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1.
J Prev Med Public Health ; 54(1): 63-72, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33618501

RESUMEN

OBJECTIVES: Recent studies have suggested that assessing handgrip strength (HGS) asymmetry together with HGS may be helpful for evaluating problems in geriatric patients. This study aimed to identify whether HGS asymmetry, weakness, or both were associated with depression in Korean older adults. METHODS: This study included 4274 subjects from the sixth and seventh Korea National Health and Nutrition Examination Survey. Depression was measured using the Patient Health Questionnaire-9. The maximum HGS of the dominant hand was used as a representative value. HGS symmetry was categorized by the ratio of the HGS of the dominant hand to that of non-dominant hand. The odds ratio (OR) for depression was calculated according to the HGS and its symmetry. RESULTS: In total, 240 (12.5%) men and 534 (22.7%) women had depression. HGS or HGS asymmetry showed no statistically significant associations with depression in elderly men. Elevated odds of depression were observed in elderly women with low HGS (OR, 1.93; 95% confidence interval [CI], 1.33 to 2.81) or prominent HGS asymmetry (OR, 1.46; 95% CI, 1.02 to 2.08). There was a positive additive interaction between asymmetric HGS and weakness, as women with low and prominently asymmetric HGS showed higher odds of depression (OR, 3.77; 95% CI, 2.16 to 6.59) than women with high and symmetric HGS. CONCLUSIONS: Depression in elderly Korean women was associated with both low and asymmetric HGS. Our findings support the potential value of HGS asymmetry as an indicator of HGS.


Asunto(s)
Depresión/complicaciones , Fuerza de la Mano/fisiología , Anciano , Anciano de 80 o más Años , Estudios Transversales , Depresión/fisiopatología , Depresión/psicología , Femenino , Geriatría/instrumentación , Geriatría/métodos , Geriatría/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Cuestionario de Salud del Paciente , República de Corea
2.
Mil Med Res ; 8(1): 14, 2021 02 16.
Artículo en Inglés | MEDLINE | ID: mdl-33593441

RESUMEN

The potential association between medical resources and the proportion of oldest-old (90 years of age and above) in the Chinese population was examined, and we found that the higher proportion of oldest-old was associated with the higher number of beds in hospitals and health centers.


Asunto(s)
Geriatría/métodos , Recursos en Salud/normas , Asignación de Recursos/provisión & distribución , Anciano de 80 o más Años , China/epidemiología , Geriatría/normas , Geriatría/estadística & datos numéricos , Recursos en Salud/estadística & datos numéricos , Humanos , Factores de Riesgo
3.
Rev Med Suisse ; 17(720-1): 33-37, 2021 Jan 13.
Artículo en Francés | MEDLINE | ID: mdl-33443828

RESUMEN

Several studies published in 2020 showed new data supporting the prescription of statins in some old and very old patients. Despite the enthusiasm about SGLT-2 inhibitors, caution must remain in frail and dependent older diabetic patients who are not well represented in most studies. Antihypertensive treatment appears more beneficial when taken at night rather than in the morning but beware of the prescribing cascade of a diuretic when a new prescription of a calcium channel blocker. Biomarkers, including plasmatic biomarkers, are becoming increasingly important in the diagnostic strategy of neurocognitive disorders. Finally, fall prevention studies showed heterogeneous results but multimodal interventions remain mainstream.


Asunto(s)
Antihipertensivos/uso terapéutico , Geriatría/métodos , Hipertensión/tratamiento farmacológico , Anciano , Bloqueadores de los Canales de Calcio/uso terapéutico , Diuréticos/uso terapéutico , Humanos , Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico
4.
J Am Geriatr Soc ; 69(3): 572-580, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33470421

RESUMEN

Older adults have been markedly impacted by the coronavirus disease 19 (COVID-19) pandemic. The American Geriatrics Society previously published a White Paper on Healthy Aging in 2018 that focused on a number of domains that are core to healthy aging in older adults: health promotion, injury prevention, and managing chronic conditions; cognitive health; physical health; mental health; and social health. The potentially devastating consequences of COVID-19 on health promotion are recognized. The purpose of this article is multifold. First, members of the Healthy Aging Special Interest Group will present the significant difficulties and obstacles faced by older adults during this unprecedented time. Second, we provide guidance to practicing geriatrics healthcare professionals overseeing the care of older adults. We provide a framework for clinical evaluation and screening related to the five aforementioned domains that uniquely impact older adults. Last, we provide strategies that could enhance healthy aging in the era of COVID-19.


