PHC group’s AFP, CA199, and CA125 were significantly higher than those of the control group, and the PHC group’s CA199 and CA125 were significantly lower than those in the CCA group (all P < .05). The positive expression of Septin9 gene methylation and the high expression of GGT were risk factors for PHC (OR>1, P < .05). The AUC of the Septin9 gene methylation, the GGT level, and the combined detection of both variables (all AUC > 0.70), suggests that the variables have a diagnostic value in the detection of PHC, with the combined detection having the highest value. The negative conversion rate after surgery of Septin9 gene methylation was 87.10%, for 27 out of 31 participants in the PHC and CCA groups (χ² = 29.405, P<.001). Conclusion • Plasma Septin9 gene methylation is a sensitive molecular marker for the diagnosis and therapeutic monitoring of older adults with PHC, and combined with the serum GGT level, has a high diagnostic efficiency, which may reflect the treatment status of patients. [ABSTRACT FROM AUTHOR]

Context • Fatigue is the most common symptom experienced by elderly cancer patients. It negatively affects their daily functioning and quality of life. Integrative approaches such as acupressure can be used to treat cancer-related fatigue in elderly patients. Objectives • The aim of this study was to investigate the effect of acupressure on the severity and level of cancerrelated fatigue in elderly patients with cancer. Design • This study was carried out in two stages comprising a quantitative study (pretest, posttest, randomized controlled) and a qualitative study (in-depth interview). Setting • The study was conducted at the hematology and medical oncology clinic in a university hospital in Turkey. Participants • The study included 31 cancer patients aged 65 and over, who were experiencing cancer-related fatigue. Intervention • Participants were randomly assigned to the acupressure group (intervention group) or the control group. The intervention group was administered acupressure on three acupuncture points on the hands and legs (LI4, SP6, ST36) by caregivers or the patients themselves for three minutes twice daily, for a period of four weeks. The acupressure group was examined before and after the fourweek intervention. The control group was similarly examined though no intervention was applied. Outcome Measures • Data were collected using Patient Information Form, Visual Analog Scale (VAS), Piper Fatigue Scale (PFS), and Acupressure Experience Patient Opinion Form. Results • In the follow-up examination of individuals in the acupressure group, there was a significant reduction in the severity and level of fatigue compared to the first examination. However, there was no significant difference between the first and second examination of individuals in the control group. The qualitative findings obtained during the in-depth interview support the quantitative findings of the study. Conclusion • Acupressure can be recommended as an integrative treatment for cancer-related fatigue because it is effective, easy to use, tolerable and does not cause serious side effects. [ABSTRACT FROM AUTHOR]

Atopic dermatitis (AD) is a chronic, recurrent inflammatory dermatosis. The most characteristic symptoms of the disease include itch, eczematous eruptions and excessive dryness of the skin. Elderly patients with AD represent a poorly characterized population because the physiological ageing, possible comorbidity and polypharmacy modify the clinical presentation typically observed in the younger age groups. The aim of the study is to comprehensively assess the clinical characteristics of elderly patients (>60 years old) with AD. Data were collected from 26 AD patients treated in the Department of Dermatology of the University Hospital in Krakow. Late-onset AD with generalized/prurigo lesions was the most predominant phenotype. Skin biopsy was required in 15 (58%) patients in the differential diagnosis process. Allergic rhinitis, a positive family history of atopy and xerosis were associated with a higher number of hospitalizations during the year prior to the last admission (p = 0.034, p = 0.046 and p = 0.036, respectively). Xerosis was more prevalent among subjects with polypharmacy (p = 0.046) and higher serum total IgE concentration (p = 0.048). AD in elderly patients is a new phenotype of the disease that requires careful differential diagnosis. Aged patients with an individual or family history of atopy, due to the increased incidence of severe exacerbations of AD, may benefit from the introduction of proactive therapy. [ABSTRACT FROM AUTHOR]

