Do changes in frailty, physical functioning, and cognitive functioning predict mortality in old age? Results from the Longitudinal Aging Study Amsterdam.

BACKGROUND: The ability to accurately predict survival in older adults is crucial as it guides clinical decision making. The added value of using various health indicators as well as changes in these indicators for predicting mortality remains unclear. The aim of this study was to investigate whether changes in health indicators such as frailty and physical performance improve mortality predictions in old age. METHODS: This is a population based prospective cohort study on 995 community-dwelling people aged 68-92 years from the Longitudinal Aging Study Amsterdam. Two measurements at a three-year interval (1995/1996 and 1998/1999) were available for the frailty index, frailty phenotype, grip strength, walking speed, and Mini-Mental State Examination (MMSE). Cox regression was used to analyze mortality risks associated with the current health status and changes in health, with mortality data up to 2017. The extent to which these health indicators improved mortality predictions compared to models with age and sex only was assessed by the area under the receiver operating characteristic curve (AUC). RESULTS: The AUC of age and sex for five-year mortality was 72.8% (95% CI 69.0 - 76.5) and was the lowest in the oldest old (age > 80.5 years). The added AUC of the current status of health indicators ranged from 0.7 to 3.3%. The added AUC of the three-year change was lower, ranging from -0.0 to 1.1%, whereas the added AUC of three-year change and current status combined was similar to current status alone, ranging from 0.6 to 3.2%. Across age, the added AUC of current status was highest in the oldest old, however there was no such pattern using three-year change. Overall, the frailty index appeared to improve mortality predictions the most, followed by the frailty phenotype, MMSE, grip strength, and walking speed. CONCLUSIONS: Current health status improved mortality predictions better than changes in health. Its contribution was highest in the oldest old, but the added value to models with age and sex only was limited.

Reablement through time and space: a scoping review of how the concept of 'reablement' for older people has been defined and operationalised.

BACKGROUND: While the field of rehabilitation has determined a common definition of professional practice, legislators and healthcare professionals in various Western countries have struggled to reach consensus about how the newer offer of 'reablement' should be organised, operationalised, and understood as a health service for older adults. International research indicates that there is confusion, ambiguity, and disagreement about the terminology and the structure of these programmes, and they may not be adequately supporting older people's self-identified goals. Could an analysis of the concept's genealogy illuminate how reablement can be more effective and beneficial in theory and in practice? METHODS: We conducted a qualitative and quantitative scoping review to determine how reablement has developed through time and space. Eligible articles (N=86) had to focus on any of the defined features of current reablement programmes; there were no restrictions on study designs or publication dates. In articles published from 1947 to 2019, we identified themes and patterns, commonalities, and differences in how various countries described and defined reablement. We also performed an analysis using computer software to construct and visualise term maps based on significant words extracted from the article abstracts. RESULTS: The fundamental principles of reablement have a long history. However, these programmes have undergone a widespread expansion since the mid-2000s with an intention to reduce costs related to providing long-term care services and in-home assistance to growing older populations. Despite theoretical aspirations to offer person-centred and goal-directed reablement, few countries have been able to implement programmes that adequately promote older people's goals, social involvement, or participation in their local community in a safe, culturally sensitive and adaptable way. CONCLUSIONS: Reablement is meant to support older people in attaining their self-defined goals to be both more physically independent at home and socially involved in their communities. However, until legislators, health professionals, and older people can collectively reach consensus about how person-centred reablement can be more effectively implemented and supported in professional home-care practice, it will be difficult to determine a conceptual description of reablement as a service that is unique, separate, and distinct from standard rehabilitation.

'Standing together - at a distance': Documenting changes in mental-health indicators in Denmark during the COVID-19 pandemic.

Aims: There is a need to document the mental-health effects of the COVID-19 pandemic and its associated societal lockdowns. We initiated a large mixed-methods data collection, focusing on crisis-specific worries and mental-health indicators during the lockdown in Denmark. Methods: The study incorporated five data sources, including quantitative surveys and qualitative interviews. The surveys included a time series of cross-sectional online questionnaires starting on 20 March 2020, in which 300 (3×100) Danish residents were drawn every three days from three population groups: the general population (N=1046), families with children (N=1032) and older people (N=1059). These data were analysed by trend analysis. Semi-structured interviews were conducted with 32 people aged 24-83 throughout Denmark to provide context to the survey results and to gain insight into people's experiences of the lockdown. Results: Absolute level of worries, quality of life and social isolation were relatively stable across all population groups during the lockdown, although there was a slight deterioration in older people's overall mental health. Many respondents were worried about their loved ones' health (74-76%) and the potential long-term economic consequences of the pandemic (61-66%). The qualitative interviews documented significant variation in people's experiences, suggesting that the lockdown's effect on everyday life had not been altogether negative. Conclusions: People in Denmark seem to have managed the lockdown without alarming changes in their mental health. However, it is important to continue investigating the effects of the pandemic and various public-health measures on mental health over time and across national contexts.

