Yoga como terapia complementaria para el Adulto Mayor / Yoga as a complementary therapy for older adult

Introducción: El yoga es una actividad que trata de un ejercicio el cual contiene una intensidad baja a moderada, la cual no se centra exclusivamente en el entrenamiento físico, sino que también en el desarrollo de la mente y el espíritu de uno mismo. El yoga puede obtener un mayor impacto en el equilibrio y en la ganancia de fuerza de la parte superior del cuerpo, además, demuestra mejora en la aptitud cardiorrespiratoria y flexibilidad. Metodología: El enfoque de desarrollo fue de tipo cuantitativo en donde se realizó una revisión sistemática como metodología de búsqueda de información, relacionada al yoga como una terapia complementaria y los beneficios que éste aportaba al bienestar de las personas mayores. Resultados: En cada uno de los ensayos controlados aleatorizados que fueron recabados para fines de esta revisión sistemática. Se destaca la importancia y los beneficios del yoga en la movilidad, fuerza, flexibilidad y espiritualidad de los usuarios que practican esta terapia. Discusión: Los artículos analizados pertenecen a ensayos clínicos o estudios aleatorizados, los cuales permitieron responder de manera efectiva a nuestra pregunta de investigación, la cual consiste en reconocer si el yoga es efectivo para disminuir el riesgo de dependencia funcional y eliminar hábitos que no son saludables para las personas mayores, además de mejorar la calidad de vida actual. Gracias a ello se pudo evidenciar que esta terapia en adultos mayores genera cambios positivos respecto a estado y condición física, la ejecución de esta práctica mejora la calidad de vida en un 80% Conclusión: La yoga como terapia complementaria si entrega beneficios en la calidad de vida de la población adulta mayor, dado que, que hubo una mejora tanto en la movilidad, calidad de vida y autovalencia de los adultos mayores[AU]

Introduction: Yoga is an activity that deals with a low to moderate intensity exercise, which is not exclusively focused on physical training, but also on the development of the mind and spirit itself. Yoga may have a greater impact on balance and upper body strength gains, and have shown improvements in cardiorespiratory fitness and flexibility. Methodology:the development approach was of a quantitative type where a systematic review was carried out as a methodology for searching for information related to yoga as a complementary therapy and the benefits that it brought to the well-being of the elderly. Results:The importance and benefits of yoga on the mobility, strength, flexibility and spirituality of users who practice this therapy are highlighted in each of the randomized controlled trials that were collected for the purposes of this systematic review. Discussion: The articles analyzed belong to clinical trials or randomized studies, which allowed us to effectively answer our research question. The activity of yoga in older adults generates positive changes regarding state and physical condition, the execution of this practice improves the quality of life by 80% Conclusion: Yoga as a complementary therapy delivers benefits in the quality of life of the adult population elderly, it can be said that there was an improvement in mobility, quality of life and self-valence of the elderly[AU]

Introdução: O Yoga é uma atividade que trata de um exercício de intensidade baixa a moderada, que não se foca exclusivamente no treino físico, mas também no desenvolvimento da mente e do espí-rito. A ioga pode ter um impacto maior no equilíbrio e nos ganhos de força da parte superior do corpo e mostrou melhorias na apti-dão cardiorrespiratória e flexibilidade. Metodologia: a abordagem de desenvolvimento foi do tipo quantitativo onde foi realizada uma revisão sistemática como metodologia de busca de informações re-lacionadas ao yoga como terapia complementar e os benefícios que trouxe para o bem-estar dos idosos. Resultados: A importância e os benefícios do yoga na mobilidade, força, flexibilidade e espiri-tualidade dos usuários que praticam esta terapia são destacados em cada um dos ensaios clínicos randomizados que foram coletados para fins desta revisão sistemática. Discussão: Os artigos analisa-dos pertencem a ensaios clínicos ou estudos randomizados, o que nos permitiu responder de forma eficaz à nossa questão de inves-tigação. A atividade de yoga em idosos gera mudanças positivas quanto ao estado e condição física, a execução desta prática mel-hora a qualidade de vida em 80% Conclusão: o yoga como terapia complementar traz benefícios na qualidade de vida da população adulta idosa, pode-se dizer que houve melhora na mobilidade, qualidade de vida e autovalência dos idosos[AU]

Effectiveness of a Virtual Reality Open-Air Bath Program in Reducing Loneliness and Improving Brain Function for Dementia Prevention in Older Adults: Protocol for a Prospective Randomized Crossover Study.

