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1.
Medicine (Baltimore) ; 99(9): e19245, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32118729

RESUMEN

This study aimed to investigate whether trunk fat mass measured using dual-energy X-ray absorptiometry (DEXA) correlates with balance and physical performance.This study utilized 2-year baseline data pertaining to 3014 participants from the database of the Korean frailty and aging cohort study. The trunk lean mass and fat mass were measured by DEXA. Trunk fat mass index (tFMI) was established using the following standard equation: Trunk fat mass (Kg)/height (m). The clinical balance tests were performed using the timed up and go test (TUG), total balance score in short physical performance battery (SPPB). We performed SPPB and evaluated independence of daily living using activities of daily living, instrumental activities of daily living (IADL), sarcopenia screening tool (SARC-F) and both hand grip power. In our study, we tried to check the correlation of tFMI with balance and physical performance and to determine the factors associated with tFMI.The tFMI was positively correlated with mean values of 4 m gait speed, repeat chair stand time in SPPB, TUG, and SARC-F and negatively correlated with hand grip, IADL, total balance test score in SPPB, total SPPB score, and age. The results of the multiple generalized linear model analysis that assessed the factors associated with balance and physical performance indicated that tFMI had a significant correlation with repeat chair stand time in SPPB (seconds) (Beta estimate [B]: 0.252), TUG (seconds) (B: 0.25), 4 m gait speed (seconds) (B: 0.055), and total balance score in SPPB (B: -0.035).Higher tFMI using DEXA was correlated with low physical performance and balance, indicating that trunk fat mass was associated with balance and physical performance in community-dwelling older people.


Asunto(s)
Grasa Abdominal/fisiopatología , Anciano Frágil , Rendimiento Físico Funcional , Sarcopenia/fisiopatología , Absorciometría de Fotón , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Femenino , Evaluación Geriátrica , Fuerza de la Mano , Humanos , Vida Independiente , Masculino , Balance Postural , República de Corea , Encuestas y Cuestionarios
2.
Stud Health Technol Inform ; 268: 77-86, 2020 Mar 02.
Artículo en Inglés | MEDLINE | ID: mdl-32141880

RESUMEN

Current legislation aims to enable older Australians to age in place, and puts public healthcare within the remit of local governments. As Australia's population ages, local governments will need to explore new methods of service delivery in order to meet the increasing need for services that promote healthy ageing. Information technology (IT) may provide one such solution, however older Australian adults are reported to have low levels of technology use. In this simple descriptive qualitative study, focus groups with local government staff and community-dwelling older adults explored their perspectives regarding: a) IT solutions that councils could use to promote community-based healthy ageing, and (b) the enablers and challenges for adopting such solutions. Twenty-four adults participated in focus groups, and eleven of these adults also provided written data in response to visual prompts. Field notes were recorded by attending researchers. These three data sources were combined through narrative synthesis. Local government staff and community-dwellers alike perceived the utility of IT solutions in connecting community members, and connecting people to services (such as transport and providers of health information). While local government staff identified that IT solutions could provide benefits to the council when implemented in conjunction with existing services (e.g., to track data and identify information about community engagement and needs), community-dwellers placed stronger emphasis on adopting technology which had a clear purpose for its use. Due to limited digital literacy and some ambivalence towards embracing technology, IT solutions should be implemented with support to increase digital literacy, be widely advertised, and be centered in community needs. Personas have been generated and provided as possible case studies for technology adoption.


Asunto(s)
Actitud hacia los Computadores , Envejecimiento Saludable , Difusión de la Información , Tecnología , Anciano , Australia , Grupos Focales , Humanos , Vida Independiente , Sistemas de Información , Investigación Cualitativa
3.
J Frailty Aging ; 9(1): 23-29, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32150210

