Visual and material representations of ageing, space and rhythms in everyday life.

A focus on the materiality within ageing studies brings into focus the material dimensions of space, rhythms and material objects in everyday life. The aim of this paper is to explore meanings around space in the context of the daily lives of people growing older and how materiality is embodied, embedded and performed in the material and social context of our everyday lives. The paper draws on data from the empirical research study Photographing Everyday Life: Ageing, Lived Experiences, Time and Space funded by the ESRC, UK. The focus of the project was to explore the significance of the ordinary and day-to-day and focus on the everyday meanings, lived experiences, practical activities, and social contexts in which people in mid-to-later life live their daily lives. The research involved a diverse sample of 62 women and men aged 50 years and over who took photographs of their different daily routines to create a weekly visual diary. The data reveals three interconnecting whilst analytically distinct themes within the materiality of ageing and the spaces around everyday life: (1) Space, materiality and everyday life; (2) Rhythms, routines and materiality; and (3) Social and material connectivity. The paper concludes by highlighting a complex engagement with space, in which participants drew and re-drew boundaries surrounding meanings of space, sometimes within the same interview or even within a discussion of the same photograph. Moreover, a focus on materiality has elicited rich and illuminating accounts of how people in mid-to-later life experience the intersections between ageing, bodies, time and space in their everyday lives.

Evolution of psychological distress with age and its determinants in later life: evidence from 17-wave social survey data in Japan.

BACKGROUND: Psychological distress (PD) is a major risk factor for mental health among middle-aged and older adults and affects their quality of life and well-being. This study aimed to examine the evolution of PD with age and the relative importance of its determinants, issues that have been insufficiently studied. METHODS: We used longitudinal data obtained from 17-wave social surveys conducted in Japan from 2005 to 2021, to track 34,128 individuals (16,555 men and 17,573 women) born between 1946 and 1955. We defined PD as a Kessler 6 score (range: 0-24) ≥ 5 and estimated fixed-effects regression models to examine the evolution of its proportion with age. We also conducted a mediation analysis to examine the relative importance of specific mediators such as self-rated health (SRH), activities of daily living (ADL), and social participation, in the association between age and PD. RESULTS: Regression model results confirmed an increase in PD with age. Poor SRH, issues with ADL, and no social participation were key mediators of aging on PD, accounting for 34.2% (95% confidence interval [CI]: 21.0-47.3%), 13.7% (95% CI: 8.2-19.3%), and 10.5% (95% CI: 8.0-13.0%), respectively; consequently increasing PD between 50 and 75 years. CONCLUSION: The results suggest the need for policy support to encourage middle-aged and older adults to promote health and increase social participation in order to prevent depression while aging.

The multinomial mixed-effect regression model for predicting PCOC phases in hospice patients.

PURPOSE: The Palliative Care Outcomes Collaboration (PCOC) aims to enhance patient outcomes systematically. However, identifying crucial items and accurately determining PCOC phases remain challenging. This study aims to identify essential PCOC data items and construct a prediction model to accurately classify PCOC phases in terminal patients. METHODS: A retrospective cohort study assessed PCOC data items across four PCOC phases: stable, unstable, deteriorating, and terminal. From July 2020 to March 2023, terminal patients were enrolled. A multinomial mixed-effect regression model was used for the analysis of multivariate PCOC repeated measurement data. RESULTS: The dataset comprised 1933 terminally ill patients from 4 different hospice service settings. A total of 13,219 phases of care were analyzed. There were significant differences in the symptom assessment scale, palliative care problem severity score, Australia-modified Karnofsky performance status, and resource utilization groups-activities of daily living among the four PCOC phases of care. Clinical needs, including pain and other symptoms, declined from unstable to terminal phases, while psychological/spiritual and functional status for bed mobility, eating, and transfers increased. A robust prediction model achieved areas under the curves (AUCs) of 0.94, 0.94, 0.920, and 0.96 for stable, unstable, deteriorating, and terminal phases, respectively. CONCLUSIONS: Critical PCOC items distinguishing between PCOC phases were identified, enabling the development of an accurate prediction model. This model enhances hospice care quality by facilitating timely interventions and adjustments based on patients' PCOC phases.

A Teleconference With Related Donors Years After Allogeneic Hematopoietic Stem Cell Transplantation.

