Navigating the Landscape of Translational Geroscience in Canada: A Comprehensive Evaluation of Current Progress and Future Directions.

The inaugural Canadian Conferences on Translational Geroscience were held as 2 complementary sessions in October and November 2023. The conferences explored the profound interplay between the biology of aging, social determinants of health, the potential societal impact of geroscience, and the maintenance of health in aging individuals. Although topics such as cellular senescence, molecular and genetic determinants of aging, and prevention of chronic disease were addressed, the conferences went on to emphasize practical applications for enhancing older people's quality of life. This article summarizes the proceeding and underscores the synergy between clinical and fundamental studies. Future directions highlight national and global collaborations and the crucial integration of early-career investigators. This work charts a course for a national framework for continued innovation and advancement in translational geroscience in Canada.

[Update 2021: Coronavirus pandemic - challenges for geriatrics]. / Update 2021: Corona-Pandemie ­ Herausforderungen für die Geriatrie.

Nobody supposed that after one year of the pandemia, the SARS-CoV-2 Virus and its emerging mutants dominates the press, our lives and the health system as a whole. As for Geriatric Medicine, many things have also changed: The majority of COVID-19 patients are no more the (oldest) old and mortality is less observed in multimorbid persons, as most of them have been vaccinated. (Oldest) old persons are still especially vulnerable to die due to a COVD-19 infection. In longterm care, a significant higher mortality was seen in the former waves, but now, some longterm care facilities have more places that they can fill. This is a situation that many European countries would never have anticipated.Ressource allocationin stormy times is now more openly discussed, especially who should be admitted to intensive care units. This has led to more detailed and new guidelines which may help even when the pandemia is over. Here, some thoughts regarding the care of older adults in times of the pandemia are discussed.

Geriatrics: Moving forward with 2020 vision.

Geriatricians have long debated the parameters, positioning, and prospects of their specialty. The year 2020 started full of promise as many organizations anticipated assessing themselves using perfect, or 2020, vision. While challenging on several levels, the momentous combination of events in 2020-the COVID-19 pandemic, Racial Justice Movement, and the November elections-provided Geriatric Medicine several opportunities to firmly secure a position in the mainstream. As we reflect on the new perspectives, programs, and partnerships initiated in 2020, five broader lessons emerge that can help safeguard the future of Geriatrics: the field could employ more intentional "direct to consumer" marketing strategies, expand the scope of what it means to be a patient advocate, pursue new strategic partnerships, take the opportunity to address racial injustice, and leverage existing skillsets to expand scope of care for patients. Given the interdisciplinary nature of Geriatrics, it is fitting that many of these lessons build upon this collaborative philosophy and are derived from domains outside of health care. So in an unexpected way, the events of 2020 may actually help Geriatrics see, with 2020 vision, how to remain mainstream. With this new clarity, Geriatrics holds renewed promise to truly become specialists in whole-person care and it is our hope that, with insight from the lessons shared here, the specialty brings this vision to fruition in the current decade and beyond.

Succeeding in Aging Research During the Pandemic: Strategies for Fellows and Junior Faculty.

Fellows and junior faculty conducting aging research have encountered substantial new challenges during the COVID-19 pandemic. They report that they have been uncertain how and whether to modify existing research studies, have faced difficulties with job searches, and have struggled to balance competing pressures including greater clinical obligations and increased responsibilities at home. Many have also wondered if they should shift gears and make COVID-19 the focus of their research. We asked a group of accomplished scientists and mentors to grapple with these concerns and to share their thoughts with readers of this journal.

[State support to elderly citizens: which gerontology needs modern Russia? (Part 1).]

The article discusses the causal relationship between the low efficiency of state policy in extending the period of active longevity. It is characterized by the absence of a correlation between basic and applied research in the field of aging and the use of an unsystematic approach to the development, implementation of targeted federal and regional programs aimed improving the quality of life older citizens. It is shown that the current negative situation, characterized by an aggravating decline in the quality and accessibility of state medical, social and psychological assistance to elderly citizens, is largely due to the incompleteness of existing laws and regulations in the field of their social support. The lack of both scientific justification for programs and terminological correctness allows officials to use a formalized, extensive approach when planning the development of the healthcare and social protection sectors, which do not take into account population aging. The problem of positioning gerontology as a scientific discipline that provides a synthesis of natural science, applied and socio-humanitarian knowledge, a complex of four scientific areas: biology, medicine, psychology, sociology is considered. The unity of the components of gerontology provides scientific background for improving public policy aimed on adapting socio-economic development to the demographic processes of population aging.

