Dinâmica temporal e espacial e fatores relacionados à mortalidade por suicídio entre idosos / Temporal and spatial dynamics and factors related to suicide mortality among the elderly

OBJETIVO: Analisar a dinâmica temporal e espacial e os fatores associados à mortalidade por suicídio entre idosos (≥60 anos de idade) no Nordeste do Brasil. MÉTODOS: Estudo ecológico que analisou os óbitos por suicídio ocorridos entre idosos na região Nordeste do Brasil, no período de 2010 a 2019. Foram realizadas análise temporal por Joinpoint, análise espacial segundo município de residência e análise multivariada pelo modelo Ordinary Least Squares Estimation, considerando-se p < 0,05. RESULTADOS: No período analisado, foi observado crescimento significativo de 3,0% (IC95%: 1,1-4,9; p < 0,001) ao ano na mortalidade por suicídio. Espacialmente, as taxas mais elevadas foram observadas prioritariamente em municípios do Piauí, Ceará e Rio Grande do Norte. Foram identificados quatro clusters de suicídio estatisticamente significativos (p < 0,001). O cluster primário (2010-2019) abrangeu 141 municípios do Ceará, Rio Grande do Norte e Paraíba, que apresentaram risco 2,3 vezes maior de ocorrência de suicídio quando comparados aos demais municípios da região. Os indicadores índice de Gini (ß = 14,02; p = 0,01), taxa de analfabetismo (ß = 0,20; p < 0,001) e taxa de envelhecimento (ß = 0,36; p = 0,02) apresentaram associação positiva com o suicídio entre idosos, enquanto razão de dependência (ß = -0,31; p < 0,001) e taxa de desocupação (ß = -0,25; p < 0,001) apresentaram associação negativa. CONCLUSÃO: Houve aumento significativo do suicídio entre idosos na região Nordeste, com maior concentração em quatro clusters espaciais localizados prioritariamente no Ceará, Paraíba, Piauí e Rio Grande do Norte. A associação com indicadores socioeconômicos reforça aspectos de vulnerabilidade dos idosos a esse tipo de agravo e auxilia na formulação de propostas de intervenções que promovam a sua redução.

OBJECTIVE: To analyze the temporal and spatial dynamics and factors associated with suicide mortality among the elderly (≥60 years of age) in Northeast of Brazil. METHODS: This is an ecological study that analyzed deaths from suicide among elderly people in the Northeast region of Brazil, from 2010 to 2019. Temporal analysis by Joinpoint, spatial analysis according to municipality of residence and multivariate analysis by the Ordinary Least Squares Estimation model were performed, considering p < 0.05. RESULTS: During the analyzed period, a significant increase of 3.0% (95%CI: 1.1-4.9; p < 0.001) per year in suicide mortality was observed. Spatially, the highest rates were observed in municipalities of Piauí, Ceará and Rio Grande do Norte. Four statistically significant suicide clusters were identified (p < 0.001). The primary cluster (2010-2019) covered 141 municipalities in Ceará, Rio Grande do Norte and Paraíba, which presented a 2.3 times higher risk of suicide when compared to other municipalities in the region. The Gini index indicators (ß = 14.02; p = 0.01), illiteracy rate (ß = 0.20; p < 0.001) and aging rate (ß = 0.36; p = 0.02) showed a positive association with suicide among the elderly, while the dependency ratio (ß = -0.31; p < 0.001) and unemployment rate (ß = -0.25; p < 0.001) had a negative association. CONCLUSION: There was a significant increase in suicide among the elderly in the Northeast region, with a greater concentration in four spatial clusters located primarily in Ceará, Paraíba, Piauí and Rio Grande do Norte. The association with socioeconomic indicators reinforces aspects of vulnerability of the elderly to this type of injury and helps in the formulation of intervention proposals that promote its reduction.