OBJECTIVES: During and after allogeneic hematopoietic stem cell donation, donors may experience adverse events. This situation can increase anxiety of candidate donors. Time to return to daily life routine and work, presentation of comorbid diseases in follow-up, and donor opinions are topics of interest. MATERIALS AND METHODS: We conducted a 14-question survey among related stem cell donors between January 2010 and March 2019 by telephone interview. RESULTS: Of 257 related donors, 175 (68.1%) were interviewed; 87 (49.7%) were female and 88 (50.3%) were male. Among donors interviewed, 144 (82.3%) donated from only peripheral blood. After harvesting of stem cells, adverse events included hip pain (38.7%), bone pain (57.2%) during mobilization, and paresthesia (28.9%) during apheresis. After apheresis, 2 serious adverse events were reported in 2 (1.3%) female donors (1 salpingo-oophorectomy and 1 nephrectomy). Splenomegaly was observed in 1 male donor (0.7%). Among donors interviewed, 77 (44%) reported being able to perform daily activities on the same day. The shortest time to daily activity was in the peripheral blood group, and the longest was in the bone marrow group (P = .001). Among working donors, 23 (27.4%) returned to work on the same day; all were peripheral blood donors. Among donors interviewed, 114 (65.1%) wanted to volunteer to donate again. One donor (0.6%) expressed guilt after donation, and 162 (92.6%) recommended other people to be stem cell donors. During the follow-up period, musculoskeletal-joint diseases increased after donation (P = .012). CONCLUSIONS: It is important to raise awareness in society about stem cell donation and to reduce the concerns among donor candidates. Although most of the adverse events after donation are temporary and mild, a few serious adverse events in donors have been observed. Stem cell donation does not cause loss of daily activity or inability to return to the work force.

Reducing refusals of care through improved personal care interactions between caregivers and people with dementia: protocol for a realist synthesis.

INTRODUCTION: People with dementia develop progressive difficulties conducting basic activities of daily living, often requiring considerable assistance from caregivers. Many people with dementia, particularly in the advanced stages, can refuse assistance with care leading to difficult interactions. The ways in which refusals of care can be best reduced are unknown. Using a realist approach, this study aims to develop and refine evidence-based programme theories showing which mechanisms of interventions contribute to reducing refusals of care between caregivers and people with dementia, in which contexts, how and why. METHODS AND ANALYSIS: The realist synthesis will be conducted in three iterative stages.Stage 1 will develop initial programme theories through secondary analysis of caregivers and persons with dementia interviews and observations, a preliminary exploratory literature review and team discussions. After initial programme theory development, the focus of the synthesis will be decided by the study team.Stage 2 will involve conducting focused, iterative and targeted literature searches to test and refine our initial programme theories considering the evidence for each setting: hospital, care home, home care and family. Data synthesis will use a realist lens to examine what works for whom in what circumstances and how, and organise related evidence to context-mechanism-outcome configurations whenever possible.Stage 3 will use stakeholder interviews to explore reactions to the programme theories and enhance validity after integration of these findings, recommendations and conclusions will be developed. ETHICS AND DISSEMINATION: The NHS Social Care Research Ethics Committee has approved the interview stage of this study (REC reference: 24/IEC08/0007; IRAS project ID: 338274). Informed consent will be obtained from all interviewees prior to data collection. Findings will be disseminated via peer-reviewed publications, conference presentations and accessible information for key stakeholders. PROPSPERO REGISTRATION NUMBER: CRD42024496072.

In-Clinic and Natural Gait Observations master protocol (I-CAN-GO) to validate gait using a lumbar accelerometer.

Traditional measurements of gait are typically performed in clinical or laboratory settings where functional assessments are used to collect episodic data, which may not reflect naturalistic gait and activity patterns. The emergence of digital health technologies has enabled reliable and continuous representation of gait and activity in free-living environments. To provide further evidence for naturalistic gait characterization, we designed a master protocol to validate and evaluate the performance of a method for measuring gait derived from a single lumbar-worn accelerometer with respect to reference methods. This evaluation included distinguishing between participants' self-perceived different gait speed levels, and effects of different floor surfaces such as carpet and tile on walking performance, and performance under different bouts, speed, and duration of walking during a wide range of simulated daily activities. Using data from 20 healthy adult participants, we found different self-paced walking speeds and floor surface effects can be accurately characterized. Furthermore, we showed accurate representation of gait and activity during simulated daily living activities and longer bouts of outside walking. Participants in general found that the devices were comfortable. These results extend our previous validation of the method to more naturalistic setting and increases confidence of implementation at-home.