Promoting social engagement of the elderly to cope with aging of the Chinese population.

China is in a stage of rapid aging of its population, and its old-age dependency ratio has been increasing for decades. The acceleration of aging of the population and the increasing old-age dependency ratio will significantly increase the pressure on social security and public services, highlight the need for the effective supply of labor, and weaken the demographic dividend, which will continue to affect social vitality, the power to innovate, and potential economic growth rates. Promoting social engagement has been widely recognized as an effective strategy to address these challenges. Such an approach not only promotes the development of social productivity, but it also alleviates the social burden. Actively promoting the social engagement of the elderly is an important task in gerontology in China. Although the development of social engagement of the elderly is on the rise, the infrastructure and institutions to provide social engagement need to be enhanced. Improving social engagement in China is not just the responsibility of older adults themselves but also of the country and society as a whole. In the future, the entire society will fully understand the special role of older adults and increase their value through social engagement to achieve active and healthy aging in China.

[Ethics, care and ageing during the Covid-19 pandemic]. / Éthique, soin et grand âge pendant l'épidémie de Covid-19.

At the beginning of the Covid-19 epidemic, National forum for ethical reflection on Alzheimer's disease and neurodegenerative diseases conducted a national survey to identify the difficulties encountered by professionals working in the field of old age and autonomy, families and volunteers, and the initiatives they have implemented. Seven major difficulties were identified: the isolation induced by the prohibition of visits, the lack of protective equipment and tests, the difficulties of people with cognitive difficulties in understanding measures to avoid the spread of the epidemic, the sustainability of overwork for professionals, the concern of the families of residents, complex situations at home and difficulties in accessing care. Four initiatives are being implemented: information and training for teams, compensation for interrupted visits, consultations and exchanges between professionals, actions to benefit people living at home. The Covid-19 epidemic hit the elderly sector at a very special moment in its history, several years of effort by the sector to reinvent itself around strong values. They have been a resource during this period of crisis. An ambitious law on old age and autonomy therefore appears to be a necessity.

Systemic and Reflexive: Foundations of Cumulative Dis/Advantage and Life-Course Processes.

Cumulative dis/advantage has been defined as the systemic tendency for interindividual divergence in a given characteristic to increase with the passage of time. Over recent decades, evidence supporting cumulative dis/advantage (CDA) as a cohort-based process that produces inequalities on a range of life-course outcomes has steadily increased. This paper reviews this growing body of work, grounding the discussion in CDA's foundation as a general sociological construct with broad relevance. I emphasize the distinction between outcome and process, and then distinguish multiple levels of social analysis at which CDA operates. From this review, I extract two principles, endogenous system dynamics and life-course reflexivity, that can be cross-classified to provide a framework for analyzing contemporary research frameworks and initiatives relevant to CDA. I argue that the full sociological impact and implications of CDA research has been unevenly developed and applied, and conclude by suggesting some possible directions for further building on CDA's insights.

DIY gerontechnology: circumventing mismatched technologies and bureaucratic procedure by creating care technologies of one's own.

This study analyses 'Do-It-Yourself' (DIY) gerontechnologies and shows that they can be viable and valuable alternatives to 'ready-made' gerontechnologies. Using the concept of innosumption, we analyze the work of care workers in gerontechnology showrooms in Norway. We show how and why care workers will sometimes advice older adults to assemble DIY-gerontechnologies. Such DIY-gerontechnologies are not high-tech solutions made by technology producers, but creative solutions that older adults' suit to their specific needs and assemble for themselves from mundane objects that are available in shops. So far, analyses of the design, implementation and use of gerontechnologies have almost exclusively focused on professionally designed and produced 'ready-made' gerontechnologies. But for various reasons, ready-made gerontechnologies often do not fit in well with the lives of older people. In such cases, care workers guide older people to the innosumption of DIY-gerontechnologies that offer workable solutions that are useful, quickly implemented, easily understandable and often cheap. We show that and how the existence of DIY-gerontechnologies questions the reasons behind the strong and widely accepted assumption that only high-tech innovations are a proper solution to the needs of older people.

Health promotion of frail elderly individuals and at risk of frailty.