RESUMEN

BACKGROUND: Stride-to-stride fluctuations, or gait variability, can be captured easily using body worn inertial sensors. Previously, sensor-measured gait variability has been found to be associated with fall risk and central nervous changes. However, further research is needed to clarify the clinical relevance of this method. OBJECTIVES: In this study, we look at how gait variability is associated with muscle strength, measured two years earlier. DESIGN, SETTING AND PARTICIPANTS: This is study of longitudinal associations. Participants were community-dwelling volunteers between 70-81 years. MEASUREMENTS: Participants were tested while walking with a single sensor at their lower back, and they walked back and forth over a distance of 6.5 meters under four conditions: at preferred speed, at fast speed, with an added cognitive task, and while walking across an uneven surface. Gait variability in the anteroposterior (AP), mediolateral (ML) and vertical (V) directions was identified. A muscle strength score was composed by transforming hand grip strength, isometric knee extension strength and the 30 second chair rise-test to z-scores and adding them. RESULTS: 56 individuals were analysed (mean age at baseline 75.8 (SD 3.43), 60 percent women). In a backwards regression method using age, gender and baseline walking speed as covariates, muscle strength predicted gait variability after two years for AP variability during preferred speed (Beta= .314, p=.025) and uneven surface walking (Beta=.326, p=.018). Further, muscle strength was associated with ML variability during preferred speed (Beta=.364, p=.048) and fast speed (Beta=.419, p=.042), and V variability during preferred speed (Beta=.402, p=.002), fast speed (Beta=.394, p=.004) and uneven surface walking (Beta=.369, p=.004). CONCLUSIONS: Sensor-measured gait variability tended to be associated with muscle strength measured two years earlier. This finding could emphasize the relevance of this relatively novel measure of gait in older adults for both research and clinical practice.


Asunto(s)
Marcha/fisiología , Fuerza Muscular , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Vida Independiente , Masculino
6.
Am J Occup Ther ; 74(1): 7401390010p1-7401390010p5, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32078523

RESUMEN

Evidence Connection articles provide clinical application of systematic reviews developed in conjunction with the American Occupational Therapy Association's (AOTA's) Evidence-Based Practice Project. In this Evidence Connection article, we describe a case report of an older adult who was referred to outpatient occupational therapy services due to chronic back pain from herniated discs. Findings from the systematic review of occupational therapy for community-dwelling older adults were published in the July/August 2018 issue of the American Journal of Occupational Therapy (Berger et al., 2018; Elliott & Leland, 2018; Hunter & Kearney, 2018; Liu et al., 2018; Smallfield & Lucas Molitor, 2018a, 2018b) and in the American Occupational Therapy Association's Occupational Therapy Practice Guidelines for Productive Aging for Community-Dwelling Older Adults. Each article in the Evidence Connection series summarizes the evidence from the published reviews on a given topic and presents an application of the evidence to a related clinical case. These articles illustrate how the research evidence from the reviews can be used to inform and guide clinical decision making.


Asunto(s)
Terapia Ocupacional , Anciano , Envejecimiento , Eficiencia , Práctica Clínica Basada en la Evidencia , Humanos , Vida Independiente , Terapia Ocupacional/métodos
8.
JAMA ; 323(8): 764-785, 2020 02 25.
Artículo en Inglés | MEDLINE | ID: mdl-32096857