Background • Dementia, a degenerative disease, requires alternative treatment to maintain function, but previous studies suggest only the therapeutic effect of a temporary program. Primary Study Objective • The current study aimed to examine the effects of assistive technologies on cognitive function, daily living ability, and psychosocial symptoms in elderlies with mild cognitive impairment, elderlies with mild dementia and their caregivers. Design • The research team designed an experimental study that used application as the intervention. Setting • To recruit participants living in the local community, research participation was supported through local public health centers, welfare centers, and social welfare organizations. Evaluation and intervention were conducted by visiting the participant’s home. Participant • The study participants were 29 Mild Cognitive Impairment (MCI) and 16 mild Alzheimer type dementia (AD) patients over the age of 75 with a total of 45 patients, 10 MCI caregivers and 11 AD caregivers with a total of 21 caregivers. Intervention • The assistive technologies used for intervention are 3 area (8 daily living assistive devices, 7 safety assistive technologies, and 7 cognitive assistive technologies). Up to 5 assistive technologies were provided to one subject, and they were instructed to use them every day for 8 weeks. Outcome measure • Participants were evaluated at baseline and postintervention using specific scales appropriate to an area: cognitive function, activities of daily living, depression, anxiety, quality of life, satisfaction. Results • Cognitive function showed statistically significant changes in the MCI group. Basic activities of daily living, depression, anxiety, quality of life, satisfaction showed statistically significant positive effects in both MCI and AD groups. Instrumental activities of daily living did not show any statistically significant differences. Conclusion • As an alternative to dementia care in the future, the application and management of assistive technologies for each area should be provided at the government level. [ABSTRACT FROM AUTHOR]

Despite a rising trend in intrahepatic cholangiocarcinoma (ICC) incidence in the elderly population worldwide, the benefit of surgery for those patients is still controversial. Data from 811 elderly patients diagnosed with non-metastatic ICC were obtained from the US surveillance, epidemiology, and end results (SEER) program database. Propensity score matched (PSM) was conducted for the better balance of baseline. The associations between tumor characteristics and surgery with overall survival (OS) and cancer specific survival (CSS) were estimated using hazard ratios (HR) and 95% confidence intervals (CI). The results showed that ICC patients above 60 years old taking surgery had better OS (hazard ratio [HR], 0.258; 95% CI, 0.205–0.324) and CSS (hazard ratio [HR], 0.239; 95% CI, 0.188–0.303) than patients without surgery. Similar trends in patients above 65 years old, above 70 years old, above 75 years old, and above 80 years old were observed, separately. This benefit was also showed in lymph node-negative (N0) and lymph node-positive (N1) subgroups and N0 patients are more likely to take an advantage from surgery than N1 patients. The different outcomes between surgery and non-surgery suggest that surgical treatment may be recommended for elderly ICC if the tumor is resectable to ensure optimal treatment. [ABSTRACT FROM AUTHOR]

Degenerative diseases are the leading cause of death globally. World Health Organization data shows that of the 57 million deaths that occur in the world, as many as 36 million or almost two thirds are caused by degenerative diseases. To determine the relationship between knowledge and degenerative disease prevention behavior in the elderly in Patok Hamlet, Marunsu Village, Samalantan District in 2022. The method used in this study is analytic observational with a cross-sectional study approach. The sampling technique in this study used total sampling, namely taking samples from the entire existing population, namely all elderly people with degenerative diseases in Patok Hamlet, Marunsu Village, Samalantan District. Data was collected using a questionnaire. The analysis technique uses the chi-square test. The results show that as many as 64.3% of respondents has lack knowledge. Negative behavior was reported by 53.6% respondents. There was a significant relationship between respondents' knowledge and prevention of behavior (p<0.05). There is a relationship between respondents' knowledge and prevention behavior regarding degenerative diseases in the elderly in Patok Hamlet, Marunsu Village, Samalantan District. [ABSTRACT FROM AUTHOR]

This study compared performances of timed up and go test subtasks between 40 older people with preserved cognition, 40 with mild cognitive impairment, and 38 with mild Alzheimer's disease. The assessment consisted of anamneses and timed up and go test subtasks (sit-to-stand, walking forward, turn, walking back, and turn-to-sit). Data were captured by Qualisys Track Manager software and processed by Visual3D software. The MATLAB program was applied to detect and analyze timed up and go test subtasks. All subtasks differentiated people with Alzheimer's disease and preserved cognition, except the sit-to-stand subtask, which did not distinguish any group. The walking forward subtask differed older people with preserved cognition from mild cognitive impairment, specifically on minimum peak of knee, average value of knee, and hip (pitch axis) during stance phase. The walking back, turn, and turn-to-sit subtasks distinguished subjects with Alzheimer's disease from mild cognitive impairment. The separated analysis of transition and walking subtasks is important in identifying mobility patterns among cognitive profiles. [ABSTRACT FROM AUTHOR]