BACKGROUND: Older adults often face loneliness due to chronic illness or loss of close ones, a situation worsened by the COVID-19 pandemic. Increased loneliness heightens the risk of diseases, especially dementia, necessitating urgent action. OBJECTIVE: This study aims to assess the impact of a virtual reality (VR)-based open-air bath program on depression and loneliness in older individuals with subjective cognitive decline/mild cognitive impairment attending the Dementia Medical Center in Kyoto, Japan. We further aim to evaluate the feasibility of the program (participant recruitment and adherence) and to measure program enjoyment and satisfaction. METHODS: The study design is a crossover trial with a 1:1 ratio, wherein 12 participants will be randomly assigned to groups 1 and 2, with group 2 serving as a waitlist control and group 1 receiving the VR program from the onset for 6 months; the VR program will be conducted 6 times (monthly). Program completion for group 1 will be followed by an observation period from months 7 to 12. Group 2 will participate in the VR program from months 7 to 12, with an observation period from months 1 to 6. Cognitive tests, psychiatric assessments, and the University of California, Los Angeles Loneliness Scale will be conducted before the study, at 6 months, and at 12 months. Results will be analyzed using repeated-measures ANOVA. Head magnetic resonance imaging and single-photon emission computed tomography scans will be performed before and after the VR program to evaluate changes and effects on brain regions. RESULTS: Recruitment began in September 2023 and data collection is expected to be completed by March 2025. Complete study results will be published by September 2025. CONCLUSIONS: This study examines the preliminary effects of VR on loneliness in older adults with predementia through open-air bath simulations. VR experiences could benefit this population, particularly those with limited outdoor activities. Quantifying VR's impact will aid in determining the size for a larger clinical trial. Qualitative results will inform participation mechanisms and guide the implementation and design of future trials. TRIAL REGISTRATION: University hospital Medical Information Network UMIN000052667; https://tinyurl.com/3yaccay5. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/57101.

Socioeconomic inequality as a predictor of unmet health needs in the older adult population of Serbia.

Objectives: The aim of this paper is to assess the relationship between demographic and socioeconomic predictors and the unmet health needs of the older adult population in Serbia. Materials and methods: The study is part of the Population Health Survey of Serbia, which was conducted in the period from October to December 2019 by the Institute for Public Health of Serbia "Dr. Milan Jovanovic Batut" and the Ministry of Health of the Republic of Serbia. The research was conducted on a representative sample of Serbian residents in the form of a cross-sectional study. For the purposes of this research study, data on senior citizens, aged 65 and older, were used. Results: Multivariate regression analysis of demographic characteristics that showed statistical significance in the univariate model as a whole explains between 4.2% (Cox & Snell R Square) and 5.9% (Nagelkerke R Square) of the variance of unmet health needs and correctly classifies 66.3% cases. Statistically significant demographic predictors were the region where the respondents live, level of education, and material condition. The results of the research show that the most dominant predictors of the unmet health needs of the older adult population are related to socioeconomic inequalities, financial reasons, and predictors related to the inaccessibility of health care. Conclusion: The results suggest that individual socioeconomic predictors have a great influence on the emergence of unmet health needs of the older adult population in Serbia. Every third older adult resident did not receive the necessary health care, most often due to financial constraints.

Topic Clusters of Successful Aging Studies: Results of a Topic Modeling Approach.

