Search Results (102)

Background: Potentially inappropriate medications (PIMs) and potential prescription omissions (PPOs) have been widely explored, but few studies focused on patients aged 75 years and over. This study was planned to explore the demographic and clinical characteristics of the older patients admitted to Units for Integrated Continuous Care, and to assess the prevalence and potential predictors of PIMs and PPOs. Methods: An observational, retrospective, and multicenter study was performed on 135 patients aged 75 years or older (i.e., 75–84 years and ≥85 years). PIMs and PPOs were investigated by applying the Screening Tool of Older People’s Prescriptions (STOPP) and Screening Tool to Alert to Right Treatment (START) criteria. Results: The oldest-old patients (≥85 years) were less likely to come from a hospital, had fewer daily medications and a lower number of oral doses, but they presented a higher Charlson Comorbidity Index, were more dependent on activities of daily living, and were less obese than those aged 75–84 years. Results showed a high prevalence of PIMs and PPOs in both age groups. The more common PIMs and PPOs were the same in both age groups. The oldest-old patients who suffered falls were more likely to have a prescription omission of vitamin D supplements. The PIM index was not significantly different between age groups but was higher in the oldest-old group. Conclusions: Patients with a higher number of prescriptions had a higher risk of PIMs. Regarding PPOs, male gender and fall risk were predictors in the youngest group, while the number of comorbidities was significantly associated with PPOs in the oldest group. This study supports the usefulness of the STOPP/START criteria to identify PIMs and PPOs in these patients, but more research is required to determine the potential adverse outcomes of PIMs and PPOs and their clinical and economic consequences. Full article

Background/Objectives: Obesity and depression, in conjunction with multimorbidity, are interconnected conditions increasingly managed in general practitioner (GP) settings, yet these associations remain insufficiently studied in older patients. This study investigates the prevalence of depression across different body mass index (BMI) classes and includes age and gender differences in multimorbid older patients, offering a novel perspective on subgroup-specific patterns. Further the agreement between GP depression diagnoses and the Geriatric Depression Scale (GDS) is studied and patient-specific factors that may affect the agreement are explored, aiming to improve future diagnostics for vulnerable subgroups. Methods: Data were provided by the baseline assessment of the MultiCare Study, a prospective multicenter observational cohort of multimorbid patients aged 65+ years recruited from 158 GP practices across eight study centers in Germany. Data from 2568 study participants were analyzed based on GP-coded International Classification of Diseases (ICD) diagnoses, structured GP questionnaires, and patient questionnaires. Assessments included data on the BMI and depression (15 item version of the GDS). Agreement between GP diagnoses of depression and GDS assessment was measured using Cohen’s kappa. Four logistic regression models were used to examine the effects of patient-specific factors on the agreement of depression diagnosis (match or mismatch). Results: GPs diagnosed depression in 17.3% of cases, compared to the detection of depressive symptoms in 12.4% of the patients by GDS (cut-off ≥ 6 points). The highest prevalence rates were observed in patients with obesity class III (25.0% by GP; 21.7% by GDS). Women were significantly more likely to receive a depression diagnosis by a GP across most BMI classes (except obesity classes II and III). The detection of depressive symptoms by GDS was significantly more prevalent in older multimorbid obese patients (≥75 years), except for patients with obesity class III. The overall agreement between GP diagnosis and GDS assessment was weak (κ = 0.156, p < 0.001). The highest agreement was found for people with obesity class III (κ = 0.256, p < 0.05). Factors associated with a True Positive depression diagnosis (match by both GDS and GP) were female gender (odds ratio (OR) = 1.83, p < 0.05), widowhood (OR = 2.43, p < 0.01), limited daily living skills (OR = 3.14, p < 0.001), and a higher level of education (OR = 2.48, p < 0.01). A significantly lower likelihood of a False Negative depression diagnosis was found for patients with obesity class III. Conclusions: This study highlights the significant prevalence of depression among multimorbid older adults across different BMI classes, particularly in those with obesity class III. The weak diagnostic agreement between GP diagnosis and GDS assessment suggests a need for improved diagnostic practices in primary care. Implementing standardized screening tools and fostering collaboration with mental health specialists could enhance the identification and management of depression in this vulnerable population. Full article