Asunto(s)
Evaluación Geriátrica/métodos , Geriatría/métodos , Promoción de la Salud/métodos , Envejecimiento Saludable , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino
5.
Age Ageing ; 50(2): 279-283, 2021 02 26.
Artículo en Inglés | MEDLINE | ID: mdl-33320183

RESUMEN

Several vaccines against coronavirus disease 2019 (COVID-19) are on the cusp of regulatory approval. Their safety and efficacy in older people is critical to their success. Even though care home residents and older people are likely to be amongst the first to be vaccinated, these patient groups are usually excluded from clinical trials. Data from several Phase II trials have given cause for optimism, with strong antibody responses and reassuring safety profiles but, with the exception of AstraZeneca's vaccine, recruited few older people. Overall, the sparse data from Phase II trials suggest a reduction in both antibody responses and mild to moderate adverse events in well older people compared to younger participants. Many of the Phase III trials have made a conscious effort to recruit older people, and interim analyses of the Pfizer and Moderna vaccine have led to press releases announcing high degrees of efficacy. However, older people with co-morbidities and frailty have once again been largely excluded and there are no published data on safety and efficacy in this group. Although the speed and impact of the pandemic on older people with frailty justify an approach where they are offered vaccination first, patients and their carers and supervising health care professionals alike will need to make a decision on accepting vaccination based on limited evidence. Here we review the main candidate vaccines that may become available, with a focus on the evidence of safety and efficacy in older people.


Asunto(s)
Anciano Frágil , Geriatría , Programas de Inmunización , Anciano , /prevención & control , /clasificación , Geriatría/métodos , Geriatría/normas , Humanos , Programas de Inmunización/métodos , Programas de Inmunización/organización & administración , Seguridad del Paciente , Selección de Paciente , Resultado del Tratamiento
6.
Healthc (Amst) ; 9(1): 100511, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33340801

RESUMEN

The COVID-19 pandemic threatens the health and well-being of older adults with multiple chronic conditions. To date, limited information exists about how Accountable Care Organizations (ACOs) are adapting to manage these patients. We surveyed 78 Medicare ACOs about their concerns for these patients during the pandemic and strategies they are employing to address them. ACOs expressed major concerns about disruptions to necessary care for this population, including the accessibility of social services and long-term care services. While certain strategies like virtual primary and specialty care visits were being used by nearly all ACOs, other services such as virtual social services, home medication delivery, and remote lab monitoring were far less commonly accessible. ACOs expressed that support for telehealth services, investment in remote monitoring capabilities, and funding for new, targeted care innovation initiatives would help them better care for vulnerable patients during this pandemic.


Asunto(s)
Organizaciones Responsables por la Atención/normas , Enfermedad Crónica/terapia , Geriatría/economía , Organizaciones Responsables por la Atención/organización & administración , Organizaciones Responsables por la Atención/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Enfermedad Crónica/economía , Geriatría/métodos , Geriatría/estadística & datos numéricos , Humanos , Encuestas y Cuestionarios , Estados Unidos
7.
Artículo en Inglés | MEDLINE | ID: mdl-32899652