OBJECTIVE: To identify interventions for the health promotion of frail elderly individuals and those at risk of frailty. METHOD: Integrative review of the literature performed in the following databases: LILACS, CINAHL, MEDLINE, Web of Science, COCHRANE and Scopus, using the. DESCRIPTORS: "frail elderly", "aging", "health services for the aged" and "health promotion" combined with Boolean operators "AND" and "OR". RESULTS: Randomized controlled clinical trials (RCTs) classified as level of evidence II represented 82.6% of studies. Interventions were analyzed according to the following categories: Interventions for the elderly at risk of frailty and Interventions for the frail elderly. CONCLUSION: The following interventions were identified: educational multiprofessional group meetings, physical training, home visit/home care program, nutrition assessment and supplementation, health maintenance programs and cognitive training; models/programs of management and monitoring, use of assistive technology devices and hospitalization program for geriatric rehabilitation.

Injuries, dislocations, and poor health perceived by older adults to result from vigorous physical activity: implications for active living, health promotion, and gerontology.

This study examines older adults' perceptions about their participation in vigorous physical activity (VPA) and the association between VPA and self-related health. A total of 686 older adults responded to self-reported questionnaires, and Pearson's ꭓ2 test and binary logistic regression were used to present findings. About 74% of older adults reported experiencing dislocations, fractures, or/and other forms of injury in intense physical activities lasting 30 minutes or more a day. After controlling for relevant socio-demographic factors, older adults who participated in VPA for 30 or more minutes a day were less likely (OR=0,129; p=0,000) to report good health compared with those who participated in VPA for less than 30 minutes. It is concluded that VPA in older populations can result in casualties that may compel older adults to underrate their health, which can discourage active living habits in older populations and discredit PA/health promotion programs.

Era of geriatric medical challenges: Multimorbidity among older patients.

The number of older adults is increasing worldwide, including in Asian countries. Various problems associated with medical care for older adults are being highlighted in aging societies. As the number of chronic diseases increases with age, older adults are more likely to have multiple chronic diseases simultaneously (multimorbidity). Multimorbidity results in poor health-related outcomes, leading to increased use and cost of healthcare. Above all, it leads to deterioration in older adults' quality of life. However, it is unclear whether any medical interventions are effective for multimorbidity, which means medical practitioners currently offer medical care "in the dark." It is therefore necessary for researchers and medical professionals involved in geriatric medicine to establish ways to manage multimorbidity among older adults. This means that the development of research in this field is essential. Geriatr Gerontol Int 2019; 19: 699-704.

Risk-period-cohort approach for averting identification problems in longitudinal models.

In epidemiology, gerontology, human development and the social sciences, age-period-cohort (APC) models are used to study the variability in trajectories of change over time. A well-known issue exists in simultaneously identifying age, period and birth cohort effects, namely that the three characteristics comprise a perfectly collinear system. That is, since age = period-cohort, only two of these effects are estimable at a time. In this paper, we introduce an alternative framework for considering effects relating to age, period and birth cohort. In particular, instead of directly modeling age in the presence of period and cohort effects, we propose a risk modeling approach to characterize age-related risk (i.e., a hybrid of multiple biological and sociological influences to evaluate phenomena associated with growing older). The properties of this approach, termed risk-period-cohort (RPC), are described in this paper and studied by simulations. We show that, except for pathological circumstances where risk is uniquely determined by age, using such risk indices obviates the problem of collinearity. We also show that the size of the chronological age effect in the risk prediction model associates with the correlation between a risk index and chronological age and that the RPC approach can satisfactorily recover cohort and period effects in most cases. We illustrate the advantages of RPC compared to traditional APC analysis on 27496 individuals from NHANES survey data (2005-2016) to study the longitudinal variability in depression screening over time. Our RPC method has broad implications for examining processes of change over time in longitudinal studies.

Pain Assessment, Management, and Impact Among Older Adults in Assisted Living.