Background/Objectives: Ageing is a continuous process of physiological changes that occur over time and affect both ability and function, including vision. A major health issue for older people is visual impairment, which affects both daily activities and quality of life. Undetected visual impairment is a significant problem. Therefore, early detection is crucial to enable older people to optimise their vision and/or receive eye care. This study protocol aims to explore the prevalence of undetected visual impairment among the ageing population and its impact on their quality of life. Methods: This study has an exploratory design. We include participants attending a healthcare centre and participants attending an optician, aged 75 years and older, in Sweden. At baseline eye examinations, fundus photography, the National Eye Institute 25-item Visual Function Questionnaire (NEI VFQ-25) and health economic data are collected. Individual semi-structured interviews (n = 25–30) will then be conducted about older people’s experiences of visual impairment, both consequences and strategies for coping with visual impairment in daily life. The NEI VFQ-25 and health economic data will be collected at 6- and 12-month follow-ups. Conclusions: This study will provide important knowledge to facilitate early detection of visual impairment in older people, thereby providing a deeper understanding of methods to preserve visual function and quality of life despite the presence of visual impairment. Full article

This study assesses the predictions of future mobility rates and tenure choice behaviors by characterizing older households by age and place, focusing on the role of intergenerational networks. This study employed mixed effects logistic regression along with longitudinal household data acquired from the 2008–2020 Korea Longitudinal Study of Aging. The findings are as follows. First, co-residence with children encouraged older people to remain in their current places of residence. In contrast, those within 30 min of a child’s house by public transportation tended to experience residential mobility and dissave their accumulated housing wealth. Second, the effects of intergenerational networks on housing behaviors—independent living, residential mobility, and tenure transition—seemed greater and statistically significant for the oldest cohort, aged 75 years and above, and in non-metropolitan areas. Finally, intergenerational networks might help vulnerable households—being single or having poor health—stay in their current independent living situations, but they did not appear to be major factors influencing housing decisions, such as residential mobility or housing adjustments, in older households. In conclusion, intergenerational networks seem to have a partial direct impact on aging in place (AIP) in Korea. Instead, older Koreans tend to relocate closer to their children and seem to age in those areas. Understanding the reasons why older households choose to stay or leave their current homes is crucial, as it relates to aging in place (AIP), a widely used term in aging-related matters and a goal of elderly housing policies. This study provides seminal insights into this issue. Full article

Background: Osteoarticular deformities or contractures in institutionalized elderly individuals, described as acquired deforming hypertonia (ADH), have a multifactorial origin. The reported prevalence of ADH in French Caucasian patients in long-term care units (LTCUs) is 25.6%. To date, ADH in the Caribbean population has never been studied. We aimed to assess the prevalence and characteristics of ADH in such a population. Materials and Methods: This was a cross-sectional observational study of a French Caribbean population in Martinique in which patients aged 75 years or older were institutionalized in LTCUs during the study period. Data extraction from the medical files of eligible LTCU patients was conducted to assess the prevalence, clinical characteristics, and impact of ADH on patients’ daily care. The assessments were performed collaboratively between the patients’ geriatric team and a PM&R physician. Results: In total, 81 patients were included, with an ADH prevalence of 77.8%. Reported ADH was bilateral (86%) or multiple (66% of patients had ≥5 ADH) and was responsible for major alterations in terms of hygiene, dressing, pain, and skin damage. ADH patients had a high level of dependence (GMP = 924), and this level of dependence was significantly associated with the presence of at least one ADH (p < 0.001) regardless of prior disease. Conclusions: The incidence of ADH in our Caribbean population seems twice as high as that in Caucasian patients, underlining the necessity for this nosological framework to be better recognized, particularly in an insular context. Local campaigns for the prevention and recognition of ADH must be considered, and targeted multidisciplinary protocols need to be established for adapted care in all institutions receiving elderly people. Full article

Background/Objectives: Data about metabolic syndrome (MS) in people who use drugs (PWUD) undergoing treatment for recovery are limited. We aimed to explore the extent of the MS and its predominant components and determinants in a sample of PWUD undergoing treatment for recovery through rehabilitation or opioid substitution treatment (OST) in Lebanon. Furthermore, we investigated the effect of each treatment modality on the MS; Methods: This was a cross-sectional study, in which demographics and treatment-related, nutritional, and biochemical data of the participants were collected. MS was defined according to the American Heart Association and the National Heart, Lung, and Blood Institute (AHA/NHLBI) criteria. Descriptive statistics were presented, and bivariate and multivariate analyses were conducted; Results: A total of 155 male subjects with the following characteristics were included: OST: n = 80; rehabilitation: n = 75; mean age: 32.53 ± 8.39 years; mean body mass index (BMI): 27.41 ± 4.99 Kg/m²; mean duration of treatment: 18 months. More than half of the sample had low HDL-C (56.8%) and/or elevated blood pressure (51.6%), 42.9% had elevated WC, 21.9% had elevated TG, and 12.3% had elevated FBS. Furthermore, 7.2% of the sample had no components of the MS, 29.2% had one component, 40.9% had two components, 16.9% had three components, and 5.8% had four components. MS was identified in 22.7% of the sample. Higher age was associated with higher odds of being diagnosed with MS (OR = 1.072; 95% CI: 1.021–1.126), whereas higher duration of current treatment was associated with lower odds (OR = 0.969; 95% CI: 0.944–0.995); Conclusions: MS and its components are prevalent in PWUD undergoing treatment for recovery. Routine screening and preventive measures are essential to prevent metabolic syndrome, particularly among older people and treatment newcomers. Full article