RESUMEN

Health and social care staff have had to quickly adapt, respond and improve teamwork, as a response to the COVID-19 pandemic. Our objective was to rapidly summarize the emerging evidence of new ways of working in the care of older people during this period. We conducted an exploration of the emerging evidence within the timeframe of 1 March 2020 to 11 May 2020. To capture a broad perspective, we undertook thematic analysis of Twitter data which was extracted through a broad search for new ways of working in health and social care. For a more in-depth focus on the health and social care of older people, we undertook a systematic scoping of newspapers using the Nexis UK database. We undertook a validation workshop with members of the interprofessional working group of the Irish National Integrated Care Programme for Older People, and with researchers. A total of 317 tweets were extracted related to six new ways of working. There was evidence of using telehealth to provide ongoing care to patients; interprofessional work; team meetings using online platforms; trust and collaboration within teams; as well as teams feeling empowered to change at a local level. 34 newspaper articles were extracted related to new ways of working in the care of older people, originating in England (n = 17), Wales (n = 6), Scotland (n = 6), Ireland (n = 4) and Germany (n = 1). Four main themes were captured that focused on role expansion, innovations in communication, environmental restructuring and enablement. The results of this exploration of emerging evidence show that health and social care teams can transform very rapidly. Much of the change was based on goodwill as a response to the pandemic. Further analysis of empirical evidence of changing practices should include the perspectives of older people and should capture the resources needed to sustain innovations, as well as evaluate gaps in service provision.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Prestación de Atención de Salud/métodos , Geriatría/métodos , Neumonía Viral/epidemiología , Anciano , Anciano de 80 o más Años , Betacoronavirus , Inglaterra , Alemania , Humanos , Irlanda , Periódicos como Asunto , Pandemias , Escocia , Medios de Comunicación Sociales , Gales
9.
PLoS One ; 15(8): e0237186, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32785232

RESUMEN

BACKGROUND: Multimorbidity is a global health challenge that is associated with polypharmacy, increasing the risk of potentially inappropriate prescribing (PIP). There are tools to improve prescription, such as implicit and explicit criteria. OBJECTIVE: To estimate the prevalence of PIP in a population aged 65 to 74 years with multimorbidity and polypharmacy, according to American Geriatrics Society Beers Criteria® (2015, 2019), the Screening Tool of Older Person's Prescription -STOPP- criteria (2008, 2014), and the Medication Appropriateness Index -MAI- criteria in primary care. METHODS: This was an observational, descriptive, cross-sectional study. The sample included 593 community-dwelling elderly aged 65 to 74 years, with multimorbidity and polypharmacy, who participated in the MULTIPAP trial. Socio-demographic, clinical, professional, and pharmacological-treatment variables were recorded. Potentially inappropriate prescribing was detected by computerized prescription assistance system, and family doctors evaluated the MAI. The MAI-associated factors were analysed using a logistic regression model. RESULTS: A total of 4,386 prescriptions were evaluated. The mean number of drugs was 7.4 (2.4 SD). A total of 94.1% of the patients in the study had at least one criterion for drug inappropriateness according to the MAI. Potentially inappropriate prescribing was detected in 57.7%, 43.6%, 68.8% and 71% of 50 patients according to the explicit criteria STOPP 2014, STOPP 2008, Beers 2019 and Beers 2015 respectively. For every new drug taken by a patient, the MAI score increased by 2.41 (95% CI 1.46; 3.35) points. Diabetes, ischaemic heart disease and asthma were independently associated with lower summated MAI scores. CONCLUSIONS: The prevalence of potentially inappropriate prescribing detected in the sample was high and in agreement with previous literature for populations with multimorbidity and polypharmacy. The MAI criteria detected greater inappropriateness than did the explicit criteria, but their application was more complex and difficult to automate.


Asunto(s)
Prescripción Inadecuada/prevención & control , Multimorbilidad , Polifarmacia , Lista de Medicamentos Potencialmente Inapropiados , Anciano , Estudios Transversales , Femenino , Geriatría/métodos , Humanos , Vida Independiente , Masculino , Prevalencia , Atención Primaria de Salud , Riesgo , España
10.
J Am Med Dir Assoc ; 21(7): 954-957, 2020 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-32674827

RESUMEN

The COVID-19 pandemic's greatest impact is among older adults. Management of the situation requires a systemic response, and post-acute care (PAC) can provide an adequate mix of active treatment, management of associated geriatric syndromes and palliative care, both in the acute phase, and in post-COVID-19 recovery. In the region of Catalonia, Spain, selected PAC centers have become sites to treat older patients with COVID-19. Referrals come from the emergency department or COVID-19 wards of the acute reference hospitals, nursing homes, or private homes. We critically review the actions taken by Parc Sanitari Pere Virgili, a PAC facility in Barcelona, to manage the pandemic, including its administration, health care, communication, psychological support, and ethical frameworks. We believe that the strategies we used and the lessons we learned can be useful for other sites and countries where similar adaptation of existing facilities may be implemented.