Background: The life expectancy of individuals with trisomy 21 (Down syndrome, DS) has risen to more than 60 years over the past few decades. As a result, diseases arising in mid and later life have become an issue of major concern in the care of individuals with DS. This article discusses and summarizes, from a multidisciplinary perspective, the diseases commonly affecting this population. Methods: This narrative review is based on publications identified by a selective literature search, extrapolation of the available evidence, and the authors' personal experience. Results: Robust epidemiological evidence indicates that many different diseases, which are dealt with by many different medical specialties, are more common in individuals with DS. The genetic background of some of these diseases is now understood down to the molecular level, e.g., primary hypothyroidism or Alzheimer's disease in DS. Recent gains in epidemiological and pathophysiological understanding contrast with a dearth of evidence on treatment for most of these disorders. Conclusion: In view of the complexity of DS-associated morbidity, it would be desirable for DS-specific multidisciplinary care to be made available to patients with DS. [ABSTRACT FROM AUTHOR]

Background: Non-alcoholic fatty liver disease (NAFLD) has emerged as a significant health issue due to its association with a growing proportion of cirrhosis and other chronic liver diseases (CLDs). To obtain a profound understanding of the burden of cirrhosis and other CLDs due to NAFLD, we aim to present a comprehensive analysis from 1990 to 2019. Methods: The study utilized data from the Global Burden of Disease database. Results: From 1990 to 2019, the global incidence, prevalence, death, and disability-adjusted life year (DALY) numbers increased 93%, 120%, 77%, and 62%, respectively. Despite the age-standardized death rate (ASDR) and the age-standardized DALY decreased, the age-standardized incident rate (ASIR) and agestandardized prevalent rate (ASPR) increased from 1.50 to 1.63 and 12065.15 to 15022.90 per 100,000 people, respectively. A higher incidence rate was observed among middle-aged individuals, while a higher prevalence, death, and DALY rates were among the elderly. Males remained higher number of prevalence, death, DALY cases than females. The low-middle and high socio-demographic index (SDI) region had the highest increase of ASIR and ASPR, respectively. The low SDI region had the largest decrease in ASDR and age-standardized DALY. Conclusions: An increasing cases of cirrhosis and other CLDs due to NAFLD was observed. The ASIR and ASPR showed a worsening trend, while ASDR and age-standardized DALY showed an improving trend. Middle-aged and older people are more susceptible. Males experienced a higher burden than females. [ABSTRACT FROM AUTHOR]

Background: Older adults suffering from traumatic brain injury (TBI) are subject to higher injury burden and mortality. Do Not Resuscitate (DNR) orders are used to provide care aligned with patient wishes, but they may not be equitably distributed across racial/ethnic groups. We examined racial/ethnic differences in the prevalence of DNR orders at hospital admission in older patients with severe TBI. Methods: We conducted a retrospective cohort study using the National Trauma Databank (NTDB) between 2007 to 2016. We examined patients ≥ 65 years with severe TBI. For our primary aim, the exposure was race/ethnicity and outcome was the presence of a documented DNR at hospital admission. We conducted an exploratory analysis of hospital outcomes including hospital mortality, discharge to hospice, and healthcare utilization (intracranial pressure monitor placement, hospital LOS, and duration of mechanical ventilation). Results: Compared to White patients, Black patients (OR 0.48, 95% CI 0.35-0.64), Hispanic patients (OR 0.54, 95% CI 0.400.70), and Asian patients (OR 0.63, 95% CI 0.44-0.90) had decreased odds of having a DNR order at hospital admission. Patients with DNRs had increased odds of hospital mortality (OR 2.16, 95% CI 1.94-2.42), discharge to hospice (OR 2.08, 95% CI 1.75-2.46), shorter hospital LOS (-2.07 days, 95% CI -3.07 to -1.08) and duration of mechanical ventilation (-1.09 days, 95% CI -1.52 to -0.67). There was no significant difference in the utilization of ICP monitoring (OR 0.94, 95% CI 0.78-1.12). Conclusions: We found significant racial and ethnic differences in the utilization of DNR orders among older patients with severe TBI. Additionally. DNR orders at hospital admission were associated with increased in-hospital mortality, increased hospice utilization, and decreased healthcare utilization. Future studies should examine mechanisms underlying race-based differences in DNR utilization. [ABSTRACT FROM AUTHOR]