Background/Objectives: This cross-sectional study aimed to investigate the relationship between swallowing function and low serum albumin levels in older Japanese people (aged ≥ 75 years). Methods: A total of 3258 participants (1325 males, 1933 females; mean age, 80.8 years) who had a dental checkup in Gifu City, Japan, between April 2020 and March 2021 were recruited. Swallowing function was assessed using the repetitive saliva swallow test, with poor swallowing function defined as swallowing fewer than three times in 30 s. A serum albumin level < 3.6 G/dL was considered low. Results: In total, 78 participants (2%) had a low serum albumin level. Furthermore, after adjusting for age, gender, circulatory disease, support/care-need certification, number of present teeth, and tongue and lip function, a low serum albumin level was positively associated with older (odds ratio [OR]: 1.115; 95% confidence interval [CI]: 1.064–1.169), male (OR: 2.208; 95% CI: 1.360–3.584), circulatory disease (OR: 1.829; 95% CI: 1.079–3.099), support/care-need certification (OR: 2.087; 95% CI: 1.208–3.606), and poor swallowing function (OR: 2.379; CI: 1.377–4.112). Conclusions: These results indicate that poor swallowing function was associated with a low serum albumin level in older Japanese people aged ≥ 75 years. Full article

Background/Objectives: A properly functioning musculoskeletal system is imperative for human well-being at every stage of life, including at an older age. This study’s aim was to assess the relationship between sociodemographic and physical functioning variables and the presence of individual musculoskeletal disorders (MSDs), MSD comorbidity, and multimorbidity, as well as to determine factors that are independent predictors of the presence of MSDs in people over 65 years old. Methods: This population-based study included 3701 participants aged 65 years and older. Data on individual MSDs addressed cervical and lumbosacral spine regions and degenerative joint disease (arthrosis). The subjects were categorized into four groups: those without any diseases; those with one MSD; those with two MSDs (comorbidities); and those with three MSDs (multimorbidities). The sociodemographic and physical functioning variables were analyzed. Results: Females were more likely to have MSDs (two: OR 1.95 and three: OR 2.25) than men. Elderly people aged 75 and above were 1.49 times more likely to have three MSDs. Elderly people with elementary school education were more likely to have MSDs (two: OR 1.34 and three: OR 2.06) than those with high school/university education. The low-income population was 2.47 times more likely to have three MSDs. Individuals with partial activity limitations because of health problems had greater chances of having one, two, or three MSDs (OR 1.60, 1.59, and 1.94, respectively), and elderly individuals with severe limitations had an OR of 1.43, 2.17, and 4.12, respectively. Individuals with some/many difficulties in walking up or down 12 steps were more likely to have MSDs (two: OR 2.26 and three: OR 2.28). Conclusions: The significant predictors of experiencing a single MSD, MSD comorbidity, or MSD multimorbidity include residing in the Serbian capital city and having limitations in activities due to health problems. A significant predictor of having a single MSD or MSD comorbidity is residing in the northern region of Serbia. A significant predictor of MSD comorbidity is residing in the southeastern region of Serbia. Significant predictors of MSD comorbidity or MSD multimorbidity include female gender, an elementary school educational level, and experiencing difficulty in walking up or down 12 steps. Significant predictors of MSD multimorbidity are being 75 years of age and above and having a lower income. Full article