RESUMEN

Importance: Early identification of cognitive impairment may improve patient and caregiver health outcomes. Objective: To systematically review the test accuracy of cognitive screening instruments and benefits and harms of interventions to treat cognitive impairment in older adults (≥65 years) to inform the US Preventive Services Task Force. Data Sources: MEDLINE, PubMed, PsycINFO, and Cochrane Central Register of Controlled Trials through January 2019, with literature surveillance through November 22, 2019. Study Selection: Fair- to good-quality English-language studies of cognitive impairment screening instruments, and pharmacologic and nonpharmacologic treatments aimed at persons with mild cognitive impairment (MCI), mild to moderate dementia, or their caregivers. Data Extraction and Synthesis: Independent critical appraisal and data abstraction; random-effects meta-analyses and qualitative synthesis. Main Outcomes and Measures: Sensitivity, specificity; patient, caregiver, and clinician decision-making; patient function, quality of life, and neuropsychiatric symptoms; caregiver burden and well-being. Results: The review included 287 studies with more than 280 000 older adults. One randomized clinical trial (RCT) (n = 4005) examined the direct effect of screening for cognitive impairment on patient outcomes, including potential harms, finding no significant differences in health-related quality of life at 12 months (effect size, 0.009 [95% CI, -0.063 to 0.080]). Fifty-nine studies (n = 38 531) addressed the accuracy of 49 screening instruments to detect cognitive impairment. The Mini-Mental State Examination was the most-studied instrument, with a pooled sensitivity of 0.89 (95% CI, 0.85 to 0.92) and specificity of 0.89 (95% CI, 0.85 to 0.93) to detect dementia using a cutoff of 23 or less or 24 or less (15 studies, n = 12 796). Two hundred twenty-four RCTs and 3 observational studies including more than 240 000 patients or caregivers addressed the treatment of MCI or mild to moderate dementia. None of the treatment trials were linked with a screening program; in all cases, participants were persons with known cognitive impairment. Medications approved to treat Alzheimer disease (donepezil, galantamine, rivastigmine, and memantine) improved scores on the ADAS-Cog 11 by 1 to 2.5 points over 3 months to 3 years. Psychoeducation interventions for caregivers resulted in a small benefit for caregiver burden (standardized mean difference, -0.24 [95% CI, -0.36 to -0.13) over 3 to 12 months. Intervention benefits were small and of uncertain clinical importance. Conclusions and Relevance: Screening instruments can adequately detect cognitive impairment. There is no empirical evidence, however, that screening for cognitive impairment improves patient or caregiver outcomes or causes harm. It remains unclear whether interventions for patients or caregivers provide clinically important benefits for older adults with earlier detected cognitive impairment or their caregivers.


Asunto(s)
Disfunción Cognitiva/diagnóstico , Demencia/diagnóstico , Tamizaje Masivo , Anciano , Cuidadores , Disfunción Cognitiva/terapia , Demencia/tratamiento farmacológico , Diagnóstico Precoz , Humanos , Vida Independiente , Tamizaje Masivo/efectos adversos , Pruebas Neuropsicológicas , Guías de Práctica Clínica como Asunto , Sensibilidad y Especificidad
9.
JAMA ; 323(8): 757-763, 2020 02 25.
Artículo en Inglés | MEDLINE | ID: mdl-32096858

RESUMEN

Importance: Dementia (also known as major neurocognitive disorder) is defined by a significant decline in 1 or more cognitive domains that interferes with a person's independence in daily activities. Dementia affects an estimated 2.4 to 5.5 million individuals in the United States, and its prevalence increases with age. Objective: To update its 2014 recommendation, the US Preventive Services Task Force (USPSTF) commissioned a review of the evidence on screening for cognitive impairment, including mild cognitive impairment and mild to moderate dementia, in community-dwelling adults, including those 65 years or older residing in independent living facilities. Population: This recommendation applies to community-dwelling older adults 65 years or older, without recognized signs or symptoms of cognitive impairment. Evidence Assessment: The USPSTF concludes that the evidence is lacking, and the balance of benefits and harms of screening for cognitive impairment cannot be determined. Recommendation: The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for cognitive impairment in older adults. (I statement).


Asunto(s)
Disfunción Cognitiva/diagnóstico , Demencia/diagnóstico , Tamizaje Masivo , Anciano , Disfunción Cognitiva/terapia , Demencia/terapia , Diagnóstico Precoz , Humanos , Vida Independiente , Tamizaje Masivo/efectos adversos , Pruebas Neuropsicológicas , Sensibilidad y Especificidad
10.
J Korean Med Sci ; 35(7): e43, 2020 Feb 24.
Artículo en Inglés | MEDLINE | ID: mdl-32080986