Depression predicts delayed return to daily activities in patients post-cardiac surgery: a prospective observational study.

BACKGROUND: Depression significantly impacts recovery and return to daily activities in cardiac surgery patients. Assessing and managing depressive symptoms before and after surgery are crucial for improving surgical outcomes and timely return to daily activities, including work. The objectives of this study were to examine differences in patients' depression levels in relation to their return to daily activities in the early post-cardiac surgery period, and to assess predictors of delayed return to daily activities. METHODS: This single-centered study assessed return to independence, social participation, hobbies, and work in 100 cardiac surgical patients at 2 and 6 weeks post-surgery. Associations between depression levels and return to daily activities scores were evaluated. RESULTS: Higher Center for Epidemiologic Studies Depression Scale (CES-D) scores were significantly associated with delayed return to daily activities in all categories at both 2 and 6 weeks post-surgery. Specifically, higher depression score delayed return to independence and social participation at 2 weeks, and delayed return to independence, social participation, and return to work at 6 weeks. CONCLUSION: Elevated depression scores are significantly associated with delayed return to daily activities post-cardiac surgery, indicating the importance of evaluating depression in cardiac surgical patients in the postend stage-operative period.

The mediating effect of life satisfaction between daily living abilities and depressive symptoms in the Chinese older people: evidence from CHARLS 2020.

Background: Depressive symptoms represent a significant public health challenge, impacting the mental well-being of older adults. Despite this, the understanding of how activities of daily living (ADL) abilities correlate with life satisfaction and depressive symptoms among older Chinese adults remains limited. Aims: This study aims to investigate the relationship between ADL and depressive symptoms in older people Chinese individuals, with a specific focus on examining the mediating role of life satisfaction within this context. Methods: The study utilized data from the China Health and Retirement Longitudinal Study (CHARLS) collected in 2020. A cohort of 8,343 individuals aged 60 years and above was included. The analysis was conducted using STATA 17.0 and SPSS 26.0, employing descriptive statistics, chi-square tests, Pearson correlations, and mediation analysis using the percentile Bootstrap method with 5,000 resamples to explore the interrelations among ADL, life satisfaction, and depressive symptoms. Results: ADL is positively correlated with life satisfaction (r = 0.129, p < 0.01) and negatively correlated with depressive symptoms (r = -0.313, p < 0.01). Additionally, life satisfaction and depressive symptoms are negatively correlated with each other (r = -0.360, p < 0.01). In the model of the mediating effect, ADL directly, significantly and negatively predicts depressive symptoms in the Chinese older people (ß = -0.193, t = -17.827, p < 0.001). After incorporating life satisfaction into the regression equation, the direct predictive effect of ADL on depressive symptoms remains significant (ß = -0.177, t = -17.099, p < 0.001); furthermore, ADL has a significant positive predictive effect on life satisfaction (ß = 0.007, t = 4.959, p < 0.001) and life satisfaction significantly negatively predicts depressive symptoms (ß = -2.235, t = -27.799, p < 0.001). Furthermore, the direct effect of ADL on depressive symptoms (-0.177) and its mediating effect (-0.016) account for 91.71% and 8.29% of the total effect (-0.193), respectively. Conclusion: ADL is inversely associated with the risk of depressive symptoms among older people Chinese individuals, with life satisfaction serving as a significant mediator in this relationship. Interventions aimed at improving life satisfaction in older people individuals with ADL impairments may effectively reduce or prevent the onset of depressive symptoms.

The Role of Functional Deficits, Depression, and Cognitive Symptoms in the Perceived Loneliness of Older Adults in Mexico City.

The world is aging and experiencing loneliness. Functional impairment in instrumental activities of daily living (IADL) in older people (OP) with mild neurocognitive disorder (MNCD) predicts loneliness. After the pandemic, there was an increase in perceived loneliness. We explored the association between loneliness, depression, deficits in IADL, and cognitive symptoms among OP. From February to December 2023, using a cross-sectional design, we interviewed probable cases with mild cognitive impairment and caregivers in two public facilities. We administered the UCLA Loneliness Scale v3, Lawton IADL Scale, Mini-Mental State Examination (MMSE), and Yesavage's Geriatric Depression Scale. Samples were matched: 85 per group, 82.4% were women, married (52.95%), and mean age of 69.17 (±6.93) years. In our study, 30% displayed moderate to high levels of perceived loneliness. Multivariate analysis showed loneliness was associated with depression, low levels of IADL, and older age, but not with cognitive symptoms, which explained 22% of the total variance (F 165) = 16.99, (p < 0.001). Targeting symptoms and behaviors that could be modified (i.e., depression and functionality) can improve feelings of perceived loneliness and have an impact on morbidity and mortality with which it is associated.