Asunto(s)
Atención Integral de Salud/organización & administración , Infecciones por Coronavirus/epidemiología , Instituciones de Salud/estadística & datos numéricos , Evaluación de Resultado en la Atención de Salud , Neumonía Viral/epidemiología , Atención Subaguda/organización & administración , Centros de Atención Terciaria/organización & administración , Anciano , Infecciones por Coronavirus/prevención & control , Femenino , Geriatría/métodos , Humanos , Masculino , Innovación Organizacional , Pandemias/prevención & control , Pandemias/estadística & datos numéricos , Neumonía Viral/prevención & control , España , Población Urbana
11.
Medicine (Baltimore) ; 99(26): e20929, 2020 Jun 26.
Artículo en Inglés | MEDLINE | ID: mdl-32590805

RESUMEN

Retrospective reviewThe degree of spinal cord compression and bony spinal canal stenosis are risk factors for the occurrence of spinal cord injury (SCI) without major fracture or dislocation, but they do not affect the severity of neurological symptoms. However, whether a relatively large spinal cord for the dural sac influences the severity of symptoms in SCI cases is unknown.The purpose of this study was to verify the influence of spinal cord size relative to dural sac on the severity of paralysis in elderly patients with cervical SCI caused by minor trauma.Subjects were 50 elderly patients with SCI caused by falls on flat ground. At 72 hours after injury, neurological assessment was performed using the Japanese Orthopaedic Association (JOA) scoring system. Bony canal anteroposterior diameters (APD) at mid C5 vertebral body were measured with computed tomography. We measured dural sac and spinal cord APD at the injured level and mid C5 with magnetic resonance imaging. Spinal cord compression ratio was calculated by dividing spinal cord at the injured level by spinal cord at mid C5. As the evaluation of spinal cord size relative to the dural sac, spinal cord/dural sac ratio was calculated at the injured level and mid C5. To clarify the factors influencing the severity of paralysis, the relationships between JOA score and those parameters were examined statistically.A significant negative correlation was observed between JOA score and spinal cord/dural sac ratio at mid C5. No clear relationship was observed between JOA score and bony canal APD or spinal cord compression ratio.In elderly patients with SCI caused by minor trauma, a relatively large spinal cord for the dural sac was shown to be a factor that influences the severity of paralysis. This result can be useful for the treatment and prevention of SCI in the elderly.


Asunto(s)
Vértebras Cervicales/lesiones , Parálisis/etiología , Conducto Vertebral/anatomía & histología , Traumatismos de la Médula Espinal/etiología , Anciano , Anciano de 80 o más Años , Vértebras Cervicales/anatomía & histología , Femenino , Geriatría/métodos , Humanos , Japón/epidemiología , Imagen por Resonancia Magnética/métodos , Masculino , Parálisis/epidemiología , Índice de Severidad de la Enfermedad , Conducto Vertebral/patología , Médula Espinal/anomalías , Médula Espinal/fisiología , Traumatismos de la Médula Espinal/clasificación , Traumatismos de la Médula Espinal/epidemiología , Tomografía Computarizada por Rayos X/métodos , Heridas y Traumatismos/complicaciones , Heridas y Traumatismos/epidemiología
13.
Disaster Med Public Health Prep ; 14(3): e13-e14, 2020 06.
Artículo en Inglés | MEDLINE | ID: mdl-32379016

RESUMEN

As the systems that people depend on are increasingly strained by the coronavirus disease-2019 (COVID-19) outbreak, public health impacts are manifesting in different ways beyond morbidity and mortality for elderly populations. Loneliness is already a chief public health concern that is being made worse by COVID-19. Agencies should recognize the prevalence of loneliness among elderly populations and the impacts that their interventions have on loneliness. This letter describes several ways that loneliness can be addressed to build resilience for elderly populations as part of the public health response to COVID-19.