RESUMEN

BACKGROUND: The 48/6 Model of Care is an integrative care initiative for improving the health outcomes of hospitalized older patients; however, its applicability in community-dwelling older adults as a health screening tool has not been investigated. The present study aimed to examine the applicability of this model, prevalence of dysfunction in 6 care areas, and its relationship with self-reported mobility in community-dwelling older adults. METHODS: This was a cross-sectional survey study of community-dwelling adults aged 65 or older. Participants were screened for problems using 9 items corresponding to the 6 care areas of the 48/6 Model of Care (cognitive functioning, functional mobility, pain management, nutrition and hydration, bladder and bowel management, and medication management). Mobility was assessed via the Life-Space Assessment (LSA). We examined the correlation between each screening item and the LSA. RESULTS: A total of 444 older adults (260 women, 58.6%) participated. The mean number of health problems was 2.3 ± 2.1, with the most common being pain, cognitive impairment, and urinary incontinence. These problems and LSA scores were significantly different by age groups. A multiple regression analysis showed that polypharmacy (ß = -10.567, P < 0.001), dysphagia (ß = -9.610, P = 0.021), and pain (ß = -7.369, P = 0.004) were significantly associated with life-space mobility after controlling for age. CONCLUSION: The 48/6 Model of Care is applicable to community-dwelling older adults, who show high prevalence of dysfunction in the 6 care areas. This study supports the role of the model in screening for the health status of older adults living in the community, and in estimating mobility.


Asunto(s)
Actividades Cotidianas , Evaluación Geriátrica , Estado de Salud , Vida Independiente , Anciano , Anciano de 80 o más Años , Disfunción Cognitiva , Estudios Transversales , Humanos , Tamizaje Masivo , Dolor , Prevalencia , Calidad de Vida , Autoinforme , Encuestas y Cuestionarios , Incontinencia Urinaria
11.
Nihon Ronen Igakkai Zasshi ; 57(1): 60-71, 2020.
Artículo en Japonés | MEDLINE | ID: mdl-32074562

RESUMEN

OBJECTIVES: We examined the associations of weight loss and low serum albumin level with death in community-dwelling elderly, as well as related factors by a systematic review with a meta-analysis. METHODS: We searched MEDLINE, Cochrane Library (CENTRAL), Web of Science, and CHINAL for articles on cohort studies investigating the association of weight loss and low serum albumin with death in community-dwelling elderly and extracted a total of 3,812 published articles. We also investigated the factors associated with this relationship. Relative risk ratios and 95% confidence intervals were cultivated. RESULTS: Based on our search for articles related to weight loss, we extracted 1,180 cases and finally analyzed 11 cases. The meta-analysis revealed that the risk ratio (RR) for mortality was 1.69 times higher than that in the weight loss group. Based on our search for articles related to low serum albumin, we extracted 2,632 cases and finally analyzed 10 cases. The mortality RR was 1.92 times higher than that in the maintenance group albumin low level group. Overall, the degree of heterogeneity in the analyzed studies was high. There were some influencing factors influencing the associations; however, the feeding behaviors, swallowing function and food eating patterns were not fully investigated. CONCLUSIONS: Our meta-analysis of the relevant literature revealed that the RR for mortality was significantly high in community dwelling elderly with weight loss or low serum albumin. Based on these results, the maintenance of body weight and serum albumin would be important for preventing death and serious diseases in the community dwelling elderly.


Asunto(s)
Vida Independiente , Albúmina Sérica , Pérdida de Peso , Anciano , Estudios de Cohortes , Humanos , Mortalidad/tendencias
12.
Sr Care Pharm ; 35(2): 85-92, 2020 Feb 01.
Artículo en Inglés | MEDLINE | ID: mdl-32019643