Hospital readmission within 30 days of older adults hospitalized in a public hospital

Older adults have difficulty monitoring their drug therapy in the first thirty days following hospital discharge. This transition care period may trigger hospital readmissions. The study aims to identify the factors associated with the readmission of older adults 30 days after discharge from the perspective of drug therapy. This is a cross-sectional study and hospital admission within 30 days was defined as readmission to any hospital 30 days after discharge. The complexity of the drug therapy was established by the Medication Regimen Complexity Index (MRCI).. Readmission risks were predicted by the "Readmission Risk Score - RRS". The multivariate logistic regression was used to identify factors associated with readmission within 30 days after discharge. Two hundred fifty-five older adults were included in the study, of which 32 (12.5%) had non-elective hospital readmission. A higher number of readmissions was observed with increased RRS value, suggesting a linear gradient effect. The variables included in the final logistic regression model were the diagnosis of cancer (OR=2.9, p=0.031), pneumonia (OR=2.3, p=0.055), and High MRCI (> 16.5) following discharge (OR=1.9, p=0.119). The cancer diagnosis is positively associated with hospital readmissions of older adults within 30 days

Malnutrition Risk among Older Mexican Adults in the Mexican Health and Aging Study.

Few studies assess the malnutrition risk of older Mexican adults because most studies do not assess nutritional status. This study proposes a modified version of the Mini Nutritional Assessment (MNA) to assess the risk of malnutrition among older Mexicans adults in the Mexican Health and Aging Study (MHAS). Data comes from the 2012, 2015, and 2018 waves of the MHAS, a nationally representative study of Mexicans aged 50 and older. The sample included 13,338 participants and a subsample of 1911 with biomarker values. ROC analysis was used to calculate the cut point for malnutrition risk. This cut point was compared to the definition of malnutrition from the ESPEN criteria, BMI, low hemoglobin, or low cholesterol. Logistic regression was used to assess predictors of malnutrition risk. A score of 10 was the optimal cut point for malnutrition risk in the modified MNA. This cut point had high concordance to identify malnutrition risk compared to the ESPEN criteria (97.7%) and had moderate concordance compared to BMI only (78.6%), and the biomarkers of low hemoglobin (56.1%) and low cholesterol (54.1%). Women, those older than 70, those with Seguro Popular health insurance, and those with fair/poor health were more likely to be malnourished. The modified MNA is an important tool to assess malnutrition risk in future studies using MHAS data.

Gateway to Global Aging Data: Resources for Cross-National Comparisons of Family, Social Environment, and Healthy Aging.

OBJECTIVES: The Gateway to Global Aging Data (Gateway; g2aging.org) is a data and information platform developed to facilitate cross-country analyses on aging, especially those using the international family of Health and Retirement studies. We provide a brief introduction to the Gateway to Global Aging Data, discussing its potential for cross-national comparisons of family, social environment, and healthy aging. METHODS: We summarize the survey metadata, study characteristics, and harmonized data available from the Gateway, describing the population represented in each study. We portray cohort characteristics and key measures of health and social environment from 37 countries in North America, Europe, and Asia using harmonized data. RESULTS: Significant cross-country heterogeneity was observed in many measures of family, social environment, and healthy aging indicators. For example, there was a threefold difference in coresidence with children, ranging from 14% in Sweden to over 46% in Spain and Korea in 2014. From 2002 to 2014, the difference between informal care receipt in individuals of low and high wealth decreased by 6% in the United States and remained unchanged in England. The percentage of individuals aged 50-59 living alone in 2012 varied 15-fold, from a low of 2% in China to a high of 30% in Mexico. DISCUSSION: By partnering with nationally representative studies around the globe, the Gateway to Global Aging Data facilitates comparative research on aging through the provision of easy-to-use harmonized data files and other valuable tools.

Sustainable urban mobility analysis for elderly and disabled people in São Paulo.

The Brazilian Urban Mobility Policy integrates urban transport with traffic planning, establishing appropriate public policies that indicate the need for a safe and accessible public transport system. The major challenge is the inclusion of the elderly and people with disabilities. In this paper, we quantify the impact of rainfall on the number of people with disabilities and elderly people who use the public bus transportation system for accessibility in the first and last miles in the city of São Paulo. The proposed methodology is used to evaluate the co-movements between the time series of free-fare users and rainfall in São Paulo. The findings confirm the hypothesis that significant rainfall causes a reduction in the number of daily free-fare passengers who use the public bus system in São Paulo.

"The Ugly Face of Old Age": Elders' Unmet Expectations for Care and Support in Rural Ethiopia.