Human Multi-Activities Classification Using mmWave Radar: Feature Fusion in Time-Domain and PCANet.

This study introduces an innovative approach by incorporating statistical offset features, range profiles, time-frequency analyses, and azimuth-range-time characteristics to effectively identify various human daily activities. Our technique utilizes nine feature vectors consisting of six statistical offset features and three principal component analysis network (PCANet) fusion attributes. These statistical offset features are derived from combined elevation and azimuth data, considering their spatial angle relationships. The fusion attributes are generated through concurrent 1D networks using CNN-BiLSTM. The process begins with the temporal fusion of 3D range-azimuth-time data, followed by PCANet integration. Subsequently, a conventional classification model is employed to categorize a range of actions. Our methodology was tested with 21,000 samples across fourteen categories of human daily activities, demonstrating the effectiveness of our proposed solution. The experimental outcomes highlight the superior robustness of our method, particularly when using the Margenau-Hill Spectrogram for time-frequency analysis. When employing a random forest classifier, our approach outperformed other classifiers in terms of classification efficacy, achieving an average sensitivity, precision, F1, specificity, and accuracy of 98.25%, 98.25%, 98.25%, 99.87%, and 99.75%, respectively.

Nutritional therapy for reducing disability and improving activities of daily living in people after stroke.

BACKGROUND: Stroke patients often face disabilities that significantly interfere with their daily lives. Poor nutritional status is a common issue amongst these patients, and malnutrition can severely impact their functional recovery post-stroke. Therefore, nutritional therapy is crucial in managing stroke outcomes. However, its effects on disability, activities of daily living (ADL), and other critical outcomes have not been fully explored. OBJECTIVES: To evaluate the effects of nutritional therapy on reducing disability and improving ADL in patients after stroke. SEARCH METHODS: We searched the trial registers of the Cochrane Stroke Group, CENTRAL, MEDLINE (from 1946), Embase (from 1974), CINAHL (from 1982), and AMED (from 1985) to 19 February 2024. We also searched trials and research registries (ClinicalTrials.gov, World Health Organization International Clinical Trials Registry Platform) and reference lists of articles. SELECTION CRITERIA: We included randomised controlled trials (RCTs) that compared nutritional therapy with placebo, usual care, or one type of nutritional therapy in people after stroke. Nutritional therapy was defined as the administration of supplemental nutrients, including energy, protein, amino acids, fatty acids, vitamins, and minerals, through oral, enteral, or parenteral methods. As a comparator, one type of nutritional therapy refers to all forms of nutritional therapies, excluding the specific nutritional therapy defined for use in the intervention group. DATA COLLECTION AND ANALYSIS: We used Cochrane's Screen4Me workflow to assess the initial search results. Two review authors independently screened references that met the inclusion criteria, extracted data, and assessed the risk of bias and the certainty of the evidence using the GRADE approach. We calculated the mean difference (MD) or standardised mean difference (SMD) for continuous data and the odds ratio (OR) for dichotomous data, with 95% confidence intervals (CIs). We assessed heterogeneity using the I2 statistic. The primary outcomes were disability and ADL. We also assessed gait, nutritional status, all-cause mortality, quality of life, hand and leg muscle strength, cognitive function, physical performance, stroke recurrence, swallowing function, neurological impairment, and the development of complications (adverse events) as secondary outcomes. MAIN RESULTS: We identified 52 eligible RCTs involving 11,926 participants. Thirty-six studies were conducted in the acute phase, 10 in the subacute phase, three in the acute and subacute phases, and three in the chronic phase. Twenty-three studies included patients with ischaemic stroke, three included patients with haemorrhagic stroke, three included patients with subarachnoid haemorrhage (SAH), and 23 included patients with ischaemic or haemorrhagic stroke including SAH. There were 25 types of nutritional supplements used as an intervention. The number of studies that assessed disability and ADL as outcomes were nine and 17, respectively. For the intervention using oral energy and protein supplements, which was a primary intervention in this review, six studies were included. The results for the seven outcomes focused on (disability, ADL, body weight change, all-cause mortality, gait speed, quality of life, and incidence of complications (adverse events)) were as follows: There was no evidence of a difference in reducing disability when 'good status' was defined as an mRS score of 0 to 2 (for 'good status': OR 0.97, 95% CI 0.86 to 1.10; 1 RCT, 4023 participants; low-certainty evidence). Oral energy and protein supplements may improve ADL as indicated by an increase in the FIM motor score, but the evidence is very uncertain (MD 8.74, 95% CI 5.93 to 11.54; 2 RCTs, 165 participants; very low-certainty evidence). Oral energy and protein supplements may increase body weight, but the evidence is very uncertain (MD 0.90, 95% CI 0.23 to 1.58; 3 RCTs, 205 participants; very low-certainty evidence). There was no evidence of a difference in reducing all-cause mortality (OR 0.57, 95% CI 0.14 to 2.28; 2 RCTs, 4065 participants; low-certainty evidence). For gait speed and quality of life, no study was identified. With regard to incidence of complications (adverse events), there was no evidence of a difference in the incidence of infections, including pneumonia, urinary tract infections, and septicaemia (OR 0.68, 95% CI 0.20 to 2.30; 1 RCT, 42 participants; very low-certainty evidence). The intervention was associated with an increased incidence of diarrhoea compared to usual care (OR 4.29, 95% CI 1.98 to 9.28; 1 RCT, 4023 participants; low-certainty evidence) and the occurrence of hyperglycaemia or hypoglycaemia (OR 15.6, 95% CI 4.84 to 50.23; 1 RCT, 4023 participants; low-certainty evidence). AUTHORS' CONCLUSIONS: We are uncertain about the effect of nutritional therapy, including oral energy and protein supplements and other supplements identified in this review, on reducing disability and improving ADL in people after stroke. Various nutritional interventions were assessed for the outcomes in the included studies, and almost all studies had small sample sizes. This led to challenges in conducting meta-analyses and reduced the precision of the evidence. Moreover, most of the studies had issues with the risk of bias, especially in terms of the absence of blinding and unclear information. Regarding adverse events, the intervention with oral energy and protein supplements was associated with a higher number of adverse events, such as diarrhoea, hyperglycaemia, and hypoglycaemia, compared to usual care. However, the quality of the evidence was low. Given the low certainty of most of the evidence in our review, further research is needed. Future research should focus on targeted nutritional interventions to reduce disability and improve ADL based on a theoretical rationale in people after stroke and there is a need for improved methodology and reporting.