RESUMEN

OBJECTIVE: To identify characteristics in an ambulatory Medicare population that are significantly more likely to be associated with a high risk of undiagnosed prediabetes.
DESIGN: Cross-sectional study.
SETTING: Fourteen health clinics targeting Medicare beneficiaries were held throughout northern and central California during the fall of 2017.
PATIENTS, PARTICIPANTS: Noninstitutionalized Medicare beneficiaries receiving medication therapy management services without self-reported diabetes.
INTERVENTIONS: Beneficiaries were screened for their risk of type 2 diabetes mellitus (T2DM) through the use of the American Diabetes Association (ADA) risk assessment (score of ≥ 5 indicates increased risk of developing type 2 diabetes) by pharmacy students. For this study, patients with a score of ≥ 5 were considered to be at high risk for undiagnosed prediabetes.
MAIN OUTCOME MEASURE(S): Characteristics significantly more likely to be identified in patients at high risk for undiagnosed prediabetes.
RESULTS: A total of 683 Medicare beneficiaries without self-reported diabetes completed the ADA risk assessment, with 457 (66.9%) receiving a score of 5 or more. In those, the presence of hyperlipidemia, hypertension, obesity, coronary heart disease, and use of aspirin were all characteristics researchers identified as significantly more likely to be found in this group. In contrast, those of Asian race or who took dietary supplements were significantly less likely to score 5 or higher in the questionnaire.
CONCLUSION: Identification of older adults at higher risk for undiagnosed prediabetes through the use of appropriate screening tools allows for targeted preventive interventions, potentially lowering risk of developing T2DM for selected patients.


Asunto(s)
Estado Prediabético , Anciano , California , Estudios Transversales , Diabetes Mellitus Tipo 2 , Humanos , Vida Independiente , Medicare , Estados Unidos
13.
Medicine (Baltimore) ; 99(8): e19145, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32080091

RESUMEN

Frailty is a pronounced symptom of aging associated with multiple comorbid states and adverse outcomes. The aim of this study was to evaluate the impact of 2 interventions, one based on prevention of falls and the other on prevention of loneliness, on total frailty and dimensions of frailty in urban community-dwelling elderly as well as associations with independent living.This prospective interventional study followed up 410 persons aged 75 to 95. The participants of the control and intervention groups were monitored through a public health intervention programme. The level of frailty was measured by the Tilburg Frailty Indicator (TFI) questionnaire and the factors of independent living were analyzed using validated questionnaires.After 1 year, physical frailty measured in the control group showed a statistically significant increase (r = -0.11), while in the intervention groups physical frailty did not increase (both P > .05). Psychological frailty measured after 1 year in the control group was significantly higher (r = -0.19), as well as in the group where the public health interventions to reduce loneliness were carried out (r = -0.19). Psychological frailty did not increase in the group in which public health interventions to prevent falls were carried out, and social frailty did not increase at all in the study period. The total level of frailty in the control group after 1 year was significantly increased (r = -0.19), while no increase was seen in the overall frailty in the intervention group. Multivariate analysis has shown that both interventions where independently associated with lower end frailty. Additionally, higher baseline frailty and visit to a physician in the last year were positively associated with higher end-study frailty level, while higher number of subjects in the household and higher total psychological quality of life (SF-12) were independently associated with lower end-study frailty. Only in the prevention of falls group there was no increase in restriction in the activities of daily living throughout study follow-up.Public health interventions to prevent falls and to prevent loneliness have a positive effect on the frailty and independent living of the elderly living in their own homes in an urban community.


Asunto(s)
Accidentes por Caídas/prevención & control , Anciano Frágil/psicología , Promoción de la Salud/organización & administración , Soledad/psicología , Actividades Cotidianas , Anciano , Anciano de 80 o más Años , Femenino , Evaluación Geriátrica , Humanos , Vida Independiente , Masculino , Estudios Prospectivos , Calidad de Vida , Población Urbana
14.
J Am Dent Assoc ; 151(2): 118-126, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32000935

RESUMEN

BACKGROUND: Decreased masticatory performance leads to deterioration of overall health among older adults. However, maintaining and improving masticatory performance in ways other than maintenance of natural teeth and appropriate prosthodontic treatment remains unclear. If the factors related to the mixing and shearing abilities for masticatory performance are clarified, it may be possible to maintain and improve the masticatory performance of older adults. We aimed to clarify the association among mixing ability, shearing ability, and masticatory performance-related factors. METHODS: Of the 707 community-dwelling older adults in Kusatsu Town, Japan, 344 who had been treated for any dental defects were enrolled in this study. Masticatory performance was evaluated on the basis of mixing ability and shearing ability. The number of natural teeth and artificial teeth, occlusal force, tongue pressure, and oral diadochokinesis /ta/ were measured as masticatory performance-related factors. Their relationship with mixing ability, shearing ability, and masticatory performance-related factors was examined by means of Spearman rank correlation coefficient and path analysis. RESULTS: Among masticatory performance-related factors, the number of natural teeth, occlusal force, and tongue pressure were directly associated with both mixing ability and shearing ability. Moreover, mixing ability was also directly associated with shearing ability. CONCLUSIONS: Tongue pressure, which can be improved by means of training, is a masticatory performance-related factor associated with both mixing and shearing abilities. PRACTICAL IMPLICATIONS: Training for tongue pressure after proper prosthetic treatment may provide an effective means of maintaining and improving masticatory performance in older adults.