BACKGROUND AND OBJECTIVES: Literature regarding successful aging reflects a wide variety of fields and perspectives. Given the range of definitions and approaches found in published literature, it is important to investigate clusters of topics studied over time. This study aimed to show the change of topic clusters within successful aging studies. RESEARCH DESIGN AND METHODS: The study used topic modeling methodology to analyze vast amounts of abstract data. Among publications collected from Scopus (4,458) and Web of Science (5,187), 5,610 publications were analyzed. Topic clusters were analyzed in two ways: by a) division of time (1960s - 1990s, 2000s, 2010s, 2020s) and b) all years combined. RESULTS: In the 1960s - 1990s, 11 topic clusters ranging from health to emotional well-being emerged without any dominant domain. In the 2000s, two clusters related to social support and health appeared as major clusters. In the 2010s, one topic cluster that included words related to health and social participation was the biggest. In the 2020s, emotional health and social participation appeared again as one of the major clusters and health-related topics started to diverge into subgroups like physical health and mental health. In all years of publications combined, the major cluster involved words that are related to either health or social domains. DISCUSSION AND IMPLICATIONS: Results revealed that successful aging has been studied in many fields using multidimensional perspectives. The dominant categories were health and social domains. These findings suggest interprofessional practice, an interdisciplinary approach in research, and multi-sector involvement in policy.

Development and Validation of Futility of Resuscitation Measure in Older Adult Trauma Patients.

INTRODUCTION: This study aimed to develop and validate Futility of Resuscitation Measure (FoRM) for predicting the futility of resuscitation among older adult trauma patients. METHODS: This is a retrospective analysis of the American College of Surgeons-Trauma Quality Improvement Program database (2017-2018) (derivation cohort) and American College of Surgeons level I trauma center database (2017-2022) (validation cohort). We included all severely injured (injury severity score >15) older adult (aged ≥60 y) trauma patients. Patients were stratified into decades of age. Injury characteristics (severe traumatic brain injury [Glasgow Coma Scale ≤ 8], traumatic brain injury midline shift), physiologic parameters (lowest in-hospital systolic blood pressure [≤1 h], prehospital cardiac arrest), and interventions employed (4-h packed red blood cell transfusions, emergency department resuscitative thoracotomy, resuscitative endovascular balloon occlusion of the aorta, emergency laparotomy [≤2 h], early vasopressor requirement [≤6 h], and craniectomy) were identified. Regression coefficient-based weighted scoring system was developed using the Schneeweiss method and subsequently validated using institutional database. RESULTS: A total of 5562 patients in derivation cohort and 873 in validation cohort were identified. Mortality was 31% in the derivation cohort and FoRM had excellent discriminative power to predict mortality (area under the receiver operator characteristic = 0.860; 95% confidence interval [0.847-0.872], P < 0.001). Patients with a FoRM score of >16 had a less than 10% chance of survival, while those with a FoRM score of >20 had a less than 5% chance of survival. In validation cohort, mortality rate was 17% and FoRM had good discriminative power (area under the receiver operator characteristic = 0.76; 95% confidence interval [0.71-0.80], P < 0.001). CONCLUSIONS: FoRM can reliably identify the risk of futile resuscitation among older adult patients admitted to our level I trauma center.

Decomposition Analysis of Depressive Symptom Differences Among Older Adults With Hypertension Between Urban and Rural Areas: Cross-Sectional Study.