Background: Hypertension is currently a non-contagious disease that primarily affects the elderly population in Indonesia. Medication adherence is critical in managing hypertension and reducing the risk of morbidity and mortality. Previous research has found that loneliness and support received by older adults with hypertension influence medication adherence. Objective: This study aimed to examine the impact of feeling lonely and receiving social support on medication adherence in the elderly with hypertension at the Community Health Center in Surabaya. Methods: The study design of this research was a descriptive cross-sectional study from December 2021 to March 2022. A total of 235 eligible subjects fulfilled the inclusion criteria. The instruments used in the data collection were the patient's information form, UCLA-Loneliness Scale, MOS-Social Support Survey, and the ARMS (Adherence to Refill and Medication Scale). Results: The results revealed that the correlation between loneliness and social support was significantly associated with medication adherence in the elderly with hypertension (p < 0.05). In addition, other factors, such as occupation status, living status, comorbidity, the number of drugs taken, and antihypertensive drug therapy, showed a significant correlation with medication adherence (p < 0,05). The most influential factor on medication adherence was loneliness (35.5%), followed by social support (24.4%), the number of drugs taken (7.1%), antihypertensive drug therapy (monotherapy or combination therapy (2.5%), occupation status (2.4%), comorbidity (1.6%), and living status (0.2%). Conclusion: This study confirms that feeling lonely and receiving social support affect medication adherence in the elderly with hypertension at the Community Health Center in Surabaya. [ABSTRACT FROM AUTHOR]

Background and Objectives Neighborhood environments are increasingly recognized as associated with mental well-being among older adults. However, their underlying mechanisms remain unclear. This study investigated mediating effects of cognitive and structural social capital (SC) in relationships between neighborhood environments and mental well-being among older adults. Research Design and Methods We conducted a cross-sectional analysis of 1,277 community-dwellers aged 60 years and older in Hong Kong in 2021. The Warwick–Edinburgh Mental Well-being Scale assessed mental well-being. Perceived age-friendly environment was assessed. Objective neighborhood environment was measured by the number of neighborhood facilities (e.g. transportation, community centers, leisure facilities) within 200-m and 500-m buffer areas from respondents' residences. Structural equational modeling was used. Results Perceived age-friendly environment regarding community and health support had a protective role on mental well-being. More community centers were directly associated with better affective-emotional well-being, while more passive leisure facilities directly lowered psychological-functioning well-being. Cognitive SC outweighed structural SC in mediating relationships of neighborhood environment on mental well-being. Discussion and Implications Our findings advance the ecological model of aging by providing evidence for cognitive and structural SC as mediators to explain the relationship between neighborhood environment and mental well-being. Policy implications for optimizing mental well-being in aging societies are discussed. [ABSTRACT FROM AUTHOR]

Background and Objectives To assess the impact of an evidence-based self-management intervention adapted through a community-engaged process for African American midlife and older adults with heart disease and/or cardiovascular risk factors. Research Design and Methods Adults 50 years and over, living in or near Detroit, MI, with diagnosed heart disease or greater or equal to two major risk factors for heart disease, were randomized to a 7-week group-format program called Take Heart , or a usual-care control group. Take Heart included education about heart disease and support for behavioral lifestyle change, using a goal-setting process based on self-regulation theory. Outcome data were collected via telephone surveys at baseline and 1 year from baseline. Primary outcomes were self-reported emergency department visits and hospitalizations in the last year. Secondary outcomes were health-related quality of life (PROMIS-29 Adult Profile) and cardiac symptom burden. Results A total of 453 participants enrolled (74% female, 84% African American, mean age 65.4 years; 55% with diagnosed heart disease and 45% with risk factors only); 362 provided baseline and follow-up data. Using generalized linear and binomial regression models, at 12-month follow-up, there were no significant differences between intervention and control groups in ED visits or hospitalizations. Intervention versus control participants had greater improvements in PROMIS fatigue (p =.003) and sleep (p =.04) subscales as well as cardiac symptom burden (p =.04). Discussion and Implications The Take Heart intervention was associated with modest improvements in sleep, fatigue, and cardiac symptom burden. Take Heart was well received and has potential for dissemination by agencies serving older adults. Clinical Trial Registration Number: https://www.clinicaltrials.gov/ct2/show/NCT02950818 [ABSTRACT FROM AUTHOR]