Osteosarcopenia in Finland: prevalence and associated factors.

This cross-sectional study investigated osteosarcopenia prevalence and its correlates among 2142 adults aged 55 and older in Finland. Findings show 3.9% had osteosarcopenia, while 13.8% and 11.1% had probable sarcopenia only or osteoporosis only, respectively. Osteosarcopenia was associated with low BMI, impaired mobility, ADL limitations and depression. Sarcopenia appeared to drive these associations more than osteoporosis. Osteosarcopenia may be a risk factor for functional decline, hospitalization, and institutionalization, warranting further research. PURPOSE: Osteosarcopenia is a disorder consisting of concurrent osteoporosis and sarcopenia. This cross-sectional study using nationally representative data from Finland in 2000 aimed to determine the prevalence of osteosarcopenia in Finland. In addition, associations of sociodemographic, lifestyle, anthropometric, physical and mental function indicators, chronic conditions and various biomarkers with osteosarcopenia were examined. METHODS: The study included 2142 subjects aged 55 and over (mean age 68.0 years, SD 9.0). Probable sarcopenia was defined as grip strength < 27 kg for men and < 16 kg for women. Osteoporosis was defined as either ultrasound-based bone density measurement of T < -2.5, or self-reported, pre-existing diagnosis of osteoporosis. Participants were categorized into 4 groups: no sarcopenia and no osteoporosis, probable sarcopenia only, osteoporosis only, and osteosarcopenia. Information on sociodemographic, lifestyle, anthropometric, physical and mental function indicators, chronic conditions and various biomarkers were collected via structured interview, questionnaires, clinical examination, and blood and urine samples. RESULTS: The prevalence of probable sarcopenia, osteoporosis and osteosarcopenia was 13.8%, 11.1%, and 3.9%, respectively. Osteosarcopenia was associated with low BMI, slow gait speed, impaired mobility, impaired ability in the activities of daily living and depression. Of the two components, probable sarcopenia appeared to contribute to these associations more than osteoporosis. CONCLUSION: According to representative population-based study, about every fifth person with probable sarcopenia also has osteoporosis. Mobility and ADL limitations were more common among people with osteosarcopenia than those with osteoporosis or probable sarcopenia alone. Future studies are needed to examine osteosarcopenia as an independent risk factor for functional decline, hospitalization, and institutionalization.