Asunto(s)
Vida Independiente , Masticación , Fuerza de la Mordida , Estudios Transversales , Japón , Presión , Lengua
15.
Adv Exp Med Biol ; 1216: 21-27, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31894543

RESUMEN

Frailty is a complex of symptoms that is characterized by impaired stress tolerance due to a decline in the functionality of different organs. Due to its multifactorial aetiology, several definitions and assessments of this symptom complex have been developed, of which the Fried Frailty Score (Phenotype Score) and the broader Frailty Index (Deficit Accumulation Index) are the most commonly used. The prevalence of frailty increases with age independently of the assessment instrument and ranges between 4 and 59% in community-dwelling elderly populations and is higher in women than in men. The actual prevalence rate in a population depends on the prevalence of chronic diseases including depression, nutritional status, and inherently socio-economic background and education. Frailty is, however, not a steady state and progression, but also reversion is common. Although numerous studies on the prevalence of frailty have been conducted, systematic assessments in different populations are rare, which reduces the comparability of results. Similarly heterogeneous, but less frequent are studies on the incidence and on trajectories and transitions of frailty, calling for further, more systematic studies on this topic.


Asunto(s)
Anciano Frágil/estadística & datos numéricos , Fragilidad/epidemiología , Anciano , Anciano de 80 o más Años , Evaluación Geriátrica , Humanos , Vida Independiente , Estado Nutricional , Prevalencia
16.
J Oral Sci ; 62(1): 67-69, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31996526

RESUMEN

Fetuin-A is a liver-secreted glycoprotein isolated from fetal bovine serum. Recent reports of its several pathological functions suggest an association between fetuin-A and systemic diseases. This study therefore examined the correlation between serum fetuin-A level and periodontal status. Data from 356 middle-aged and elderly adults who underwent health examinations in Goto, Japan, during the period from 2008 through 2010 were analyzed. Systemic and periodontal measurements were recorded, and serum fetuin-A level was determined by using an enzyme-linked immunosorbent assay. Fetuin-A levels for participants with moderate to severe periodontitis were significantly lower than those for participants with no or mild periodontitis. Additionally, fetuin-A level negatively correlated with periodontal clinical attachment loss. Moderate to severe periodontitis was significantly correlated with low serum fetuin-A levels (odds ratio, 1.69; 95% confidence interval, 1.01-2.69) in logistic regression analysis. Low serum fetuin-A level was correlated with worse periodontal status and could thus potentially serve as a marker of periodontitis.


Asunto(s)
Periodontitis , alfa-2-Glicoproteína-HS , Adulto , Anciano , Humanos , Vida Independiente , Japón , Persona de Mediana Edad , Pérdida de la Inserción Periodontal
17.
BMC Health Serv Res ; 20(1): 22, 2020 Jan 08.
Artículo en Inglés | MEDLINE | ID: mdl-31914993

