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Epidemiology of Aging: Unmet Needs

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Epidemiology & Public Health".

Deadline for manuscript submissions: closed (30 April 2025) | Viewed by 9359

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Special Issue Editor

Dr. Vincenza Frisardi

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Geriatric Acute Care, Orthogeriatric Unit & Center for Diagnosis of Cognitive Disorders and Dementia, IRCCS AOUBO, 40138 Bologna, Italy
Interests: gerontology; geriatric psychiatry; neurodegenerative diseases; cognition disorders; memory; cognitive rehabilitation; Alzheimer's disease; dementia; aging; aging research; oncology; geriatric

Special Issue Information

Dear Colleagues,

We have witnessed significant demographic changes in the health of older individuals across the globe in recent decades, and unmet healthcare needs are expected to increase exponentially. Unmet needs rely on the difference between the healthcare services deemed necessary and the services received.

We are excited to invite you to contribute to this Special Issue of the Journal of Clinical Medicine, aiming to increase our understanding of the epidemiology of aging through the lens of medical and non-medical unmet needs in our target group. We aim to explore the associated factors of developing negative outcomes by covering various critical points (ethical, policies, healthcare models and health service provision for older individuals in line with these unmet needs). We also want to give space to innovative research, particularly in the context of aging in place, healthy aging and unmet needs.

The topics of interest for publication include, but are not limited to, the clinical dimension of unmet needs. We welcome reviews (systematic and narrative), original reports, perspectives, hypothesis and theory, methods and case reports.

We hope to receive your valuable contribution to advance our knowledge in this field.

Dr. Vincenza Frisardi
Guest Editor

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Keywords

unmet needs
unmet healthcare needs
ecological model
older adults
aging
quality of life
well-being
social deter-minants of health
ethical concern
what matters
addressing needs
barriers and facilitators

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Published Papers (7 papers)

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Research

9 pages, 213 KiB

Open AccessArticle

The Unseen Burden: A Qualitative Investigation of Polish LGBTQ+ Caregivers’ Experiences

by Magdalena Leszko

J. Clin. Med. 2025, 14(6), 1959; https://doi.org/10.3390/jcm14061959 - 14 Mar 2025

Viewed by 539

Abstract

Background/Objectives: As the world’s population ages, the growing number of individuals affected by Alzheimer’s disease and related dementias (ADRDs) will undoubtedly continue to impose social and economic challenges. Informal caregivers play a crucial role in providing essential support for individuals with ADRD. However, there is limited research that investigates the psychosocial functioning of caregivers (partners) from minoritized groups. Methods: This study aimed to explore the experiences of lesbian, gay, bisexual, transgender and queer (LGBTQ+) caregivers of individuals with ADRDs. Semi-structured in-depth interviews were conducted with seven caregivers of partners diagnosed with ADRDs. Three themes were identified based on reflexive thematic analysis: (i) experiencing familial alienation; (ii) fear about the future; and (iii) finding strength in the face of adversity. Results: The research highlighted difficulties reported by LGBTQ+ caregivers, while also showing how such caregivers cope. The findings provide a basis for developing targeted interventions for caregivers from minoritized groups. Conclusions: These findings have important implications for policy and intervention development concerning LGBTQ+ caregivers’ mental and physical health outcomes. Full article

(This article belongs to the Special Issue Epidemiology of Aging: Unmet Needs)

11 pages, 353 KiB

Open AccessArticle

Isotemporal Substitution Effect of 24-h Movement Behaviors on Well-Being, Cognition, and BMI Among Older Adults