Utility values and electronic device use in low-vision people attending rehabilitation services: Data from a nation-wide registry in Italy.

PURPOSE: To estimate utility values associated with visual loss using EuroQol (EQ-5D) questionnaire, the impact of low-vision (LV) device use on utilities and the contribution of Instrumental Activities of Daily Living (IADL) score in patients attending vision rehabilitation (VR) services enrolled in the Italian Device & Aids Register (D.A.Re). METHODS: This is a multicenter, prospective, cross-sectional study. D.A.Re. collects general and clinical information, vision-specific variables, use of electronic devices and quality of life questionnaires. RESULTS: A total of 442 patients (75.0±16.6 years, 275 female) were included, 88 (19.9%) used specialised electronic LV devices, and 116 (26.2%) used smartphones and tablets. Users of smartphones and tablets were younger than non-users (67.5 vs. 77.6 years, p<0.001), but overall, their age ranged between 20 and 93. Stronger associations were found between vision-specific variables and IADL score compared to EQ-5D score. In multivariable age-adjusted models, the utility value of using smartphones and tablets on EQ-5D score was 0.12 (p<0.01), slightly larger than that of 1.0 logMAR difference (-0.09, p<0.01) or visual field damage within 10° of fixation (-0.10, p<0.01). Use of portable low-vision electronic devices and being employed or student (vs. retired) was also associated with better utility values (0.12 and 0.15, respectively, p<0.05). CONCLUSIONS: Visual loss is associated with loss of utilities in Italian patients attending VR services, whereas special-purpose electronic aids, and smartphone and tablet use are associated with better utility values. We found that IADL may be more sensitive to visual loss than EQ-5D and could be a valid health-related quality of life outcome in trials on VR.

Total life expectancy and disability-free life expectancy and differences attributable to cigarettes' smoking among Chinese middle-aged and older adults.

OBJECTIVES: Middle-aged and older adults smoking for years are afflicted by smoking-related diseases and functional limitations; however, little is known about the effect of smoking on nonfatal conditions in middle and later life. This study aims to investigate the impact of smoking on both total life expectancy (TLE) and disability-free life expectancy (DFLE) and the variations in such effects by educational level in China. METHODS: Data were drawn from the China Health and Retirement Longitudinal Study (CHARLS), 2011-2018, with a total sample of 16,859 individuals aged 45 years or older involved in the final analysis. The Activities of Daily Living (ADL) scale was used to measure disability, and the population-based multistate life table method was used to estimate the differences in TLE and DFLE by smoking status and educational attainment. RESULTS: At baseline, 28.9% of participants were current smokers, 8.5% were former smokers, and 62.6% never smoked. Approximately 5.6% were identified with ADL disability. Both current smokers and former smokers experienced lower TLE and DFLE than never smokers, and such differences were particularly prominent among men. Intriguingly, former smokers manifested a lower DFLE for both sexes and a lower TLE among women, though a longer TLE among men, compared with current smokers. Similar differences in TLE and DFLE by smoking status were observed for groups with different levels of education. CONCLUSION: Never smokers live longer and healthier than current smokers and persons who quit smoking. Smoking was associated with greater reductions in TLE and DFLE among men. However, educational attainment might not moderate the adverse effect of smoking on both fatal and nonfatal conditions in the context of China. These findings have implications for disability prevention, aged care provision and informing policies of healthy aging for China and elsewhere.

'If It Was Easy Somebody Would Have Fixed It': An Exploration of Loneliness and Social Isolation Amongst People Who Frequently Call Ambulance Services.