RESUMEN

BACKGROUND: Given the increasing importance of formal home care services in policies dedicated to elder care, there is major interest in studying individuals' characteristics determining their utilization. The main objective of this research was to quantify, during a 6-year timeframe, home care use trajectories followed by community-dwelling participants in a cohort study of older adults. The secondary objective was to identify factors associated with home care utilization using Andersen's Behavioural Model of Health Services Use. METHODS: We proceeded to an analysis of data prospectively collected in the setting of the Lc65+ population-based study conducted in Lausanne (Switzerland). Self-reported utilization of professional home care in 2012 and 2018 was used to define trajectories during this timeframe (i.e. non-users, new users, former users and continuing users). Bivariable analyses were performed to compare new users to non-users regarding the three dimensions of Andersen's model (predisposing, enabling and need factors) measured at baseline. Then, binomial logistic regression was used in a series of two hierarchical models to adjust for need factors first, before adding predisposing and enabling factors in a second model. RESULTS: Of 2155 participants aged between 69 and 78 in 2012, 82.8% remained non-users in 2018, whereas 11.2% started to use professional home care. There were 3.3% of continuing users and 2.7% of former users. New users exhibited a higher burden of physical and psychological complaints, chronic health conditions and functional limitations at baseline. After adjusting for these need factors, odds of home care utilization were higher only in participants reporting a difficult financial situation (OR 1.65, 95% CI 1.12-2.45). CONCLUSIONS: In the setting of a Swiss city, incident utilization of formal home care by older adults appeared to be largely determined by need factors. Modifiable factors like personal beliefs and knowledge about home care services did not play a role. After adjusting for need, odds of becoming home care user remained higher in participants reporting a difficult financial situation, suggesting such vulnerability does not hamper access to professional home care in this specific context.


Asunto(s)
Utilización de Instalaciones y Servicios/estadística & datos numéricos , Servicios de Atención de Salud a Domicilio/estadística & datos numéricos , Anciano , Enfermedad Crónica , Estudios de Cohortes , Femenino , Encuestas de Atención de la Salud , Humanos , Vida Independiente , Modelos Logísticos , Masculino , Suiza
18.
J Stroke Cerebrovasc Dis ; 29(2): 104497, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31810723

RESUMEN

BACKGROUND: Evidence of the relationship between periodic limb movements during sleep (PLMS) and cerebral small vessel disease (cSVD) is limited and inconsistent. Here, we aimed to assess the independent association between PLMS and the different neuroimaging signatures of cSVD. METHODS: Atahualpa residents aged more than or equal to 60 years enrolled in the Atahualpa Project undergoing polysomnography and MRI with time intervals less than or equal to 6 months were included. MRI readings focused on white matter hyperintensities (WMH) of presumed vascular origin, deep cerebral microbleeds (CMB), silent lacunar infarcts (LI), and more than 10 enlarged basal ganglia-perivascular spaces (BG-PVS). Data from single-night polysomnograms were interpreted according to recommendations of the American Academy of Sleep Medicine. Associations between the PLMS index and neuroimaging signatures of cSVD (as dependent variables) were assessed by means of logistic regression models, adjusted for relevant confounders. RESULTS: A total of 146 individuals (mean age: 71.4 ± 7.5 years; 64% women) were included. A PLMS index more than or equal to 15 per hour were noted in 48 (33%) participants. Moderate-to-severe WMH were present in 33 individuals (23%), deep CMB in 9 (6%), silent LI in 16 (11%), and more than 10 BG-PVS in 44 (30%). In univariate analyses, silent LI (P = .035) and the presence of more than 10 enlarged BG-PVS (P = .034) were significantly higher among participants with a PLMS index more than or equal to 15 per hour. However, fully-adjusted multivariate models showed no significant association between PLMS index more than or equal to 15 per hour and any of the neuroimaging signatures of cSVD. CONCLUSIONS: This study shows no independent association between the PLMS index and neuroimaging signatures of cSVD in stroke-free community-dwelling older adults.


Asunto(s)
Enfermedades de los Pequeños Vasos Cerebrales/diagnóstico por imagen , Vida Independiente , Extremidad Inferior/inervación , Imagen por Resonancia Magnética , Movimiento , Neuroimagen/métodos , Síndrome de Mioclonía Nocturna/fisiopatología , Sueño , Anciano , Anciano de 80 o más Años , Enfermedades de los Pequeños Vasos Cerebrales/epidemiología , Enfermedades de los Pequeños Vasos Cerebrales/fisiopatología , Ecuador/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Síndrome de Mioclonía Nocturna/diagnóstico , Síndrome de Mioclonía Nocturna/epidemiología , Polisomnografía , Valor Predictivo de las Pruebas , Medición de Riesgo , Factores de Riesgo , Salud Rural
19.
Int J Dent Hyg ; 18(1): 52-61, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31394021