Background: Hypertension is the most prevalent chronic disease among China's older population, which comprises a growing proportion of the overall demographic. Older individuals with chronic diseases have a higher risk of developing depressive symptoms than their healthy counterparts, as evidenced in China's older population, where patients with hypertension exhibit varying rates of depression depending on residing in urban or rural areas. Objective: This study aimed to investigate factors influencing and contributing to the disparities in depressive symptoms among older urban and rural patients with hypertension in China. Methods: We used a cross-sectional study design and derived data from the 8th Chinese Longitudinal Health Longevity Survey of 2018. The Fairlie model was applied to analyze the factors contributing to disparities in depressive symptoms between urban and rural older populations with hypertension. Results: The sample size for this study was 5210, and 12.8% (n=669) of participants exhibited depressive symptoms. The proportions of depressive symptoms in rural and urban areas were 14.1% (n=468) and 10.7% (n=201), respectively. In rural areas, years of education (1-6 years: odds ratio [OR] 0.68, 95% CI 1.10-1.21; ≥7 years: OR 0.47, 95% CI 0.24-0.94), alcohol consumption (yes: OR 0.52, 95% CI 0.29-0.93), exercise (yes: OR 0.78, 95% CI 0.56-1.08), and sleep duration (6.0-7.9 hours: OR 0.29, 95% CI 0.17-0.52; 8.0-9.9 hours: OR 0.24, 95% CI 0.13-0.43; ≥10.0 hours: OR 0.22, 95% CI 0.11-0.41) were protective factors against depressive symptoms in older adults with hypertension, while gender (female: OR 1.94, 95% CI 1.33-2.81), self-reported income status (poor: OR 3.07, 95% CI 2.16-4.37), and activities of daily living (ADL) dysfunction (mild: OR 1.69, 95% CI 1.11-2.58; severe: OR 3.03, 95% CI 1.46-6.32) were risk factors. In urban areas, age (90-99 years: OR 0.37, 95% CI 0.16-0.81; ≥100 years: OR 0.19, 95% CI 0.06-0.66), exercise (yes: OR 0.33, 95% CI 0.22-0.51), and sleep duration (6.0-7.9 hours: OR 0.27, 95% CI 0.10-0.71; 8.0-9.9 hours: OR 0.16, 95% CI 0.06-0.44; ≥10.0 hours: OR 0.18, 95% CI 0.06-0.57) were protective factors, while years of education (1-6 years: OR 1.91, 95% CI 1.05-3.49), self-reported income status (poor: OR 2.94, 95% CI 1.43-6.08), and ADL dysfunction (mild: OR 2.38, 95% CI 1.39-4.06; severe: OR 3.26, 95% CI 1.21-8.76) were risk factors. The Fairlie model revealed that 91.61% of differences in depressive symptoms could be explained by covariates, including years of education (contribution 63.1%), self-reported income status (contribution 13.2%), exercise (contribution 45.7%), sleep duration (contribution 20.8%), ADL dysfunction (contribution -9.6%), and comorbidities (contribution -22.9%). Conclusions: Older patients with hypertension in rural areas had more depressive symptoms than their counterparts residing in urban areas, which could be explained by years of education, self-reported income status, exercise, sleep duration, ADL dysfunction, and comorbidities. Factors influencing depressive symptoms had similarities regarding exercise, sleep duration, self-reported income status, and ADL dysfunction as well as differences regarding age, gender, years of education, and alcohol consumption.

Enhancing Emergency Department Pain Management for Older Adults with the Hip Fracture Fast-Track (HFFT) Protocol in a Middle-Income Country.

Purpose: This study aimed to evaluate the impact of the Hip Fracture Fast-Track (HFFT) protocol, designed specifically for older patients at our hospital, which commenced on January 1, 2022, on the management of emergency department (ED) pain in older adults with hip fractures. Patients and Methods: Retrospective pre- and post-study data from electronic health records (EHR) at our hospital, using the International Classification of Diseases (ICD)-10 codes S72.0, S72.1, S72.8, and S72.9, were utilized. The study included patients aged 65 years or older who presented to the ED with low-energy, non-pathologic isolated hip fractures or proximal femur fractures. The pre-HFFT period included patients from January 1, 2020, to December 31, 2021, and the post-HFFT period included patients from January 1, 2022, to October 31, 2023. Data were compared for the proportion of patients undergoing pain evaluation in the ED, before discharge, time to first analgesia, number of patients receiving pain relief in the ED, and the use of fascia iliaca compartment blocks (FICBs) and pericapsular nerve group blocks (PENGBs). Results: The final analysis involved 258 patients, with 116 in the pre-protocol group and 142 in the post-protocol group. The rate of analgesic use increased significantly in the post-HFFT group (78 [67.24%] vs 111 [78.17%], P = 0.049). The rate of pain score screening at triage increased from 51.72% before the HFFT protocol to 86.62% post-HFFT protocol (p < 0.001). Compared with the pre-HFFT protocol, the post-HFFT protocol exhibited a higher rate of FICB (0% vs 14.08%, p < 0.001) and PENGB (0% vs 5.63%, p = 0.009) administration. Conclusion: The HFFT protocol's implementation was associated with improved ED pain evaluation and analgesic administration in older adults with hip fractures. These findings indicate that tailored protocols, such as the HFFT, hold promise for enhancing emergency care for this vulnerable population.