by John Oginni, Suryeon Ryu, Yingying Chen and Zan Gao

J. Clin. Med. 2025, 14(3), 965; https://doi.org/10.3390/jcm14030965 - 3 Feb 2025

Viewed by 747

Abstract

Background: This study investigated the interdependent relationships among older adults’ daily engagement in physical activity (PA), sedentary time (ST), sleep, and their well-being, cognition, and body mass index (BMI). Method: Forty healthy older adults (31 females; Mean [age] = 70.8 ± 5.58) were included in the analysis. Participants wore a Fitbit tracker for an average of 23 h a day, five days a week, over six months. The Fitbit device tracked lightly active time, active time, ST, and sleep durations. Quality of life and cognitive flexibility were assessed using validated instruments. BMI was calculated using participants’ self-reported height and weight. A compositional analysis (CODA) investigated the codependent associations among these variables and model time reallocation between behaviors. Results: Regression models utilizing CODA indicated significant associations between the outcomes of BMI (p = 0.05; Adj. R² = 0.20), while cognitive flexibility and quality of life revealed no association (p > 0.05). Shifting 10 min from ST to active time is associated with a theoretical decrease of −0.76 (95% CI, −1.49 to −0.04) units in BMI. Similarly, reallocating 10 min from active time to ST is associated with a theoretical increase of 1.17 (95% CI, 0.03 to 2.3) units in BMI. Reallocating 10 min between other movement behaviors yielded no statistical significance. Conclusions: Our study highlights the importance of promoting active time to improve BMI in this population. Encouraging 10 min bouts of PA among older adults, in place of ST, is vital for improving national PA guideline adherence. Full article

(This article belongs to the Special Issue Epidemiology of Aging: Unmet Needs)

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11 pages, 394 KiB

Open AccessArticle

The Association Between Delirium Upon Admission to a Rehabilitation Hospital and Motor Rehabilitation Outcomes Among Hip Fracture Surgery Patients: A Historical Cohort Study

by Anna Balzer, Anne Marie Novak, Pnina Marom, Oren Schwartz, Michael Brik, Katia Slutzki, Rafi J. Heruti and Rachel Dankner

J. Clin. Med. 2024, 13(23), 7394; https://doi.org/10.3390/jcm13237394 - 4 Dec 2024

Viewed by 994

Abstract

Background: Delirium is a common neuropsychiatric syndrome characterized by the acute and fluctuating impairment of cognition, attention, and consciousness, which is prevalent in older adults following surgical procedures. Despite the recognized impact of delirium on recovery, its specific effects on motor rehabilitation outcomes in the geriatric population remain underexplored. This historical cohort study aimed to evaluate the association between the presence of delirium upon admission to a rehabilitation hospital and the motor functional gain at discharge among older patients following hip fracture surgery. Methods: The collected data included socio-demographic characteristics, comorbidities, medications, Mini-Mental State Examination (MMSE) scores, and the Functional Independence Measure (FIM). Motor rehabilitation outcomes were assessed using Motor Absolute Functional Gain (mAFG), the Montebello Rehabilitation Factor Score (mMRFS), and Rehabilitation Efficiency (mRE). Results: Of the 143 hip fracture patients admitted for rehabilitation, 38 (26.6%) were diagnosed with delirium. Patients with delirium had lower MMSE scores (18.1 ± 5.8 vs. 22.4 ± 6.0, p < 0.001), higher benzodiazepine prescription rates (50.0% vs. 14.3%, p < 0.001), and longer lengths of stay in acute care and rehabilitation (42.7 ± 10.4 vs. 37.3 ± 11.2 days, p = 0.01). Despite significant improvements in the FIM scores for both groups (p < 0.001), patients with delirium had lower mAFG (11.87 ± 7.26 vs. 15.91 ± 8.73, p = 0.01), mMRFS (0.22 ± 0.14 vs. 0.31 ± 0.15, p = 0.001), and mRE (0.28 ± 0.17 vs. 0.44 ± 0.25, p < 0.001). However, the multivariate regression models showed no association between delirium and functional improvement after adjusting for confounders. Conclusions: While both patients with and without delirium showed improvement in their motor functions by the time they were discharged from a rehabilitation hospital, patients with delirium showed lower absolute and relative improvements. Tailored programs addressing the special needs of patients with delirium after hip fracture surgery may enhance outcomes for this vulnerable population. A specialized, multidisciplinary approach tailored to the patient’s cognitive status and overall condition is key to maximizing the recovery of older hip fracture patients with delirium. Full article

(This article belongs to the Special Issue Epidemiology of Aging: Unmet Needs)