RESUMEN

OBJECTIVES: While common in the elderly, dry mouth can negatively affect their oral health and nutritional status. Self-administered oral care by the elderly can improve their oral health and prevent oral diseases. This study aimed to identify the content of oral health promotion programmes for community-dwelling elderly and to determine which programmes are effective in improving oral health decreasing xerostomia in these populations. METHODS: A systematic literature search and meta-analysis was conducted using the PRISMA guidelines. All available papers published in English or Korean were searched between 1 June and 13 June 2018. The relevant databases in PubMed Central, MEDLINE, CINAHL, the Cochrane Library and Embase, as well as open dissertation and academic searches, were performed. Data were extracted from the selected studies based on PICOS, and the health outcomes of the elderly were subjected to meta-analysis categorized by salivary secretion rates and oral health-related quality of life (OHQoL). RESULTS: A total of nine studies had sufficient data for a systematic review and meta-analysis. The intervention programmes consisted mainly of oral health promotion programmes, mouth exercises, toothbrushing and salivary massage. The meta-analysis indicated that elderly participating in oral health programmes had significantly increased oral salivary secretion rates and OHQoL (effect sizes of 0.63 and 0.80, respectively). CONCLUSIONS: Oral health promotion programmes in the elderly provide the positive effects of relieving dry mouth and improving OHQoL. This systematic review confirmed the contents and effects of the oral health promotion programmes provided to community-dwelling elderly.


Asunto(s)
Salud Bucal , Xerostomía , Anciano , Humanos , Vida Independiente , Calidad de Vida , Cepillado Dental
20.
Int Heart J ; 61(1): 109-114, 2020 Jan 31.
Artículo en Inglés | MEDLINE | ID: mdl-31875617

RESUMEN

Lipoprotein-associated phospholipase A2 (Lp-PLA2) and high-sensitivity C-reactive protein (hs-CRP) have been reported to be associated with cardiovascular disease (CVD). However, whether the combination of these two markers can improve the prediction of CVD is unknown.A total of 1,921 participants without CVD, aged 40 years or older, were enrolled from 2010 to 2011. Plasma Lp-PLA2 and hs-CRP were measured at baseline. Participants were subsequently followed until December 2015. We identified a total of 148 cardiovascular events (myocardial infarction, stroke, and all-cause death). Cox proportional-hazard models were used to determine the association between two independent markers and cardiovascular outcomes. The C statistic, Net Reclassification Improvement (NRI), and Integrated Discrimination Improvement (IDI) were used to determine the utility of the two markers in predicting cardiovascular risk.After adjustment for potential confounders, compared with the first quartile, hazard ratios (HRs) with 95% confidence interval (CI) for the third and fourth quartiles for Lp-PLA2 were 2.09 (1.17-3.73) and 2.62 (1.48-4.67), respectively, and HRs with 95%CI for the fourth quartile for hs-CRP was 1.78 (1.08-4.67). Compared with conventional risk factors, the combination of hs-CRP and Lp-PLA2 provided greater incremental information, and the C statistic increased by 0.013. The NRI and IDI were also statistically significant for cardiovascular events (P = 0.004 and P < 0.001, respectively).Hs-CRP and Lp-PLA2 have complementary effects in predicting cardiovascular outcomes in adults aged 40 years or older.


Asunto(s)
1-Alquil-2-acetilglicerofosfocolina Esterasa/sangre , Proteína C-Reactiva/metabolismo , Vida Independiente , Infarto del Miocardio/diagnóstico , Accidente Cerebrovascular/diagnóstico , Adulto , Anciano , Anciano de 80 o más Años , Biomarcadores/sangre , Causas de Muerte , China/epidemiología , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/sangre , Infarto del Miocardio/epidemiología , Valor Predictivo de las Pruebas , Modelos de Riesgos Proporcionales , Medición de Riesgo , Factores de Riesgo , Accidente Cerebrovascular/sangre , Accidente Cerebrovascular/epidemiología
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