INTRODUCTION: The aim of the study was to explore social isolation and loneliness in those who frequently contacted the ambulance service, what factors contributed to this and how unmet needs could be addressed. METHODS: Semi-structured interviews with staff from the ambulance service and service users who were identified as frequently contacting the ambulance service. Service users also completed the UCLA loneliness scale and personal community maps. Data were analysed thematically before triangulation with the UCLA loneliness scale and personal community maps. RESULTS: The final analysis was drawn from 15 staff and seven service user participants. The relationship between social isolation and loneliness and contacting the ambulance service was a contributing, but not the driving, factor in contacting the ambulance service. For service users, we identified three key themes: (1) impact on activities of daily living and loneliness and/or isolation as a result of a health condition; (2) accessing appropriate health and social care services to meet needs; (3) the link between social isolation and/or loneliness and contact with the ambulance service. The analysis of staff data also highlighted three key themes: (1) social isolation and/or loneliness in their role; (2) access to other appropriate health and social care services; (3) the impact of austerity and Covid-19 on social isolation and/or loneliness. CONCLUSIONS: Our research emphasises the complex nature of social isolation and loneliness, including the cyclic nature of poor health and social isolation and loneliness, and how this contributes to contact with the ambulance service. PATIENT OR PUBLIC CONTRIBUTION: The advisory group for the study was supported by a public and patient representative who contributed to the design of the study documentation, data analysis and authorship.

[Relationship between cognitive status and other geriatric syndromes in patients aged 65 years and older with chronic heart failure.]

This article presents the incidence of geriatric syndromes in patients with chronic heart failure 65 years of age and older, depending on cognitive status. At the Russian gerontological center, 149 people with confirmed chronic heart failure were selected according to the European criteria of 2021. In this sample, 50,3% of patients had mild cognitive impairment, and 17,5% had severe cognitive impairment. With age, the incidence and severity of cognitive impairment increased. Among patients with cognitive impairment, there were more patients with reduced basic and instrumental activities of daily living, with a high risk of malnutrition and malnutrition, frailty and patients with hearing loss. Also, as cognitive functions declined, the median score of the Barthel and Lawton index, the mini nutritional assessment, the short physical performance battery, the Lubben social network scale decreased, and the median of the Morse fall risk scale and the geriatric depression scale increased. The presence of hearing loss was associated with a 3,6-fold increase in the odds of being diagnosed with cognitive impairment, and the presence of frailty syndrome, basic dependence in daily life, or the risk of malnutrition by a 2,4-fold increase.

[The effect of various visual impairments on the daily activities of older patients.]

Visual impairment due to ophthalmological diseases significantly affects functional activity in everyday life, since good eyesight is crucial in daily activities. Data from 837 respondents were studied, allowing for analysis of such medical and demographic indicators as age, gender, level of education, visual acuity arterial hypertension and diabetes mellitus. To measure functional status, the main activities in daily life (ADL) and instrumental activities in daily life (IADL) were evaluated using a modified version of the Katz scale and the IADL OARS scale. Statistical methods of Mantel-Hansel Chi-squared analysis were used to assess differences in the prevalence of functional blindness and visual deficit. The study showed that medical and demographic factors have a relatively smaller impact on vision deficiency compared to functional blindness, with age being a significant factor in both cases. Among the medical and demographic factors, the age of patients, as well as diabetes mellitus, significantly increase the development of visual deficiency and functional blindness. Functional blindness, in comparison with visual deficiency, causes more significant restrictions on activities in everyday life and instrumental activities in everyday life, and also causes dependence on help from others.

Predicting Complete versus Incomplete Long-Term Functional Independence after Acute AIS Grade D Spinal Cord Injury: A Prospective Cohort Study.

Background: The proportion of patients with American Spinal Injury Association Impairment Scale (AIS) grade D traumatic spinal cord injuries (tSCI) is increasing. Although initial motor deficits can be relatively mild, some individuals fail to recover functional independence. Objectives: This study aims to identify factors associated with failure to reach complete functional independence after AIS grade D tSCI. Methods: An observational prospective cohort study was conducted at a level 1 trauma center specialized in SCI care. A prospective cohort of 121 individuals with an AIS-D tSCI was considered. The baseline characteristics, length of acute stay, need for inpatient rehabilitation, and 12-month functional status were assessed. Univariate and classification and regression tree (CART) analyses were performed to identify factors associated with reaching complete versus incomplete functional independence (defined as perfect total SCIM III score at 12-month follow-up). Results: There were 69.3%, 83.3%, and 61.4% individuals reaching complete independence in self-care, respiration/sphincter management, and mobility, respectively. A total of 64 individuals (52%) reached complete functional independence in all three domains. In the CART analysis, we found that patients are more likely to achieve complete functional independence when they have a baseline motor score ≥83 (65% individuals) and if they present fewer medical comorbidities (70% individuals if Charlson Comorbidity Index [CCI] ≤4). Conclusion: About half of individuals with AIS grade D tSCI can expect complete long-term functional independence. It is important to recognize early during acute care individuals with baseline motor score <83 or a high burden of comorbidities (CCI ≥5) to optimize their rehabilitation plan.