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12 pages, 785 KiB

Open AccessArticle

Self-Rated Health and Mortality Among Older Adults in Israel: A Comparison Between Jewish and Arab Populations

by Itamar Shafran, Yael Benyamini, Lital Keinan-Boker and Yariv Gerber

J. Clin. Med. 2024, 13(22), 6978; https://doi.org/10.3390/jcm13226978 - 20 Nov 2024

Cited by 1 | Viewed by 950

Abstract

Background: Self-rated health (SRH) has been shown to predict mortality across a lifespan. However, its predictive value might differ between populations. We compared the association between SRH and mortality in Israeli Jewish and Arab older adults (65+). Methods: A prospective cohort study was conducted among Jewish (n = 1463) and Arab (n = 298) participants in the first National Health and Nutrition Survey of Older Adults (2005–2006). SRH was measured on a four-point scale. Mortality data were available from baseline (2005–2006) through 2019. A survival analysis was performed using Cox models. Results: Mean baseline age (SD) was 75 (6) years among Jewish participants (54% women) and 72 (5) years among Arab participants (50% women). Jewish participants were more likely to rate their health as not good (35% vs. 29%) or poor (11% vs. 8%) than Arab participants (p = 0.01). During a median follow-up of 13.3 years, 896 deaths occurred; 744 in the Jewish group (mean age [SD] 77.8 [6.6] years) and 152 in the Arab group (mean age [SD] 74.0 [5.2] years). The age- and sex-adjusted hazard ratio (HR) for mortality in the Arab vs. Jewish participants was 1.33 (95% CI: 1.12–1.60). Mortality risk increased with declining SRH, with multivariable-adjusted HRs in the lowest vs. most-favorable SRH categories of 2.46 (95% CI: 1.66–3.63) in the Jewish sample and 2.60 (95% CI: 0.98–6.93) in the Arab sample. Conclusions: Although Jewish participants reported poorer SRH, their survival rate was better than Arab participants. Lower SRH was consistently and strongly associated with higher mortality in both groups in a dose–response manner. Full article

(This article belongs to the Special Issue Epidemiology of Aging: Unmet Needs)

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11 pages, 241 KiB

Open AccessArticle

Association Between Race and Comorbid Conditions Among Older Adults with Dementia

by Parham Habibzadeh and Jennifer Albrecht

J. Clin. Med. 2024, 13(21), 6368; https://doi.org/10.3390/jcm13216368 - 24 Oct 2024

Viewed by 1128

Abstract

Background/Objective: Dementia is estimated to affect over 150 million individuals by 2050. Individuals with dementia commonly suffer from other comorbid conditions which can affect quality of life and result in increased health care expenditures. We conducted this study to determine the frequency of comorbid conditions between representative samples of non-Hispanic Black and White US adults aged ≥65 with dementia. Methods: This cross-sectional study was conducted on non-Hispanic Black and White adults aged 65 and older with dementia whose data were retrieved from the National Hospital Ambulatory Medical Care Survey, 2016–2021, and the National Ambulatory Medical Care Survey, 2016, 2018, and 2019. Dementia was defined based on medical record abstraction. The exposure was Black vs. White race. The outcome was a sum of 13 comorbid conditions, including obesity, hypertension, cancer, cerebrovascular disease, congestive heart failure, and coronary artery disease, assessed in older adults with dementia. Results: A total of 1354 non-Hispanic (1175 White and 179 Black) participants were studied. The mean number of comorbid conditions, as well as the prevalence of obesity, cerebrovascular disease, congestive heart failure, and coronary artery disease, was significantly (p < 0.01) higher in the Black vs. White study participants. The Black participants were more likely to have more than two comorbid conditions relative to those who were White (odds ratio 2.5; 95% confidence interval 1.6 to 3.7). Conclusions: A higher burden of comorbid conditions was observed among non-Hispanic Blacks compared to non-Hispanic White older adults with dementia. Future studies should examine the quality of life and health care utilization implications of this finding. Full article

(This article belongs to the Special Issue Epidemiology of Aging: Unmet Needs)

26 pages, 720 KiB

Open AccessArticle

Under-Prescription of Drugs in the Elderly Population of Western Romania: An Analysis Based on STOPP/START Version 2 Criteria

by Petru Baneu, Andreea Prelipcean, Valentina Oana Buda, Narcisa Jianu, Anca Tudor, Minodora Andor, Cristina Merlan, Mirabela Romanescu, Maria Suciu, Simona Buda, Teodora Mateoc, Daniela Gurgus and Liana Dehelean