Introduction. The study aim was to estimate the prevalence of sarcopenia in community-dwelling Nigerian older adults using the Asian Working Group for Sarcopenia (AWGS) and the revised European Working Group on Sarcopenia in Older People (EWGSOP2) references. Methods. A total of 767 community-dwelling older adults aged ≥60 years were recruited for the study. Sarcopenia was defined in accordance with the AWGS and EWGSOP2 references. Results. As for the AWGS reference, 24.4% (95% CI: 21.4-27.6) of older adults had sarcopenia and the prevalence was significantly similar between men and women (p = 0.18); whereas with the EWGSOP2 reference, 36.2% were classified as having sarcopenia and the prevalence was significantly higher in men (p < 0.001). The agreement between the AWGS and EWGSOP2 criteria in estimating the prevalence of sarcopenia was moderate (= 0.591), with EWGSOP2 showing higher sensitivity (0.882). In accordance with the 2 references, the multivariable logistic regression showed that age was consistently associated with increased odds of sarcopenia, whereas female gender, muscle strength, and physical performance were significantly associated with decreased odds of sarcopenia in older adults (p < 0.001). Conclusions. The EWGSOP2 reference, compared with the AWGS reference, is more likely to identify older individuals with sarcopenia. Both references showed that muscle strength and physical performance were associated with a decreased risk of sarcopenia. Clinicians may use the EWGSOP2 reference criteria for early diagnosis and management of sarcopenia in older adults. [ABSTRACT FROM AUTHOR]

Background: Due to the importance of anxiety and its common symptoms with other physical and mental diseases in elderly patients, valid screening measures are needed. Based on this need, the present study attempted to assess the reliability and validity of the Persian version of the Rating Anxiety in Dementia (RAID). Methods: This research was a cross-sectional study on the development and localization of instruments, conducted on 209 patients with dementia referring to psychiatry clinics of the elderly in Isfahan, Iran, with the convenience sampling method. The procedures for RAID localizations were translated and back-translated in 2021 using central and distributive tendencies and inferential statistical methods, internal consistency of the scale and exploratory factor analysis (EFA) were tested. To conduct the statistical calculations, SPSS software was used. Results: 209 participants with a mean age of 52.6 ± 13.3 were selected. Seventy-eight participants were men (37.3%), and 126 were women (60.3%). The Cronbach's alpha coefficient was found to be 0.89. Based on the varimax rotation, in the five-factor model (according to principal component analysis, irritability, tension, anxiety, worry, weakness), questions 2 and 11 were removed for weak factor loading, and eigenvalue was explained by 66.2% variance. The convergent validity between Mini-Mental State Examination (MMSE) scale and RAID was positive (r = 0.25, P = 0.002). Conclusion: The findings confirmed the validity and reliability of the Iranian version of RAID as an appropriate instrument for screening anxiety in elderly patients with dementia. [ABSTRACT FROM AUTHOR]

Lumbar degenerative disease is a common problem in an aging society. Oblique lateral interbody fusion (OLIF) is a minimally invasive surgical (MIS) technique that utilizes a retroperitoneal antepsoas corridor to treat lumbar degenerative disease. OLIF has theoretical advantages over other lumbar fusion techniques, such as a lower risk of lumbar plexus injury than direct lateral interbody fusion (DLIF). Previous studies have reported favorable clinical and radiological outcomes of OLIF in various lumbar degenerative diseases. The use of OLIF is increasing, and evidence on OLIF is growing in the literature. The indications for OLIF are also expanding with the help of recent technical developments, including stereotactic navigation systems and robotics. In this review, we present current evidence on OLIF for the treatment of lumbar degenerative disease, focusing on the expansion of surgical indications and recent advancements in the OLIF procedure. [ABSTRACT FROM AUTHOR]

Background: As the proportion of elderly population grows, it raises concern about impaired oral health which has been reported to be associated with increased risk of numerous adverse health events. Emerging study defined oral frailty as poor oral health accumulation and demonstrated that oral frailty was a risk factor of disability, physical frailty and mortality. In this study, we examined the association between subjective oral dysfunction and all‐cause mortality in the United States. Methods: In this cross‐sectional observational study, a total of 7827 participants who completed oral functions data from 1999 to 2002 NHANES database were recruited. Subjective oral dysfunction included 3 components: limited eating ability, dry mouth and difficult swallowing, which were obtained from self‐reported questionnaire. For primary outcome, all‐cause mortality was followed from baseline to death or 2006. The relationship of subjective oral dysfunction and all‐cause mortality was assessed by Cox regression model. Results: A statistically significant relationship between subjective oral dysfunction and all‐cause mortality was observed in fully adjusted model. Participants with more components of subjective oral dysfunction had worse risk of all‐cause mortality. Limited eating ability was inversely associated with muscle strength. Conclusion: Subjective oral dysfunction which was obtained from an easy self‐assessment survey might be a potential risk factor for all‐cause mortality and could be used for initial screening during general health examination. [ABSTRACT FROM AUTHOR]