Poland Syndrome and Multimorbidity in a 79-Year-Old Male.

This case study highlights a 79-year-old man with chronic low back pain attributed to severe lumbar scoliosis. Physical examination revealed the unilateral absence of pectoral muscles and ipsilateral hand anomalies, indicative of Poland syndrome (PS). The patient also experienced depression due to chronic pain and PS-related anomalies. A multi-disciplinary approach proved effective in alleviating both pain and depression.

A Case Report of an Elderly Patient With Cushing's Disease and Multiple Chronic Conditions.

Cushing's disease (CD) is a rare and serious condition characterized by a persistent increase in cortisol levels, resulting in various complications across multiple bodily systems. Elderly individuals often face a multitude of chronic illnesses and geriatric syndromes, which can complicate the diagnosis and treatment of CD in this demographic. This case study details the presentation of an elderly patient with adrenocorticotropic hormone (ACTH)-dependent CD, who initially presented with an acute exacerbation of chronic obstructive pulmonary disease. The article delves into the unique onset characteristics and treatment strategies for CD in the elderly, providing valuable insights for the comprehensive management of similar clinical cases.

Investigation of Correlation between Communication Skills and Self-Reported Elder Mistreatment in Family Abuse.

Introduction In today's world, old age has become an important global phenomenon following the increase in life expectancy and the decrease in birth rates. Communication skills are an important requirement in old age. Changing role of the family and existing tensions, mental pressures, and modern life undermine the social position of the elderly and lead to abuse of the elderly by family members. The goal of the present study is to determine the relationship between communication skills and family self-reported domestic abuse among older adult in Iran. Materials and Methods For this cross-sectional-analytical study, 153 elderly adult people admitted in hospitals of the Guilan province were randomly selected. The research instruments were the following questionnaires: demographic characteristics, abbreviated mental test (AMT), the Persian version of Domestic Elder Abuse Questionnaire, family mistreatment of the elderly (Heravy), and Queendom Communication Skill Test-Revise (QCSTR). The data were analyzed by SPSS software (version 22) using descriptive (frequency distribution tables, mean, and standard deviation [SD]) and analytical statistics (Mann-Whitney, Kruskal-Wallis, and Spearman's correlation tests) considering the significance level of 0.05. Results A majority of the elderly were men (51%), were in the age group of 60 to 69 years (72.5%) and married (75.5%), did not hold high school diploma (88.8%), had four to five children (41.2%) with low income (75.9%), and suffered from chronic diseases (68.6%). The mean score of communication skills was 129.09 ± 12.60. The mean score of domestic elder abuse was 2.89 ± 3.97. Communication skills have a significant relationship with age and marital status, but not with sex, education level, income, and chronic disease. There is an inverse correlation between communication skills and domestic elder_abuse ( p < 0.001, r = -0.468). Conclusion Communication skills are one of the influential factors of domestic violence. Therefore, to prevent or reduce the amount of violence, it is recommended that family members increase the communication skills of the elderly.

Surgical Aspects of Wound Care in Older Adults.

The physical, emotional, and financial toll of acute and chronic nonhealing wounds on older adults and their caregivers is immense. Surgical treatment of wounds in older adults can facilitate healing but must consider the medical complexity of the patient, the patient's desires for treatment and the likelihood of healing. Innovative approaches and devices can promote rapid healing. By using a team approach, from preoperative planning to postoperative care, with a focus on the needs and desires of the patient, successful outcomes with improved patient satisfaction are possible even in medically complex patients.

[Characterization of older adult patients admitted to an acute unit of a high complexity hospital in Bogotá, Colombia]. / Caracterización de los pacientes adultos mayores ingresados a una unidad de agudos de un hospital de alta complejidad en Bogotá, Colombia.