Asunto(s)
Infecciones por Coronavirus/psicología , Geriatría/métodos , Soledad/psicología , Neumonía Viral/psicología , Salud Pública/métodos , Adaptación Psicológica , Infecciones por Coronavirus/prevención & control , Geriatría/tendencias , Humanos , Pandemias/prevención & control , Neumonía Viral/prevención & control , Salud Pública/tendencias
14.
Can J Aging ; 39(3): 344-347, 2020 09.
Artículo en Inglés | MEDLINE | ID: mdl-32423497

RESUMEN

The COVID-19 global crisis is reshaping Canadian society in unexpected and profound ways. The significantly higher morbidity and mortality risks by age suggest that this is largely a "gero-pandemic," which has thrust the field of aging onto center stage. This editorial emphasizes that vulnerable older adults are also those most affected by COVID-19 in terms of infection risk, negative health effects, and the potential deleterious outcomes on a range of social, psychological, and economic contexts - from ageism to social isolation. We also contend that the pathogenic analysis of this pandemic needs to be balanced with a salutogenic approach that examines the positive adaptation of people, systems and society, termed COVID-19 resilience. This begs the question: how and why do some older adults and communities adapt and thrive better than others? This examination will lead to the identification and response to research and data gaps, challenges, and innovative opportunities as we plan for a future in which COVID-19 has become another endemic infection in the growing list of emerging and re-emerging pathogens.


Asunto(s)
Ageísmo , Envejecimiento , Infecciones por Coronavirus , Geriatría , Pandemias , Neumonía Viral , Marginación Social/psicología , Anciano , Ageísmo/ética , Ageísmo/prevención & control , Ageísmo/psicología , Envejecimiento/fisiología , Envejecimiento/psicología , Betacoronavirus , Canadá/epidemiología , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/psicología , Infecciones por Coronavirus/terapia , Geriatría/métodos , Geriatría/tendencias , Humanos , Evaluación de Necesidades , Pandemias/ética , Neumonía Viral/epidemiología , Neumonía Viral/psicología , Neumonía Viral/terapia , Factores de Riesgo , Estigma Social , Poblaciones Vulnerables
15.
Am J Nurs ; 120(6): 24-36, 2020 06.
Artículo en Inglés | MEDLINE | ID: mdl-32443122

RESUMEN

BACKGROUND: Food insecurity, which can be defined as having limited access to nutritional and safe foods as a result of a lack of financial resources, is believed to adversely influence health outcomes. Older adults, in particular, face rising health care costs and may be forced to choose between purchasing prescribed medications or using their limited financial resources for basic needs, such as food. PURPOSE: The purpose of this systematic review was to examine the relationship between food insecurity and cost-related medication nonadherence (CRN) in older adults living in a community setting. METHODS: A comprehensive electronic review of the literature was performed. Criteria for inclusion were original quantitative or qualitative research, written in English, involving community-dwelling U.S. adults 60 years of age and older. RESULTS: Six studies met all criteria and were included for analysis. Two studies reported a significant dose-response relationship between food insecurity and CRN, and a third reported an increased risk of CRN in subjects with persistent food insecurity. Three key predictors of food insecurity and CRN in older adults were identified: low income, health insurance gaps, and higher out-of-pocket prescription costs. Most studies reported that subjects with higher food insecurity and CRN were more likely to be young-old (ages 60 to 84), have lower income, and have relatively more chronic conditions. CONCLUSION: Overall, the findings indicate that older adults who have multiple chronic conditions and only receive Medicare are at increased risk for food insecurity and CRN. Finding ways for health care providers and organizations to help manage these risks is critical to improving health outcomes and reducing use of health care services. Nurses can be pivotal in taking the lead to develop appropriate interventions and programs for patients, and to advocate better government-funded health care and policy reform in order to improve outcomes in this vulnerable population.