Objectives: Previous studies have found that severe acute respiratory syndrome (SARS) was associated with the physical and psychological stress of those infected. However, research is sparse regarding the long‐term health consequence of community SARS exposure for older adults. Methods: Using data from the 2011 and 2015 China Health and Retirement Longitudinal Study (CHARLS), we estimated multilevel regression models of allostatic load (AL) in the years after the SARS epidemic among 7735 respondents. Interaction terms between SARS epidemic exposure and social participation or community environment were included to examine potential effects. Results: We found that community SARS exposure was associated with greater AL for those who had no social participation. Among those who were in worse community environment, community SARS exposure was strongly related to elevated load in the cardiovascular system. However, for those had social participation and lived in better community environment, community SARS exposure manifested no association with AL years later. Active social participation and better community environment could offset the negative association between SARS exposure and AL. Conclusions: Taken together, these findings helped determine the positive direction of future social efforts and policy decisions to guide the global recovery from the devastating COVID‐19 pandemic. [ABSTRACT FROM AUTHOR]

Background and Objective: Periodontal disease is one of the most common chronic oral diseases worldwide. A variety of foods may affect periodontal health. Due to the importance of periodontal health in the old age, this study was designed to investigate the association between carbohydrate intake and periodontal health in the elderly in Amirkola, northern Iran. Methods: This cross-sectional study is part of the second phase of the Amirkola Health and Ageing Project (AHAP). The evaluated participants included 400 elderly people (200 men and 200 women). Socio-demographic data of all subjects were recorded in the information form. Periodontal status, including plaque index (PI), periodontal disease index (PDI) and Oral Hygiene Index (OHI) were evaluated. Then, the Semi-Quantitative Food Frequency Questionnaire (SQFFQ) was completed in order to receive daily carbohydrates in grams per day for all Participants. Then, the relationship between carbohydrate intake and periodontal health was evaluated. Findings: The participants consumed an average of 316±102.4 gr/day carbohydrates. The mean range of PI, OHI, PDI and in the high carbohydrate intake (>300 gr) group were 2.18±1.39, 2.84±1.51 and 1.51±0.86, respectively, and this rate was lower than the group with low carbohydrate intake (<300 gr) (1.96±1.52, 2.56±1.53 and 1.37±0.91), but the difference between the two groups was not significant. Conclusion: In the present study, there was no relationship between periodontal health indices and carbohydrate intake. [ABSTRACT FROM AUTHOR]

Objective: To examine the cross‐sectional association of ascending pain mechanisms, implicated in pain sensitization, and descending pain modulation with pain patterns and unpredictability of pain. Methods: The Multicenter Osteoarthritis Study is a longitudinal cohort of older adults with or at risk of knee osteoarthritis. Peripheral and central ascending pain mechanisms were assessed using quantitative sensory tests, pressure pain thresholds using a handheld pressure algometer (knee/peripheral and wrist/central), and temporal summation using weighted probes (wrist/central). Descending modulation was assessed by conditioned pain modulation using pressure pain thresholds and a forearm ischemia test. Pain patterns were characterized based on responses to the Intermittent and Constant Osteoarthritis Pain questionnaire: 1) no intermittent or constant pain, 2) intermittent pain only, 3) constant pain only, and 4) combined constant and intermittent pain. A question regarding frequency assessed unpredictable pain. We assessed the association of quantitative sensory test measures to pain patterns using regression models with generalized estimating equations. Results: There were 2,794 participants (mean age 63.9 years, body mass index 29.5 kg/m2, and 57% female). Lower pain sensitization by wrist pressure pain threshold (odds ratio [OR] 0.80 [95% confidence interval (95% CI) 0.68, 0.93]) and adequate conditioned pain modulation (OR 1.45 [95% CI 1.10, 1.92]) were associated with having constant ± intermittent pain compared with intermittent pain only. Higher pain sensitization (by pressure pain thresholds and temporal summation) was associated with a higher likelihood of unpredictable pain. Conclusion: Knee pain patterns appear to be related to peripheral ± central facilitated ascending pain mechanisms and descending modulatory mechanisms. These findings highlight the need for a broader approach to understanding pain mechanisms by symptomatic disease progression. [ABSTRACT FROM AUTHOR]