Aim: Older age is not a homogenous or stereotypical experience. Age-stereotypical representations can often be disconnected from older people’s own experiences. Challenging the status quo is relevant for aging well. The aim of this study is to analyze older adults’ perspectives on stereotypical versus their own age representations. Method: This qualitative study included a sample of 433 older adults who were 65 to 74, 75 to 84, and 85+ years of age. Content analysis was carried out. Results: Findings from this study indicated that the great majority of the participants (88%) did not identify with stereotypical age representations. This was so among participants in the 65–74 age group in relation to Showing a sense of agency (81.1%); Feeling spiritual (73.4%); Having meaningful goals (72.2%); Holding a significant social network (70.9%); Staying tuned to the world (67.1%); and feeling physically attractive (59.8%). Participants who were 75–84 years of age clarified what physical health (81.0%) and surviving chronic illnesses (78.9%), autonomy (75.5%), being socially active (74.9%), and staying mentally active (70.1%) represent at that age. The +85 years age group drew attention to No pain or physical limitations (95.6%), Physical health (93.1%), Cognitive autonomy (87.1%), Staying tuned to society and the world (76.3%); and Mobility (72.2%). Conclusions: Participants’ favoring their own over stereotypical thinking about people their age represents inner resourcefulness and a penchant for aging well. Collaborative partnerships for sharing such wisdom around could enrich policy programs and interventions that favor inclusivity and fight ageism, fostering a more accurate perspective of what it means to be a certain ‘age’ versus simply being ‘old’. Full article

Background/Objectives: Old age and illnesses can limit physical activity (PA). We have assessed the level of PA and its limitations in older people with diabetes (DM). Methods: Cross-sectional study, period: January and June 2024, place: Diabetes Center, subjects: patients (N = 207) > 64 years with DM), Surveying using: IPAQ, Accompanying Survey (AS). The significance was assessed by: Student’s t-test, Mann–Whitney U test, Pearson’s test. The relationships between the IPAQ and the AS results were analyzed based on a meta-analysis model for variable effects, OR with a 95% CI. ROC curve was used to determine the threshold values for age, BMI. Correlations between selected key variables were evaluated using the PCA. Results: The median age: 72 years (65–87), BMI: 28.70 (18.61–49.69). The median PA level: 1837 MET-min/week (0–9.891). The individuals who obtained insufficient (n = 28), sufficient (n = 75), and high levels of PA (n = 53) were 17.95%, 48.08%, and 33.97%, respectively. Diseases were the main factor limiting PA (53.54%) in patient’s opinion, followed by the lack of a companion or motivation. The meta-analysis found no diseases linked to insufficient PA, but those with BMI > 33.3 and over 75 years old more often had insufficient PA. PCA revealed several characteristics that predispose individuals to insufficient PA. Conclusions: People over 75 years of age tend to avoid PA more than younger seniors, leading to its insufficient level, similarly like higher BMI. The individual with DM who has an insufficient level of PA is typically a single, woman, over 75, BMI > 33. Full article

Background: The association between mortality and heatwaves is well documented. Heatwaves frequency, intensity, and duration increase with global climate change. The most vulnerable group for dying during heatwaves is older people. Knowing which diseases contribute to a higher number of deaths during heatwaves is important for planning appropriate public health preventive measures. Methods: We assessed the short-term association between the number of deaths for older adults (75+ years) and heatwaves in the years 1999 to 2020 in Slovenia. We estimated the relative risks (RR) with a 95% confidence interval for the number of deaths for the observed diagnosis (all causes, circulatory, respiratory) and urban vs. rural areas associated with heatwaves in Slovenia for each year, comparing the number of deaths during heatwaves with reference days. Results: Most years showed no significant increase in deaths during heatwaves for those aged 75 and older. However, in 2006, 2007, 2014, and 2015, there was a significant increase in deaths during heatwaves. For the general population, heatwaves were associated with an increase in deaths due to all causes: 10% more in 2006 and 26% more in both 2007 and 2014. For those aged 75 and older, heatwaves were associated with an increase in deaths due to all causes: 22% more in 2007, 27% more in 2014, and 28% more in 2015. For those aged 75 and older, heatwaves were associated with an increase in deaths due to circulatory system diseases: 25% more in 2006, 33% more in 2007, 30% more in 2014, and 27% more in 2015. Regarding urban vs. rural areas, in 2006 and 2012, the elderly in urban areas were more affected, with 33% and 26% more deaths, respectively. In contrast, in 2007, 2014, and 2015, old age population in rural areas was more affected, with 29%, 26%, and 31% more deaths, respectively. Conclusions: According to the literature data, older adults are most susceptible to the effects of extreme heat due to physiological changes that occur with aging, chronic diseases, certain medications, a sedentary lifestyle, and social isolation. The results of our study will help in planning appropriate preventive public health measures to better protect older adults during the next heatwaves in Slovenia. Full article