BACKGROUND AND OBJECTIVES: The objective is to describe the demographic, clinical, functional characteristics and outcomes of older adult patients hospitalized in the acute unit of the San Ignacio University Hospital (HUSI). METHODS: Descriptive, cross-sectional observational study, based on the review of the medical records of patients hospitalized in the Geriatrics Unit of the HUSI during the period 2019-2021. VARIABLES: Demographics, comorbidities, baseline situation, main cause of entry and outcomes. The diagnosis of geriatric syndromes was made through the Barthel index, the Lawton and Brody scale, FRAIL scale, mini nutritional assessment short form and Confusion Assessment Method criteria. RESULTS: A total of 4601 patients were analyzed, whose average age was 83years (56.2% women). 72.4% had some degree of dependency for basic activities of daily living, 90.8% had some degree of dependency for instrumental activities of daily living, 32.2% had malnutrition, 15. 7% falls, 9.9% oropharyngeal dysphagia, 32.2% frailty, 28.1% delirium, 54.1% previous dementia. The main comorbidities presented were arterial hypertension, chronic obstructive pulmonary disease and diabetes. 2.9% had some complication during their hospitalization, 10.8% died, and the hospital stay was 5days. CONCLUSION: Older adult patients admitted to the acute unit of the HUSI have a high frequency of dependency, dementia and nutritional disturbances.

Impact of Fruit and Vegetable Enzyme Supplementation on Aerobic Performance and Lactate Response in Older Adults Following High-Intensity Interval Exercise Through Exergaming: Randomized Experimental Matched-Pair Study.

Background: Exercise offers substantial health benefits but can induce oxidative stress and inflammation, especially in high-intensity formats such as high-intensity interval exercise (HIIE). Exergaming has become an effective, enjoyable fitness tool for all ages, particularly older adults. Enzyme supplements may enhance exercise performance by improving lactate metabolism and reducing oxidative stress. Objective: This study investigates the efficacy of fruit and vegetable enzyme supplementation in modulating fatigue and enhancing aerobic capacity in older adults following HIIE through exergaming. Methods: The study recruited 16 older adult female participants and allocated them into 2 distinct groups (enzyme and placebo) based on their pretest lactate levels. This division used pairwise grouping to guarantee comparability between the groups, ensuring the integrity of the results. They engaged in HIIE using Nintendo Switch Ring Fit Adventure, performing 8 sets of 20 seconds of maximum effort exercise interspersed with 30 seconds of rest, totaling 370 seconds of exercise. Key metrics assessed included blood lactate levels, heart rate, rating of perceived exertion, and training impulse. Participants in the enzyme group were administered a fruit and vegetable enzyme supplement at a dosage of 30 mL twice daily over a period of 14 days. Results: The enzyme group showed significantly lower blood lactate levels compared to the placebo group, notably after the fourth (mean 4.29, SD 0.67 vs mean 6.34, SD 1.17 mmol/L; P=.001) and eighth (mean 5.84, SD 0.63 vs mean 8.20, SD 1.15 mmol/L; P<.001) exercise sessions. This trend continued at 5 minutes (mean 6.85, SD 0.82 vs mean 8.60, SD 1.13 mmol/L; P=.003) and 10 minutes (mean 5.91, SD 1.16 vs mean 8.21, SD 1.27 mmol/L; P=.002) after exercise. Although both groups exceeded 85% of their estimated maximum heart rate during the exercise, enzyme supplementation did not markedly affect the perceived intensity or effort. Conclusions: The study indicates that fruit and vegetable enzyme supplementation can significantly reduce blood lactate levels in older adults following HIIE through exergaming. This suggests a potential role for these enzymes in modulating lactate production or clearance during and after high-intensity exercise. These findings have implications for developing targeted interventions to enhance exercise tolerance and recovery in older adults.

Adverse childhood experiences and cognitive function in later life: the sequential mediating roles of education level and adult loneliness.