The present study aimed to clarify the difference in physical activity (PA) due to sarcopenia in community-dwelling older adults with long-term care insurance (LTCI). This was a cross-sectional study that investigated data of 97 consecutive community-dwelling older Japanese adults with LTCI who underwent rehabilitation at one day care center in Japan from November 2018 to May 2019. Sarcopenia was determined according to criteria of the AsianWorking Group for Sarcopenia. Unpaired t-test, Mann-Whitney U test, chi-square test and analysis of covariance were used to compare participant characteristics and clinical parameters between the older adults with and without sarcopenia. A receiver operating characteristic (ROC) curve was constructed to determine the cut-off value of PA for sarcopenia. The sarcopenia group (n = 20) had significantly lower body mass index (BMI), skeletal muscle mass index, gait speed, and PA than those in the no sarcopenia group (n = 28) (p < 0.05). After adjustment for BMI and sex, the sarcopenia group showed significantly lower PA than the no sarcopenia group. Findings showed that the cut-off value of PA indicating sarcopenia by ROC curve analysis was 1494.4 steps/day (p < 0.05); this value may aid in identifying sarcopenia in older adults with LTCI. [ABSTRACT FROM AUTHOR]

We present an 81-year-old man who presented for evaluation of an indurated plaque with an exophytic, pearly, skin-red-brown colored nodule with central ulceration on his chest that evolved over the course of several months and was initially suspected to be basal cell carcinoma. Biopsy demonstrated histological features of dermal spindle cell proliferation in a storiform fashion with CD34 positivity confirming a diagnosis of dermatofibrosarcoma protuberans (DFSP). Dermatofibrosarcoma protuberans are rare, slowly progressive soft tissue sarcomas. The rate of DFSP is greatest among African Americans (8.3/1,000,000), occurring nearly twice as frequently when compared to Caucasians. Aside from race/ethnicity, age, and skin trauma, no specific risk factors are associated with DFSP. Complete excision is curative. Given its pearly skin colored appearance, papular/nodular/atrophic morphology variants, and tendency to form indurated plaques, DFSP may be mistaken for nodular and morpheaform basal cell carcinoma subtypes, as well as a variety of other conditions. This case highlights the importance of maintaining DFSP on the differential diagnosis of slowly progressive nodules and indurated plaques, especially in African Americans. [ABSTRACT FROM AUTHOR]

Hyaluronic acid (HA) intra-articular injections are increasingly used for the treatment of knee osteoarthritis. Described adverse reactions of HA intra-articular injections include injection site pain or swelling. A 71-year-old man and a 65-year-old woman independently presented with photodistributed lesions shortly after receiving a repeat HA injection (hylan G-F 20) intra-articularly. A punch biopsy was performed which was consistent with a photodrug or hypersensitivity reaction. Two cases are presented to describe a novel presentation of a photosensitivity reaction to HA. [ABSTRACT FROM AUTHOR]

Primary cutaneous diffuse large B-cell lymphoma, leg type is a rare entity accounting for 4% of all primary cutaneous lymphomas whose clinical presentation encompasses a range of possibilities. COVID-19 has caused a delay in diagnosis of malignant neoplasms and consequently, this has resulted in poorer prognoses. A 62-year-old woman presented with two smooth-surfaced, mobile, well-circumscribed, oval, skin-colored nodules approximately one-cm in diameter with nonerythematous borders on the lower third of the left leg. Two months later, eleven nodules measuring between one and 1.5cm with erythematous halo, slight scaling, central erosion, and crusting had appeared. Histological study showed moderate pericapillary lymphocytic infiltration in the papillary and reticular dermis and prominent diffuse proliferation of medium to large cells in the subcutis. These exhibited irregular vesicular nuclei, a conspicuous solitary nucleolus of two to three small nucleoli, and three mitoses per high power field. Adipocytes were consistently encircled by neoplastic lymphocytes. Primary cutaneous diffuse large B-cell lymphoma, leg type is a high-grade lymphoma that can manifest as a diagnostic challenge and requires adequate immunohistochemistry and in situ hybridization studies for proper diagnosis, treatment, and prognosis. [ABSTRACT FROM AUTHOR]