OBJECTIVES: The purpose of this study was to describe the incidence, pharmacologic management, and impact of pain on function, agitation, and resistiveness to care among assisted living residents. DESIGN: This was a descriptive study. DATA SOURCES: Baseline data from 260 residents in the second cohort of the study Dissemination and Implementation of Function Focused Care for Assisted Living Using the Evidence Integration Triangle. REVIEW/ANALYSIS METHODS: Descriptive analyses for the Pain Assessment in Advanced Dementia (PAINAD), Visual Descriptor Scale (VDS), and use of medication for pain management and hypothesis testing using linear regression analyses were performed. RESULTS: The majority of the sample was female (71%) and white (96%) with a mean age of 87 (standard deviation = 7). Fifty-two out of the 260 residents (20%) reported pain based on either the PAINAD or the VDS. Out of the total 260 residents, 75 (29%) received pain medication. Twenty-two out of the 52 individuals (42%) reporting pain were not getting pain medication. Controlling for age, gender, and cognition, the PAINAD was significantly associated with agitation, function, and resistiveness to care and the VDS was only associated with function. CONCLUSIONS: The incidence of pain was low among participants based on the PAINAD or the VDS. Pain measured by the PAINAD was significantly associated with function, agitation, and resistiveness to care.

Potential of a nurse telephone triage line to direct elderly to appropriate health care settings.

AIM: To explore the potential of a nurse health triage telephone line to advise and guide elderly users' decisions regarding the appropriate health care setting and self-care. BACKGROUND: Ageing is a concern in many countries and poses challenges to health care services. Triage and advice lines can play an important role for the (re)organisation of health care delivery. Discussion has been focused on the capacity of these lines to reduce inappropriate demand for acute and emergency departments. METHODS: Cross-sectional descriptive analysis. RESULTS: Nurses directed elders to a health care service both by downgrading their initial intentions (concurring to the most common objective) and by upgrading them (e.g., directing elders that intended to stay at home to acute and emergency care). The intention to comply with the nurse's disposition was high. CONCLUSIONS: The line helped to improve the appropriateness of acute and emergency care demand and to reduce the overall demand for care by elders. There is nonetheless space for improvement given the underuse of the line by elders. IMPLICATIONS FOR NURSING MANAGEMENT: Health telephone-based triage and advice should be promoted to increase the match between the needs of elderly patients and health resources, thus improving health equity.

Changes in the Use of Comprehensive Geriatric Assessment in Clinical Trials for Older Patients with Cancer over Time.

BACKGROUND: The objective of this study was to describe the implementation of comprehensive geriatric assessment (CGA) in clinical trials dedicated to older patients before and after the creation of the International Society of Geriatric Oncology in the early 2000s. SUBJECTS, MATERIALS, AND METHODS: All phase I, II, and III trials dedicated to the treatment of cancer among older patients published between 2001 and 2004 and between 2011 and 2014 were reviewed. We considered that a CGA was performed when the authors indicated an intention to do so in the Methods section of the article. We collected each geriatric domain assessed using a validated tool even in the absence of a clear CGA, including nutritional, functional, cognitive, and psychological status, comorbidity, comedication, overmedication, social status and support, and geriatric syndromes. RESULTS: A total of 260 clinical trials dedicated to older patients were identified over the two time periods: 27 phase I, 193 phase II, and 40 phase III trials. CGA was used in 9% and 8% of phase II and III trials, respectively; it was never used in phase I trials. Performance status was reported in 67%, 79%, and 75% of phase I, II, and III trials, respectively. Functional assessment was reported in 4%, 11%, and 13% of phase I, II, and III trials, respectively. Between the two time periods, use of CGA increased from 1% to 11% (p = .0051) and assessment of functional status increased from 3% to 14% (p = .0094). CONCLUSION: The use of CGA in trials dedicated to older patients increased significantly but remained insufficient. IMPLICATIONS FOR PRACTICE: This article identifies the areas in which research efforts should be focused in order to offer physicians well-addressed clinical trials with results that can be extrapolated to daily practice.

Dementia care in Israel: top down and bottom up processes.

Dementia is one of the main causes of disability among older adults and is viewed as one of the most distressing and devastating of conditions. Dementia has a profound impact on those who suffer from the disease and on their family caregivers. In this article, we describe the added benefit of implementing top-down and bottom-up strategies in the process of influencing and developing healthcare services. We use Israel as an example to argue that breakthroughs in care implementation and development of services are more likely to occur when there is a convergence of top-down and bottom-up processes. In the first section of the article, we present the top-down plans, initiated to address the needs of people with dementia and their families. In the second section, we present examples of bottom-up projects that developed in Israel before and after the top-down plans were initiated. In the third section, we contend that it is the combination of these top-down and bottom-up strategies that led to a breakthrough and the expansion of services for people with dementia and their families, and we argue that the Israeli case study is applicable to other health systems.

Population ageing in a globalized world: Risks and dilemmas?