Background: This study assesses the impact of adverse childhood experiences (ACEs) on the cognitive function of older adults. Furthermore, it examines the potential underlying mechanism involving education level and the subjective "feeling of loneliness" (FOL). Methods: Analyzing a population-based cohort sample from the China Health and Retirement Longitudinal Study database, 8,365 subjects aged 45 or older were interviewed in 2018. Ten ACEs indicators were measured using life history questionnaires assessed at 2014. FOL was assessed using a single item from 10-item Center for Epidemiological Studies Depression Scale (CESD-10). Cognitive function was assessed using a structured questionnaire comprising four dimensions: memory, orientation, computation, and visuospatial abilities. Results: In the fully adjusted model, which accounted for age, gender, marital status, smoke, drink, rural residence, and education levels of both mothers and fathers, the linear regression analysis indicated that ACEs were inversely associated the lower education level (B = -0.058, 95% CI = -0.090, -0.026, p < 0.001), and ACEs were found to be linked to an elevated risk of FOL (B = 0.072, 95% CI = 0.056, 0.089, p < 0.001). In addition, ACEs was not significantly associated with cognitive function (B = -0.047, 95% CI = -0.108, 0.015, p = 0.136), but FOL was significantly associated with cognitive function (B = -0.483, 95% CI = -0.561, -0.404, p < 0.001). Mediation analysis revealed that education level and FOL sequentially and partially mediated the association between ACEs and the total cognitive score, with a proportion mediated of 52.58%. Limitations: The evaluation of ACEs exposure was based on binary response options. This method limited our ability to explore various dimensions of adversity, such as ages of occurrence, severity, frequency, duration, and the extent of psychological effects at the time. Furthermore, the assessment of loneliness relied on a single item from the CESD-10, introducing a potential source of measurement error. Conclusion: Our study unveils a substantial association between ACEs and education level, as well as with FOL and cognitive function in the older adults. Moreover, education level and FOL serve as sequential mediating factors in the relationship between ACEs and cognitive function.

Clinical Features of Actinomycosis in Older Adults: A 10-Year Experience of a Single Institute in Beijing, China.

BACKGROUND: Actinomycosis is a rare infectious disease with non-specific clinical presentations often resulting in delayed diagnosis, especially in older adults. Diagnosing and treating actinomycetal infections in this population can be particularly challenging due to the lack of comprehensive case series studies focusing specifically on actinomycosis in older adults. The existing literature mainly consists of case reports, highlighting the need for more extensive research in this area. This study aimed to provide a profile of actinomycosis in older adults to guide future research efforts. METHODS: Elderly patients aged 60 years and older who satisfied the inclusion criteria for actinomycosis at Peking Union Medical College Hospital from January 2014 to May 2024 underwent a retrospective analysis. The research centered on describing the clinical features and diagnostic techniques, distinguishing between different conditions, and treating clinically important instances of actinomycosis within this specific age bracket. RESULTS: This study involved 22 patients, with a balanced gender distribution of 11 males and 11 females, aged between 60 and 84 years, and a median age of 67 years. The disease predominantly affected the thoracic region (n=17), followed by the abdominal-pelvic (n=2) and orocervicofacial (n=2) regions, along with one case involving soft tissue (n=1). Microbiological methods confirmed the diagnosis in 17 cases (77%), while histopathological examination was employed in the remaining five cases (23%). General symptoms, such as fever and weight loss, were reported by 64% of the patients, whereas 32% exhibited symptoms localized to the infection site. Only one patient (4%) did not present any symptoms. The median duration from the onset of initial symptoms to diagnosis was 120 days (IQR 34.5-240). Nine patients were successfully treated with antibiotics, with only one patient experiencing a relapse during the follow-up period. CONCLUSIONS: Infections caused by actinomycetes are infrequent among the elderly and often exhibit non-specific clinical symptoms and imaging results. Among the various types of actinomycetal infections in this demographic, pulmonary actinomycosis is the most prevalent. Recognizing the wide-ranging capacity of actinomycetes to induce infections beyond our present knowledge is essential. It is important for healthcare practitioners to deepen their knowledge of actinomycosis to prevent delays in both diagnosis and treatment.

Training Service Users in the Use of Telehealth: Scoping Review.