Background: This study aimed to determine the prevalence and associated factors of dizziness in older community-dwelling adults in India. Methods: The cross-sectional sample was composed of 21,343 individuals (=65 years) from the Longitudinal Aging Study in India (LASI) Wave 1 in 2017-2018. Dizziness was assessed by determining if the individuals suffered from "persistent or troublesome dizziness or light headedness" in the past 2 years. Results: Women and men had the overall prevalence of 14.6%/17.2% and 11.6% in past 2-year dizziness, respectively. Adjusted logistic regression analysis revealed that sociodemographic factors (female sex), physical chronic conditions (angina), geriatric conditions (incontinence and impaired vision), stress and mental health (poor or fail self-rated health, perceived discrimination, neurological or psychiatric problems, insomnia symptoms, persistent headaches, and severe fatigue or exhaustion) and health risk behavior (tobacco use) were positively associated with dizziness. Conclusions: One in seven older adults in India had past 2-year dizziness. The factors associated with dizziness included female sex, angina, incontinence, impaired vision, poor or fair self-rated health, perceived discrimination, neurological or psychiatric problems, insomnia symptoms, persistent headaches, severe fatigue or exhaustion, and tobacco use. [ABSTRACT FROM AUTHOR]

Purpose: Racial and ethnic disparities in periodontal disease exist in the United States. This study examined the prevalence of self-reported periodontal disease, and the extent to which racial/ethnic disparities in the reported disease were reduced or eliminated after controlling for various risk factors in a multi-ethnic study population of older adults.Materials and Methods: Information from the baseline examination (July 2000-August 2002) of the Multi-Ethnic Study of Atherosclerosis (MESA) was used. Study participants (N = 6256) were age 45-84 years and identified themselves as either: white, black, Hispanic or Chinese. Periodontal disease was assessed by self-report; demographic and socioeconomic status (SES) indicators, biomedical risk factors and psychosocial stress factors were used as predictors of self-reported periodontal disease.Results: Chinese displayed the highest prevalence of self-reported periodontal disease (39.8%), followed by blacks (32.0%) and whites (26.0%), with Hispanics displaying the lowest prevalence (17.4%). Chinese and black participants had a significantly higher prevalence of disease compared to whites that persisted after adjusting for demographic and SES indicators, biomedical risk factors and psychosocial stress factors. After such adjustment, Hispanics did not differ significantly from whites in their reporting of disease.Conclusion: Racial/ethnic disparities in self-reported periodontal disease persisted after adjusting for all study covariates. This study highlights the need for continued research into the determinants of racial/ethnic disparities in periodontal disease in order to better target interventions aimed at reducing the burden of disease in all segments of the U.S. population. [ABSTRACT FROM AUTHOR]

Objective: To determine the associations of delirium with urinary tract infection (UTI) and asymptomatic bacteriuria (AB) in individuals aged 65 and older. Methods: The protocol for this systematic review and meta‐analysis was published on PROSPERO (CRD42020164341). Electronic databases were searched for relevant studies, professional associations and experts in the field were additionally contacted. Studies with control groups reporting associations between delirium and UTI as well as delirium and AB in older adults were included. The random effects model meta‐analysis was conducted using odds ratios (ORs) with 95% confidence intervals (CIs) as effect size measures. The Newcastle‐Ottawa scale was used to rate the studies' quality. Heterogeneity was assessed using the Q and I2 tests. The effects of potential moderators were investigated by both subgroup and meta‐regression analyses. The risk of publication bias was evaluated using the funnel plot and Egger's test. Results: Twenty nine relevant studies (16,618 participants) examining the association between delirium and UTI in older adults were identified. The association between delirium and UTI was found to be significant (OR 2.67; 95% CI 2.12–3.36; p < 0.001) and persisted regardless of potential confounders. The association between delirium and AB in older adults in the only eligible study found (192 participants) was insignificant (OR 1.62; 95% CI 0.57–4.65; p = 0.37). All included studies were of moderate quality. Conclusion: The results of this study support the association between delirium and UTI in older adults. Insufficient evidence was found to conclude on an association between delirium and AB in this age group. These findings are limited due to the moderate quality of the included studies and a lack of available research on the association between delirium and AB. Future studies should use the highest quality approaches for defining both delirium and UTI and consider AB in their investigations. [ABSTRACT FROM AUTHOR]