Correction: Religion, faith, and spirituality influences on HIV prevention activities: A scoping review.

[This corrects the article DOI: 10.1371/journal.pone.0234720.].

[Screening tools do not measure up against rigorous history taking]. / Gaan we luisteren of meten?

Provision of appropriate care services for older adults is a challenge for contemporary medical practice, especially for cases where elderly patients present in an emergency department. Manifold questionnaires, inventories and screening tools have been developed to identify those who are at an increased risk of adverse outcomes. The complex problems with which older adults present are difficult to capture in these standardized instruments, whereas the prognostic accuracy is insufficient for personalized risk estimation. Instead of relying on questionnaires and inventories, it is strongly advised to follow the iterative and associate approach of history taking that starts with listening to what is there to say by patients and/or carers.

Do psychosocial factors modify the negative association between disability and life satisfaction in old age?

CONTEXT: Many assume that having poor physical health in old age lowers life satisfaction, but in fact there are large differences in life satisfaction among older people who experience disability. OBJECTIVE: To investigate whether psychosocial factors modify the negative association between disability and life satisfaction in older people and whether these differ across the life course. DESIGN: Cross sectional study. SETTING: 66,561 community-dwelling Survey of Health, Ageing, and Retirement in Europe (SHARE) participants aged 50-106 with a mean age of 67.8 ± 9.9 (SD) years from 17 European countries and Israel. METHODS: Psychosocial factors included depression (EURO-D scale), perceived loneliness, having a spouse, having children, contact with children, and participation in social activities. Disability was assessed by limitations in (Instrumental) Activities of Daily Living ((I)ADL) and life satisfaction by Cantril's ladder. We also ran the analyses with the Control Autonomy Self-realization Pleasure (CASP-12) Index, a normative measure of quality of life. We used multiple linear regressions to estimate associations and proportion of variance explained. RESULTS: The variance in life satisfaction that could be attributed uniquely to ADL and IADL disability was 0.17% and 0.33% respectively (both p < 0.001). The impact of (I)ADL disabilities on life satisfaction was strongest at age 50 and gradually decreased with increasing age (p trend < 0.001). Mental health explained more variance; 5.75% for depressive symptoms and 2.50% for loneliness and for social resources this ranged from 0.09% to 0.47% (all p < 0.001). While disability has a negative effect on life satisfaction, the effect was not stronger in older persons who were depressed, neither in those who felt lonely nor in those without social resources. Similar outcomes were found when using CASP-12 as the explained variable. CONCLUSION: The impact of (I)ADL disabilities on life satisfaction in community-dwelling older people decreases with age. These associations are not affected by psychosocial factors and these patterns cannot be explained by people changing their norms and values.

The added value of health indicators to mortality predictions in old age: A systematic review.

BACKGROUND: Numerous risk prediction models use indicators of health to predict mortality in old age. The added value to mortality predictions based on demographic variables is unknown. OBJECTIVE: To evaluate the accuracy of health indicators in predicting all-cause mortality among individuals aged 50+ using area under receiver operating characteristic curve (AUC). Specifically, to assess the added value of health indicators relative to demographic variables. METHODS: We conducted a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. There were no restrictions on study designs, follow-up duration, language, or publication dates. We also examined the quality of studies using the Checklist for Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies. RESULTS: Out of 804 studies investigating all-cause mortality in older persons, 16 studies were eligible. In community-dwelling populations, the accuracy of demographic variables and health indicators combined ranged from AUC 0.71 to 0.82, indicating modest ability to predict mortality. Age contributed the most to mortality prediction (AUC 0.65 to 0.78) and compared to age and sex, the added values of genetics, physiology, functioning, mood, cognition, nutritional status, subjective health, disease, frailty, and lifestyle ranged from AUC 0.01 to 0.10. The lack of validation samples made it difficult to assess their true added value. Findings were similar in institutionalized populations. Heterogeneity of the studies prevented us from performing a meta-analysis. CONCLUSION: Age and sex contributed the most to mortality predictions in old age while the added value of health indicators is likely to be limited.

Discrimination ability of comorbidity, frailty, and subjective health to predict mortality in community-dwelling older people: Population based prospective cohort study.