As migration, urbanization, and aging accelerate in developing nations, traditional family supports for elders are diminishing. With these trends in mind, hermeneutic phenomenology was used to examine the experiences of 10 rural Ethiopian elders of age 70 and older. Narrative data from in-depth interviews revealed three prominent themes: the "good old days," drained happiness, worry and pessimism. Elders felt devalued by their children, grandchildren, and youth in general. Compared to how they treated their own parents, elders believed that their children's sense of filial obligation was weak and unreliable. Interactions were described as undermining, embarrassing, and abusive. Elders were pessimistic about the prospect of reliable caregivers, even expressing a wish to die before they become dependent on others for care. Despite such challenges, participants viewed aging as a privilege. New cooperative models of community-based care are needed to ensure that elders in developing nations can expect adequate care throughout their lives.

A Thematic Analysis of Weibo Topics (Chinese Twitter Hashtags) Regarding Older Adults During the COVID-19 Outbreak.

OBJECTIVES: We explored the portrayal of older adults and the public response to topics concerning older adults during the COVID-19 pandemic in Chinese social media (Weibo topics, equivalent to hashtags on Twitter). We also explored the temporal trends of dominant themes to identify changes over time. METHODS: Topics related to older adults were searched in the Weibo topic search engine between January 20 and April 28, 2020. Overall, 241 topics and their view frequency and comment frequency were collected. Inductive thematic analysis was conducted to classify the topics into themes. The popularity of each theme was also analyzed. In addition, the frequency with which each theme appeared during the 3 major stages of the pandemic (outbreak, turnover, and post-peak) was reported. RESULTS: Six main themes were identified. "Older adults contributing to the community" was the most prominent theme with the highest average comment frequency per topic. It was also the most dominant theme in the first stage of the pandemic. "Older patients in hospitals" was the second most prominent theme and the most dominant theme in the second and third stages of the pandemic. The percentage of topics with the themes "Care recipients" and "Older adults caring for the young" increased over time. DISCUSSION: The portrayal of older people as being warm, competent, and actively exercising their agency is prevalent on Weibo. The Weibo-viewing public shows signs of interest in intergenerational solidarity during the pandemic in China. These findings are different from findings reported by studies conducted in the West.

Is Exposure to Epidemic Associated With Older Adults' Health Behavior? Evidence From China's 2002-2004 SARS Outbreak.

OBJECTIVES: To determine whether exposure to an epidemic is associated with better health behaviors. METHODS: Using nationally representative survey data collected in 2011 and 2014, we identified middle-aged and older Chinese adults whose communities experienced an outbreak of the 2002-2004 severe acute respiratory syndrome (SARS). We estimated logistic models of health behaviors in the years after the SARS epidemic. RESULTS: Compared to those who lived in communities not hit by the epidemic, respondents who lived in communities with a SARS outbreak in 2002-2004 were more likely to get a physical examination in 2010-2011 and have their blood pressure checked and participate in regular physical exercise in the years following the SARS epidemic. These associations varied by gender and rural-urban residence. DISCUSSION: Exposure to the SARS epidemic could be positively associated with health behavior among middle-aged and older Chinese adults.

Análise do Índice de Vulnerabilidade Clínico-Funcional-20 dos idosos usuários do sistema único de saúde / Clinical-Functional Vulnerability Index-20 analysis of older people using the Brazilian Public Health System

Objetivo: Aplicar a versão do profissional de saúde do Índice de Vulnerabilidade Clínico-Funcional-20 em uma população-alvo idosa. Métodos: Foi conduzido um estudo de caráter transversal, observacional e individuado, em idosos cadastrados no Ambulatório Cruz Preta, em Alfenas (MG), sendo aplicado o Índice de Vulnerabilidade Clínico-Funcional-20 na amostra selecionada. Para tanto, foram selecionados 66 idosos, e os dados obtidos foram submetidos à análise multivariada. Resultados: Dentre os participantes, 29% apresentaram alto risco de vulnerabilidade, seguidos de 41% com risco moderado e 30% com baixo risco. Ao se considerar o ponto de corte para fragilidade, 70% da população de idosos classificou-se como frágil ou sob risco de fragilização. Houve correlação entre as características dos idosos com as variáveis do Índice de Vulnerabilidade Clínico-Funcional-20, que foram: redução da capacidade de exercer atividades de vida diária, declínio cognitivo, alteração de humor, dificuldade para caminhar e quedas. Conclusão: A população-alvo de idosos pode ser considerada frágil ou sob risco de fragilização, o que indica a necessidade de ampliação do atendimento geriátrico especializado estudado. Além disso, foi possível identificar os principais fatores que levam à fragilização da população idosa, o que permite delinear estratégias com o objetivo de prevenção da fragilidade e melhorar o atendimento da população fragilizada.