J. Clin. Med. 2024, 13(19), 5970; https://doi.org/10.3390/jcm13195970 - 8 Oct 2024

Viewed by 2090

Abstract

Background/Objectives: Numerous European countries, including Romania, are facing the concern of rapid ageing of their populations. Moreover, Romania’s life expectancy ranks among the lowest in the European Union. In light of this, it is imperative that the assessment of medication-related harm be given national priority in order to secure and enhance pharmacotherapy and the medical act. In this study, we sought to describe and evaluate the under-prescribing practices among the Romanian elderly population. Methods: We conducted a cross-sectional study in urban areas of two counties in Western Romania (Timis and Arad) from November 2017 to February 2019. We collected chronic electronic prescriptions issued for elderly patients (>65 years old) with chronic conditions. The medication was prescribed by generalist or specialist physicians for periods ranging between 30 and 90 days. To assess inappropriate prescribing behaviours, a multidisciplinary team of specialists applied the Screening Tool of Older Persons’ Prescriptions/Screening Tool to Alert to Right Treatment (STOPP/START) v.2 criteria to the collected prescriptions. Results: Within the 1498 prescriptions included in the study, 57% were issued to females, the mean age was 74.1 ± 6.95, and the average number of medicines per prescription was 4.7 ± 1.51. The STOPP criteria most commonly identified were the (1) long treatment duration (23.6%) and (2) prescription of neuroleptics (14.6%) or zopiclone (14.0%) as medications that increase the risk of falls. According to START criteria, the following medicines were under-prescribed: (1) statins (47.4%), (2) beta-blockers (24.5%), (3) antiresorptive therapy (10.0%), and (4) β2-agonists and muscarinic antagonists for chronic obstructive pulmonary disease (COPD) (4.5%). Within our study group, the prevalence of potentially inappropriate medications was 18.58%, whereas the prevalence of potential prescribing omissions was 49.2%. Conclusions: To decrease medication-related harm and morbid-mortality, and to increase the quality of life for elderly people in Romania, immediate actions are needed from national authorities. These actions include reinforcing primary care services, providing periodic training for physicians, implementing medication review services by pharmacists, and utilising electronic health records at their full capacity. Full article

(This article belongs to the Special Issue Epidemiology of Aging: Unmet Needs)

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14 pages, 2372 KiB

Open AccessArticle

Reference Values for Habitual and Fast Gait Speed in Singapore Adults Aged 21 to 80

by Mingxing Yang, Leik Yu Leung, Zhi Yan Lim, Richmond W. Ang, Ho Man Ip, Xin Qian Lee, Kellee Y. Lim, Li Ching Teoh and Meredith T. Yeung

J. Clin. Med. 2024, 13(12), 3507; https://doi.org/10.3390/jcm13123507 - 15 Jun 2024

Cited by 1 | Viewed by 1645

Abstract

Objectives: Gait speed indicates the individual’s functional status and predicts overall health. This study aims to determine (1) the intra- and inter-rater and test–retest reliability of the dynamic 4 m gait speed test protocol; (2) establish the normative reference values of habitual and fast gait speeds in community-dwelling healthy Singaporean adults aged 21 to 80; and (3) explore the association of age, gender, height, weight, and body mass index (BMI) on gait speed. Methods: This prospective cross-sectional study recruited healthy ambulatory community-dwelling Singaporeans aged 21 to 80 who could ambulate independently without aid. Participants were excluded if they required walking aids; were pregnant; or had physical, medical, or cognitive conditions that may affect gait. Each participant completed at least two habitual and fast gait speed test trials via a 4 m walkway with a dynamic start. The data were analysed by descriptive statistics, the Mann–Whitney test, the Spearman coefficient, and the interclass correlation coefficient (ICC). Results: In total, 178 males and 201 females were included in the data analysis. The median age was 45.0 years [interquartile range (IQR) 26.2–59.0], and the median height was 1.64 metres (m) (IQR 1.58–1.70). The median habitual gait speed was 1.08 metre/second (m/s) (IQR 0.97–1.22), and the fast gait speed was 1.55 m/s (IQR 1.40–1.70). The ICC for reliability ranged from 0.84 to 0.99, indicating that the 4 m gait speed test had good-to-excellent reliability. Conclusions: Gait speeds were not influenced by gender but declined with age advancement. Age and height and age and BMI were weakly correlated to habitual and fast gait speed, respectively. We established the norm values for the 4 m gait speeds in Singapore and proved it to be a reliable gait speed assessment ready for immediate community applications. Full article

(This article belongs to the Special Issue Epidemiology of Aging: Unmet Needs)

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