Asunto(s)
Abastecimiento de Alimentos/normas , Geriatría/métodos , Gastos en Salud/normas , Cumplimiento de la Medicación/psicología , Anciano , Anciano de 80 o más Años , Correlación de Datos , Femenino , Abastecimiento de Alimentos/estadística & datos numéricos , Gastos en Salud/tendencias , Humanos , Masculino , Factores Socioeconómicos , Estados Unidos
18.
Medicine (Baltimore) ; 99(17): e19896, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32332664

RESUMEN

BACKGROUND: Delirium is a common postoperative complication in older patients undergoing thoracic surgery and presages poor outcomes. Postoperative pain is an important factor in the progression of delirium. The purpose of this study was to test whether continuous thoracic paravertebral block (PVB), a more effective approach for analgesia, could decrease the incidence of delirium in elderly patients undergoing esophagectomy. METHODS: A total of 180 geriatric patients undergoing esophagectomy were randomly divided into 2 groups and treated with PVB or patient-controlled analgesia (PCA). Perioperative plasma CRP, IL-1ß, IL-6, and TNF-α levels were detected in all patients. Pain intensity was measured by a numerical rating scale. Delirium was assessed using the confusion assessment method. RESULTS: The incidence of postoperative delirium was significantly lower in the PVB group than in the PCA group. Patients in the PVB group had lower plasma CRP, IL-1ß, IL-6, and TNF-α levels and less pain when coughing after surgery. CONCLUSIONS: Ultrasound-guided continuous thoracic paravertebral block improved analgesia, reduced the inflammatory reaction and decreased the occurrence of delirium after surgery.


Asunto(s)
Delirio/prevención & control , Esofagectomía/normas , Bloqueo Nervioso/métodos , Ultrasonografía/normas , Anciano , Anciano de 80 o más Años , Analgesia Controlada por el Paciente/métodos , Analgesia Controlada por el Paciente/normas , Delirio/tratamiento farmacológico , Esofagectomía/métodos , Femenino , Geriatría/métodos , Humanos , Masculino , Persona de Mediana Edad , Bloqueo Nervioso/normas , Complicaciones Posoperatorias/tratamiento farmacológico , Complicaciones Posoperatorias/prevención & control , Estudios Prospectivos , Ultrasonografía/métodos , Ultrasonografía/estadística & datos numéricos
20.
Global Health ; 16(1): 29, 2020 03 30.
Artículo en Inglés | MEDLINE | ID: mdl-32228631

RESUMEN

BACKGROUND: In Ireland, rising temperatures remains the climate projection that national climate scientists associate with the highest degree of confidence. However, the health challenge of heat has been largely absent from Ireland's public health sector. This is epitomised by the lack of a comprehensive public health-focused heat-health action plan or country-specific codes of practice for heat-health when working outdoors. Our objective is to highlight the anticipated heat-health challenges in Ireland, and other temperate regions, through analysing vulnerable groups and systems, reinforcing the need to respond. METHODS: A scoping literature review was conducted to determine how heat affects health of the vulnerable in temperate climatic regions, with a focus on Ireland. Additionally, national Google Trends data was coarsely analysed to determine whether heat is a growing societal concern. RESULTS AND DISCUSSION: The heat-vulnerable include: older people; chronically ill; infants, pregnant women, children; outdoor workers; socio-economically disadvantaged; urban dwellers; food systems and the health sector. Google Trends data suggest an increase in heat-related health searches over time, demonstrating rising levels of concern to temperature increases, reinforcing a gap in national policy associated with communication of, and response to, the heat-health challenge. Specific, actionable recommendations for adaptation and mitigation strategies are proposed. CONCLUSION: Heat poses a public and occupational health challenge, receiving limited attention in Ireland. Lack of a co-ordinated effort, places vulnerable populations at risk. Our recommendations, with reference to vulnerable groups and acknowledging the multi-sectoral nature of heat-health and climate change, advocate for the adoption of a "health and climate change in all policies" approach and the development of a public health-focused heat-health action plan.


Asunto(s)
Respuesta al Choque Térmico/fisiología , Calor/efectos adversos , Adulto , Anciano , Anciano de 80 o más Años , Enfermedad Crónica/epidemiología , Cambio Climático/estadística & datos numéricos , Femenino , Geriatría/métodos , Humanos , Lactante , Recién Nacido , Irlanda , Masculino , Embarazo
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