Objective: To apply the Medical Professional version of the Clinical-Functional Vulnerability Index-20 in the target population of older people. Methods: A cross-sectional, observational, and individual study was conducted with older patients enrolled in Ambulatório Cruz Preta, in the city of Alfenas (MG), and the Clinical-Functional Vulnerability Index-20 was applied to the selected sample. For this, 66 older people were selected and data were subjected to multivariate analysis. Results: Of the participants, 29% presented high risk of vulnerability, followed by 41% with moderate risk, and 30% with low risk. When considering the cut-off point for fragility, 70% of the elderly population were classified as frail or under risk of becoming frail. There was a correlation between the characteristics of the older people with Clinical-Functional Vulnerability Index-20 variables, which were: reduced ability to perform activities of daily life, cognitive decline, mood alteration, difficulty walking, and falls. Conclusion: the target population of older individuals may be considered frail or under risk of becoming frail, which indicates the need for expanded specialized geriatric care studied. In addition, it was possible to identify the main factors leading to older population frailty, which allows the development of strategies aimed at preventing frailty and improving care for the frail population.

A puertas cerradas: La vejez en instituciones en Buenos Aires y el Interior: 1850-1950 / Behind closed doors: Old age in institutions in Buenos Aires and in the country: 1850-1950

Un aspecto clave de la historia de la vejez es el de la asistencia a los ancianos pobres, enfermos o sin familia, sobre todo durante el siglo XIX y principios del XX que constituyen la edad de oro del asilo de ancianos. Partiendo de esa constatación y de los principales problemas historiográficos involucrados, se propone como objetivo principal reconstruir la oferta de instituciones existentes y la proporción de personas atendidas. Para ello explora, en primer lugar las posibilidades y límites de las escasas fuentes estadísticas disponibles. En segundo término, propone una comparación exploratoria con el interior del país y con la asistencia a otros grupos de edad, en particular los niños. Tanto por la centralidad de los procesos históricos involucrados (crecimiento urbano, impacto de la inmigración, desarrollo de políticas sociales), como por la consecuente disponibilidad de fuentes, el caso porteño constituye el eje central de la indagación. (AU)

Clinical outcomes of acute pancreatitis in elderly patients: An experience of single tertiary center.

BACKGROUND: Although well understanding the course of diseases in geriatric population is of paramount importance in order to provide the optimal treatment, there is only a few studies with controversial results that have been conducted about the course and outcomes of acute pancreatitis (AP) in elderly. We aimed to compare clinical outcomes of AP disease in geriatric age group and to evaluate the risk factors affecting outcomes. METHODS: A total of 336 patients diagnosed with AP, hospitalized and followed-up in our hospital between July/2013-February/2019 were included in this study. Patients aged 65 years and over were assessed as elderly population. Patients' demographic data, comorbidities, duration of hospitalization, local systemic complications, and mortality rates were documented. RESULTS: 196(58.3%) of the patients were female with a mean age of 54.1 ± 17.9 years. The number of patients was 114(33.9%) in the elderly group and 222(66.1%) in the non-elderly group. Although there was no significant difference between both groups in terms of abscess, pseudocyst and necrosis, pancreatic necrosis and systemic complications were higher in the elderly group (p < 0.05). The durations of oral intake and hospitalization were longer, the mortality rate and severity of AP according to the Ranson and Atlanta criteria were significantly higher in the geriatric population (p < 0.05). In addition, age and severity of AP were found to be independent predictive factors of developing complications. CONCLUSIONS: Early recognition of AP is important in the geriatric population. Clinical and laboratory investigations, and early diagnosis in severe patients will be largely helpful in providing close follow-up and the optimal treatment.