RATIONALE, AIMS, AND OBJECTIVES: This article aims to examine global population ageing and to evaluate the likely risks and dilemmas of demographic ageing within the context of the health and well-being of individuals. METHODS: This paper is based on the author's research in the field of social gerontology, demography, and public health. In addition, a literature review has been carried out focused on the objectives of the research. RESULTS: The study has identified potential risks and dilemmas that the older people may face in the globalized world. There are four main aspects that contribute to an unequal distribution of risks in later life: (a) burden of disease in epidemiological transition, (b) financial security in retirement, (c) familial resources for older peoples' care, and (d) availability of workforce for older peoples' care. Whilst population ageing is a global trend, its impact is not equal across the world, and this is highlighted in this research. There are some important dilemmas which are identified in this paper that may also fuel the potential risks and challenges facing ageing societies. CONCLUSIONS: It is apparent that older people will face numerous risks in later life and those in developing countries are likely to face more challenges than those in developed countries. The findings may be useful to policymakers for formulating future plans and policy implementation. Further research is required to identify the number of health care workers needed to tackle the challenges of an ageing societies across the globe.

Health promotion of frail elderly individuals and at risk of frailty / Promoción de la salud de ancianos frágiles y con riesgo de fragilidad / Promoção da saúde de idosos frágeis e em risco de fragilização

ABSTRACT Objective: To identify interventions for the health promotion of frail elderly individuals and those at risk of frailty. Method: Integrative review of the literature performed in the following databases: LILACS, CINAHL, MEDLINE, Web of Science, COCHRANE and Scopus, using the Descriptors: "frail elderly", "aging", "health services for the aged" and "health promotion" combined with Boolean operators "AND" and "OR". Results: Randomized controlled clinical trials (RCTs) classified as level of evidence II represented 82.6% of studies. Interventions were analyzed according to the following categories: Interventions for the elderly at risk of frailty and Interventions for the frail elderly. Conclusion: The following interventions were identified: educational multiprofessional group meetings, physical training, home visit/home care program, nutrition assessment and supplementation, health maintenance programs and cognitive training; models/programs of management and monitoring, use of assistive technology devices and hospitalization program for geriatric rehabilitation.

RESUMEN Objetivo: Identificar intervenciones para promover la salud de ancianos frágiles y con riesgo de fragilidad. Método: Revisión integrativa de la literatura realizada en las siguientes bases de datos: LILACS, CINAHL, MEDLINE, Web of Science, COCHRANE y Scopus, utilizando los Descriptores: "frail elderly", "aging", "health services for the aged" y "health promotion", combinados por medio de operadores Booleanos "AND" y "OR". Resultados: Los ensayos clínicos aleatorizados controlados (ECAC) clasificados como nivel de evidencia II correspondieron al 82,6% de los estudios. Las intervenciones fueron analizadas según las categorías: Intervenciones para ancianos con riesgo de fragilidad e Intervenciones para el anciano frágil. Conclusión: Las intervenciones identificadas fueron: reuniones educativas de grupos multiprofesionales, entrenamiento físico, visita domiciliaria/programa de atención domiciliaria, evaluación y suplementación nutricional, programas para el mantenimiento de la salud y entrenamiento cognitivo; modelos/programas de gestión y monitoreo, uso de dispositivos de tecnología asistiva y programa de internación para rehabilitación geriátrica.

RESUMO Objetivo: Identificar intervenções para promoção da saúde de idosos frágeis e em risco de fragilização. Método: Revisão integrativa da literatura realizada nas bases de dados: LILACS, CINAHL, MEDLINE, Web of Science, COCHRANE e Scopus, utilizando os Descritores: "frail elderly", "aging", "health services for the aged" e "health promotion", combinados por meio de operadores boleanos "AND" e "OR". Resultados: Ensaios clínicos randomizados controlados (ECRC) classificados como nível de evidência II corresponderam a 82,6% dos estudos. As intervenções foram analisadas segundo as categorias: Intervenções para idoso em risco de fragilização e Intervenções para o idoso frágil. Conclusão: As intervenções identificadas foram: reuniões educativas de grupos multiprofissionais, treinamento físico, visita domiciliar/programa de cuidados domiciliar, avaliação e suplementação nutricional, programas para manutenção da saúde e treinamento cognitivo; modelos/programas de gestão e monitoramento, uso de dispositivos de tecnologia assistiva e programa de internação para reabilitação geriátrica.