BACKGROUND: The use of telehealth has rapidly increased, yet some populations may be disproportionally excluded from accessing and using this modality of care. Training service users in telehealth may increase accessibility for certain groups. The extent and nature of these training activities have not been explored. OBJECTIVE: The objective of this scoping review is to identify and describe activities for training service users in the use of telehealth. METHODS: Five databases (MEDLINE [via PubMed], Embase, CINAHL, PsycINFO, and Web of Science) were searched in June 2023. Studies that described activities to train service users in the use of synchronous telehealth consultations were eligible for inclusion. Studies that focused on health care professional education were excluded. Papers were limited to those published in the English language. The review followed the Joanna Briggs Institute guidelines for scoping reviews and was reported in line with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. Titles and abstracts were screened by 1 reviewer (EG). Full texts were screened by 2 reviewers (EG and JH or SC). Data extraction was guided by the research question. RESULTS: The search identified 8087 unique publications. In total, 13 studies met the inclusion criteria. Telehealth training was commonly described as once-off preparatory phone calls to service users before a telehealth visit, facilitated primarily by student volunteers, and accompanied by written instructions. The training content included guidance on how to download and install software, troubleshoot technical issues, and adjust device settings. Older adults were the most common target population for the training. All but 1 of the studies were conducted during the COVID-19 pandemic. Overall, training was feasible and well-received by service users, and studies mostly reported increased rates of video visits following training. There was limited and mixed evidence that training improved participants' competency with telehealth. CONCLUSIONS: The review mapped the literature on training activities for service users in telehealth. The common features of telehealth training for service users included once-off preparatory phone calls on the technical elements of telehealth, targeted at older adults. Key issues for consideration include the need for co-designed training and improving the broader digital skills of service users. There is a need for further studies to evaluate the outcomes of telehealth training activities in geographically diverse areas.

Efficacy and safety of sarilumab in patients with rheumatoid arthritis stratified by age (<65 and ≥65 years): A post-hoc analysis of Japanese phase 3 clinical trials.

OBJECTIVES: This study aimed to assess the efficacy and safety of sarilumab in older patients with active rheumatoid arthritis (RA). METHODS: This is a post-hoc analysis of KAKEHASI (NCT02293902) and HARUKA (NCT02373202) trials with stratification by age (<65 and ≥65 years). Patients with moderately-to-severely active RA were treated with sarilumab in combination with methotrexate (MTX) or with conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) or as monotherapy. The primary endpoints in KAKEHASI and HARUKA trials were the American College of Rheumatology 20% improvement criteria (ACR20) responses at Week 24 and safety, respectively. Secondary endpoints were other RA disease activity measures, including Clinical Disease Activity Index (CDAI). RESULTS: Approximately 20% of patients were aged ≥65 years in treatment arms across both trials, except the sarilumab+csDMARDs arm (40%, 12/30). ACR20 response rates were similar between age groups across sarilumab treatment arms and similar results were obtained for CDAI scores. Safety profiles were similar between age groups except for a higher incidence of serious adverse events in patients aged ≥65 years in the sarilumab+MTX arm. CONCLUSIONS: In Japanese patients with RA enrolled in phase 3 studies for sarilumab, no clear difference in efficacy or safety was observed between patients aged <65 and ≥65 years.

Correlates of Loneliness and Social Isolation among Older Adults during the COVID-19 Outbreak: A Comprehensive Assessment from a National United States Sample.

This study examined the correlates of loneliness and social isolation among older adults in the United States (U.S.) during the COVID-19 outbreak. We analyzed data from the 2020 National Health and Aging Trends Study, a nationally representative sample of 3257 U.S. older adults aged 65 years and older. We analyzed and identified the sociodemographic, health, social support, and community correlates of loneliness, higher loneliness during versus before the COVID-19 outbreak, and social isolation using weighted multiple logistic regression models. About 35.2% of U.S. older adults reported loneliness during the COVID-19 outbreak, 21.9% reported higher loneliness compared to before the COVID-19 outbreak, and 32.8% were socially isolated during the outbreak. Correlates for increased odds of loneliness included female gender, higher education, physical activity, depression, anxiety, functional limitations, and virtual communication access (only for higher loneliness during COVID-19 outbreak). Correlates for increased odds of social isolation included higher age, non-Hispanic Black, Hispanic, higher number of household children, and metropolitan residence. Our findings provide insights into evidence-based approaches to address social disconnection among U.S. older adults. The wide range of sociodemographic, health, social support, and community correlates identified in this study warrants multifaceted interventions that traverse individual, community, and societal levels to address the loneliness and social isolation epidemic.