OBJECTIVE: To investigate the added value of comorbidity, frailty, and subjective health to mortality predictions in community-dwelling older people and whether it changes with increasing age. PARTICIPANTS: 36,751 community-dwelling subjects aged 50-100 from the longitudinal Survey of Health, Ageing, and Retirement in Europe. METHODS: Mortality risk associated with Comorbidity Index, Frailty Index, Frailty Phenotype, and subjective health was analysed using Cox regression. The extent to which health indicators modified individual mortality risk predictions was examined and the added ability to discriminate mortality risks was assessed. MAIN OUTCOME MEASURES: Three-year mortality risks, hazard ratios, change in individual mortality risks, three-year area under the receiver operating characteristic curve (AUC). RESULTS: Three-year mortality risks increased 41-folds within an age span of 50years. Hazard ratios per change in health indicator became less significant with increasing age (p-value<0·001). AUC for three-year mortality prediction based on age and sex was 76·9% (95% CI 75·5% to 78·3%). Information on health indicators modified individual three-year mortality risk predictions up to 30%, both upwards and downwards, each adding <2% discriminative power. The added discrimination ability of all health indicators gradually declined from an extra 4% at age 50-59 to <1% in the oldest old. Trends were similar for one-year mortality and not different between sexes, levels of education, and household income. CONCLUSION: Calendar age encompasses most of the discrimination ability to predict mortality. The added value of comorbidity, frailty, and subjective health to mortality predictions decreases with increasing age.

When Contact Is Not Enough: Affecting First Year Medical Students' Image towards Older Persons.

CONTEXT: Many medical schools have initiated care internships to familiarize their students with older persons and to instil a professional attitude. OBJECTIVE: To examine the impact of care internships on the image that first-year medical students have of older persons and to explore the underlying concepts that may play a role in shaping this image. DESIGN: Survey before and after a two-week compulsory care internship using the Aging Semantic Differential (ASD; 32 adjectives) and the Attitudes toward Old People (AOP; 34 positions) questionnaires. PARTICIPANTS: Before and after a care internship involving interpersonal contact, 252 and 244 first-year medical students at the Leiden University Medical Centre (LUMC) in the academic year 2012-2013 participated. METHOD: Descriptive statistics, analyses of variance, and principal component analysis were used; clusters of adjectives and positions were reduced into concepts to examine dominant patterns of views. Changes in image were investigated as mean differences of the total and concept scores. RESULTS: Both the ASD and the AOP questionnaires showed a poor general image of older persons that significantly worsened after the care internship (p < 0.01). The percentage of students considering over 75 years as being old increased from 17.2% to 31.2% (p < 0.01) and those who thought they would find as much satisfaction in care for older as for younger patients decreased from 78.5% to 62.1% (p < 0.001). Exploratory principal component analysis showed particularly low scores on 'comportment' and 'pleasurable interaction' whereas the scores on 'personality traits' and 'habitual behaviour' significantly deteriorated (both p < 0.001). These patterns were irrespective of the student's gender and previous contact experience. CONCLUSION: Medical schools should carefully consider care internships to ensure that students do not worsen their views on older patients, which may occur due to inadequate contact depth and quality within a rather unsupportive context.

Successful ageing: A study of the literature using citation network analysis.

BACKGROUND: Ageing is accompanied by an increased risk of disease and a loss of functioning on several bodily and mental domains and some argue that maintaining health and functioning is essential for a successful old age. Paradoxically, studies have shown that overall wellbeing follows a curvilinear pattern with the lowest point at middle age but increases thereafter up to very old age. OBJECTIVE: To shed further light on this paradox, we reviewed the existing literature on how scholars define successful ageing and how they weigh the contribution of health and functioning to define success. METHODS: We performed a novel, hypothesis-free and quantitative analysis of citation networks exploring the literature on successful ageing that exists in the Web of Science Core Collection Database using the CitNetExplorer software. Outcomes were visualized using timeline-based citation patterns. The clusters and sub-clusters of citation networks identified were starting points for in-depth qualitative analysis. RESULTS: Within the literature from 1902 through 2015, two distinct citation networks were identified. The first cluster had 1146 publications and 3946 citation links. It focused on successful ageing from the perspective of older persons themselves. Analysis of the various sub-clusters emphasized the importance of coping strategies, psycho-social engagement, and cultural differences. The second cluster had 609 publications and 1682 citation links and viewed successful ageing based on the objective measurements as determined by researchers. Subsequent sub-clustering analysis pointed to different domains of functioning and various ways of assessment. CONCLUSION: In the current literature two mutually exclusive concepts of successful ageing are circulating that depend on whether the individual himself or an outsider judges the situation. These different points of view help to explain the disability paradox, as successful ageing lies in the eyes of the beholder.