Background and Objectives: The predicted serum concentrations of vancomycin are determined using population pharmacokinetic parameters. However, the accuracy of predicting vancomycin serum concentrations in the older population remains unclear. Therefore, this study aimed to investigate the accuracy of predicting vancomycin serum concentrations and identifying elements that diminish the prediction accuracy in older people. Materials and Methods: A total of 144 patients aged 75 years or older were included. The serum vancomycin concentrations in the patients were predicted based on population pharmacokinetic parameters common in Japan. We examined the accuracy of serum vancomycin concentration prediction in elderly individuals by comparing the predicted and measured serum vancomycin concentrations in each patient. The prediction accuracy was evaluated using the mean prediction error (ME) and mean absolute error of prediction (MAE) calculated from the measured and predicted serum vancomycin concentrations in each patient. Results: The ME for all patients was 0.27, and the 95% CI included 0, indicating that the predicted values were not significantly biased compared to the measured values. However, the predicted serum concentrations in the <50 kg body weight and serum creatinine (Scr) < 0.6 mg/dL groups were significantly biased compared to the measured values. The group with a history of intensive care unit (ICU) admission showed the largest values for the ME and MAE. Conclusions: Our prediction accuracy was satisfactory but tended to be lower in underweight patients, those with low creatinine levels, and patients admitted to the ICU. Patients with multiple of these factors may experience a greater degree of decreased predictive accuracy. Full article

Falls are among the top 10 causes of years lived with disability in people aged 75 and over. Preventive programs like case management (CM) are crucial. Objectives: To evaluate the effects of a multifactorial fall prevention program based on CM on physical performance, the presence of pain, and the risk of falls and fractures in older people who have suffered falls. Methods: This randomized, single-blind clinical trial with parallel groups, Intervention Group (IG) and Control Group (CG), was composed of 55 older people with a history of falling, living in the community. All participants underwent an initial assessment via video call (containing anamnesis, timed up-and-go test, falls risk score, short physical performance battery, and clinical frax). The IG underwent CM, the physical exercise protocol, and the cognitive stimulation protocol. The CG was monitored through telephone calls and received general health and fall guidance. Results: No significant results were found in the physical capacity, the presence of pain, the risk of falls, or the fractures between the Intervention and Control Groups and between assessments. Conclusion: This program was not effective in improving functional performance, but it was important for characterizing pain and the probability of fracture in the next 10 years in this population. Full article

Managing health care for older adults aged 75 years and older can pose unique challenges stemming from age-related physiological differences and comorbidities, along with elevated risk of delirium, frailty, disability, and polypharmacy. This review is aimed at providing a comprehensive analysis of the management of acute coronary syndromes (ACS) in older patients, a demographic substantially underrepresented in major clinical trials. Because older patients often exhibit atypical ACS symptoms, a nuanced diagnostic and risk stratification approach is necessary. We aim to address diagnostic challenges for older populations and highlight the diminished sensitivity of traditional symptoms with age, and the importance of biomarkers and imaging techniques tailored for older patients. Additionally, we review the efficacy and safety of pharmacological agents for ACS management in older people, emphasizing the need for a personalized and shared decision-making approach to treatment. This review also explores revascularization strategies, considering the implications of invasive procedures in older people, and weighing the potential benefits against the heightened procedural risks, particularly with surgical revascularization techniques. We explore the perioperative management of older patients experiencing myocardial infarction in the setting of noncardiac surgeries, including preoperative risk stratification and postoperative care considerations. Furthermore, we highlight the critical role of a multidisciplinary approach involving cardiologists, geriatricians, general and internal medicine physicians, primary care physicians, and allied health, to ensure a holistic care pathway in this patient cohort. Full article

This retrospective cohort study explored the prevalence of substantial weight loss (≥10% per year) in independent older individuals in order to develop and validate a scoring system for high-risk group identification and targeted intervention against malnutrition. We used insurance claims and the Kokuho Database (KDB), a nationwide repository of Japanese-specific health checkups and health assessments for the older people. The study included 12,882 community-dwelling individuals aged 75 years and older who were self-supported in their activities of daily living in Saga Prefecture, Japan. Health evaluations and questionnaires categorized weight-loss factors into organic, physiological, psychological, and non-medical domains. The resulting scoring system (SAGA score), incorporating logistic regression models, predicted ≥ 10% annual weight-loss risk. The results revealed a 1.7% rate of annual substantial weight loss, with the SAGA score effectively stratifying the participants into low-, intermediate-, and high-risk categories. The high-risk category exhibited a weight-loss rate of 17.6%, highlighting the utility of this scoring system for targeted prevention. In conclusion, the validated SAGA score is a crucial tool for identifying individuals at high risk of significant weight loss, enabling tailored interventions and social support benefiting both older individuals and their relatives. Full article