Choosing between the UN's alternative views of population aging.

Commonly used measures of population aging categorize adults into those who are "old" and those who are not. How this threshold of the stage of "old age" is determined is crucial for our understanding of population aging. We propose that the old age threshold be determined using an equivalency criterion. People at the old age threshold should be roughly equivalent to one another in relevant characteristics regardless of when and where they lived. The UN publishes two variants of the potential support ratio based on different old age thresholds. One old age threshold is based on a fixed chronological age and the other on a fixed remaining life expectancy. Using historical data on 5-year death rates at the old age threshold as an indicator of one aspect of health, we assess the extent to which the two approaches are consistent with the equivalency criterion. The death rates are derived from all the complete cohort life tables in the Human Mortality Database. We show that the old age threshold based on a fixed remaining life expectancy is consistent with the equivalency criterion, while the old age threshold based on a fixed chronological age is not. The picture of population aging that emerges when measures consistent with the equivalency criterion are used are markedly different from those that result when the equivalency criterion is violated. We recommend that measures of aging that violate the equivalency criterion should only be used in special circumstances where that violation is unimportant.

Prospects of activity limitations among older adults in 23 low and middle income countries.

Increasing life expectancy and a growing share of older people around the world spotlight the issue of health during additional years of life. Research on trends of proportions of older people with activity limitations for low and middle income countries is sparse. We use data from the World Health Survey and the UN World Population Prospects to predict prevalence of activity limitations for 23 low and middle income countries for the upcoming 30 years. Our projections highlight huge variation in the proportion of older adults with limitations across investigated countries and this variation is not expected to diminish. However, these countries are facing considerable demographic changes and even though prevalence rates appear almost constant, absolute numbers are changing which require policy interventions. Furthermore, variations across countries reflect not only disparities in health conditions, but also differences in cultural peculiarities of reporting and historical perception of health.

Participation of Women and Older Participants in Randomized Clinical Trials of Lipid-Lowering Therapies: A Systematic Review.

Importance: Randomized clinical trials (RCTs) of lipid-lowering therapies form the evidence base for national and international guidelines. However, concerns exist that women and older patients are underrepresented in RCTs. Objective: To determine the trends of representation of women and older patients (≥65 years) in RCTs of lipid-lowering therapies from 1990 to 2018. Data Sources: The electronic databases of MEDLINE and ClinicalTrials.gov were searched from January 1990 through December 2018. Study Selection: RCTs of lipid-lowering therapies with sample sizes of at least 1000 patients and follow-up periods of at least 1 year were included. Data Extraction and Synthesis: Two independent investigators abstracted the data on a standard data collection form. Main Outcomes and Measures: Patterns of representation of women and older adults were examined overall in lipid-lowering RCTs and according to RCT-level specific characteristics. The participation-to-prevalence ratio (PPR) metric was used to estimate the representation of women compared with their share of disease burden. Results: A total of 60 RCTs with 485 409 participants were included. The median (interquartile range) number of participants per trial was 5264 (1062-27 564). Overall, representation of women was 28.5% (95% CI, 24.4%-32.4%). There was an increase in the enrollment of women from the period 1990 to 1994 (19.5%; 95% CI, 18.4%-20.5%) to the period 2015 to 2018 (33.6%; 95% CI, 33.4%-33.8%) (P for trend = .01). Among common limiting factors were inclusion of only postmenopausal women or surgically sterile women (28.3%; 95% CI, 18.5%-40.7%) or exclusion of pregnant (23.3%; 95% CI, 14.4%-35.4%) and lactating (16.6%; 95% CI, 9.3%-28.1%) women. Women were underrepresented compared with their disease burden in lipid RCTs of diabetes (PPR, 0.74), heart failure (PPR, 0.27), stable coronary heart disease (PPR, 0.48), and acute coronary syndrome (PPR, 0.51). Only 23 RCTs with 263 628 participants reported the proportion of older participants. Overall representation of older participants was 46.7% (95% CI, 46.5%-46.9%), which numerically increased from 31.6% (95% CI, 30.8%-32.3%) in the period 1995 to 1998 to 46.2% (95% CI, 46.0%-46.5%) in the period 2015 to 2018 (P for trend = .43). A total of 53.0% (95% CI, 41.8%-65.3%) and 36.6% (95% CI, 25.6% to 49.3%) trials reported outcomes according to sex and older participants, respectively, which did not improve over time. Conclusions and Relevance: In this systematic review of RCTs of lipid-lowering therapies, the enrollment of women and older participants increased over time, but women and older participants remained consistently underrepresented. This limits the evidence base for efficacy and safety in these subgroups.