Establishing the Predictive Validity of the Assessment of Motor and Process Skills for Driving Performance Outcomes.

IMPORTANCE: Although the Assessment of Motor and Process Skills (AMPS) is an excellent tool for evaluating the functional performance of instrumental activities of daily living (IADLs), a limited number of studies have used the AMPS for decisions regarding the IADL of fitness to drive and community mobility. OBJECTIVE: To determine the specificity and sensitivity of the AMPS as a tool for determining a person's fitness to drive. DESIGN: Cross-sectional observational design. SETTING: Three driving rehabilitation programs in three states. PARTICIPANTS: Participants were 388 community-living adults (M age = 68.74 yr, SD = 11.53); 196 adults were recruited before completing a comprehensive driving evaluation, and 192 were recruited in two other studies of older drivers. OUTCOME AND MEASURES: AMPS and results of comprehensive driving evaluation or on-road assessment. RESULTS: Using a logistical regression, AMPS Motor and Process Skills scores yielded a sensitivity of 84.6% and a specificity of 88.8%. The odds ratio of the AMPS Motor Skills score was .347; for the AMPS Process Skills score, it was .014. Using cross-validations, the model with AMPS Motor and Process scores produced a cross-validation area under the curve of .918, with sensitivity and specificity of 84.6% and 88.4%, respectively, and a probability greater than .334 was used for predicting a fail or drive-with-restriction evaluation. CONCLUSIONS AND RELEVANCE: The AMPS Motor and Process Skills scores revealed significant differences between those who failed or had driving restrictions and with those who passed the driving evaluation, which supported the AMPS as an effective tool for predicting fitness to drive. Plain-Language Summary: This study demonstrates how the Assessment of Motor and Process Skills (AMPS), as a top-down occupational therapy assessment tool, can be used to differentiate between medically at-risk drivers who are likely to pass a comprehensive driving evaluation and those who are likely to fail or need restrictions. AMPS will assist occupational therapy practitioners in determining who is most appropriate to receive driving rehabilitation services and/or when to refer a person for a comprehensive driving evaluation.

Protocol for a feasibility randomised controlled trial of the 'Outdoor' mobility intervention for older adults after hip fracture.

BACKGROUND: A high proportion of patients do not regain outdoor mobility after hip fracture. Rehabilitation explicitly targeting outdoor mobility is needed to enable these older adults to recover activities which they value most. The overarching aim of this study is to determine the feasibility of a randomised controlled trial which aims to assess the clinical- and cost-effectiveness of an intervention designed to enable recovery of outdoor mobility among older adults after hip fracture (the OUTDOOR intervention). METHODS: This is a protocol for a multi-centre pragmatic parallel group (allocation ratio 1:1) randomised controlled assessor-blinded feasibility trial. Adults aged 60 years or more, admitted to hospital from- and planned discharge to- home, with self-reported outdoor mobility in the three-months pre-fracture, surgically treated for hip fracture, and who are able to consent and participate, are eligible. Individuals who require two or more people to support mobility on discharge will be excluded. Screening and consent (or consent to contact) will take place in hospital. Baseline assessment and randomisation will follow discharge from hospital. Participants will then receive usual care (delivered by physiotherapy, occupational therapy, or therapy assistants), or usual care plus the OUTDOOR intervention. The OUTDOOR intervention includes a goal-orientated outdoor mobility programme (supported by up to six in-person visits), therapist-led motivational dialogue (supported by up to four telephone calls), supported by a past-patient led video where recovery experiences are shared, and support to transition to independent ongoing recovery. Therapists delivering the OUTDOOR intervention (distinct from those supporting usual care) will receive training in motivational interviewing and behaviour change techniques. Baseline demographics will be collected. Patient reported outcome measures including health related quality of life, activities of daily living, pain, community mobility, falls related self-efficacy, resource use, readmissions, and mortality will be collected at baseline, 6-weeks, 12-weeks, and 6-months (for those enrolled early in the trial) post-randomisation. Exercise adherence (6- and 12- weeks) and intervention acceptability (12-weeks) will be collected. A subset of 20 participants will also support accelerometery data collection for 10 days at each time point. DISSEMINATION: The trial findings will be disseminated to patients and the public, health professionals and researchers through publications, presentations and social media channels. TRIAL REGISTRATION: The trial has been registered at ISRCTN16147125. PROTOCOL VERSION: 3.0.