The Sociocultural Meaning of "My Place": Rural Korean Elderly People's Perspective of Aging in Place.

PURPOSE: Aging in place becomes an important concept in elderly care plans worldwide. It pursues to enhance quality of later lives and maintain dignity in older adults. However, one's own place may have some kinds of symbols and meanings to an individual in accordance with the culture he/she belongs to. Without considering it, many cultural conflicts can emerge when policies are realized. Thus, the purpose of this study was to explore the sociocultural meaning of "my place" for elderly Koreans ahead of enacting a policy for the so-called "integrated community care" in South Korea, pursuant to aging in place for the elderly population. METHODS: This study used an ethnographical methodology. The data were collected by observation, in-depth interviews with 10 informants, home visits, field notes, and photos, and analyzed using Spradley's ethnographic approach. RESULTS: As a result, the cultural theme of "my place" in elderly Koreans was "A place that makes me be present." Three categories representing the meaning of "my place" were emerged: keeping me safe and comfortable, representing my life, and maintaining my control and influence. CONCLUSION: Researchers and policymakers should carefully consider the sociocultural perspective when planning, moderating, and implementing a new long-term care policy to achieve aging in place in South Korea.

Decomposition Analyses of the Trend in Poverty Among Older Adults: The Case of South Korea.

OBJECTIVES: We examine the sharp increase in poverty among older adults since the mid-1990s in South Korea. METHOD: We apply decomposition analyses to quantify the contributions of demographic and household characteristics, as well as income sources, to the rise in poverty among older adults. RESULTS: A rapid increase in the number of older adults living independently, combined with an increase in the number of old older adults, largely explains the rising poverty rate among Korean older adults. At the same time, market incomes and private transfers are no longer dominant sources of income for older adults. Gradually rising public transfer incomes offset most of the decline in market and private transfer incomes. Public transfer could not counteract the formidable consequences of changing living arrangements and other changes related to a rapidly aging population. DISCUSSION: The Korean experience shows what would have happened to older adults in rich welfare states if mature old-age income security programs had not been in place. It may also provide some lessons for lower-income countries where poverty among older adults is set to become a larger problem in the coming decades.

Adverse Consequences of Unmet Needs for Care in High-Need/High-Cost Older Adults.

OBJECTIVES: We explore adverse consequences of unmet needs for care among high-need/high-cost (HNHC) older adults. METHOD: Interviews with 4,024 community-dwelling older adults with ADL/IADL/mobility disabilities from the 2011 National Health and Aging Trends Study (NHATS). Reports of socio-demographics, disability compensatory strategies, and adverse consequences of unmet needs in the past month were obtained from older adults with multiple chronic conditions (MCC), probable dementia (DEM), and/or near end-of-life (EOL) and compared older adults not meeting these criteria. RESULTS: Older adults with MCC (31.6%), DEM (39.6%), and EOL (48.7%) reported significantly more adverse consequences than low-need older adults (21.4%). Persons with MCC and DEM (53.4%), MCC, and EOL (53.2%), and all three (MCC, DEM, EOL, 65.6%) reported the highest levels of adverse consequences. HNHC participants reported more environmental modifications, assistive device, and larger helper networks. HNHC status independently predicted greater adverse consequences after controlling for disability compensatory strategies in multivariate models. DISCUSSION: Adverse consequences of unmet needs for care are prevalent among HNHC older adults, especially those with multiple indicators, despite more disability-related compensatory efforts and larger helper networks. Helping caregivers provide better informal care has potential to contain healthcare costs by reducing hospitalization and unplanned readmissions.