Intervenciones para adultos con dependencia funcional y sus cuidadores durante la pandemia de COVID-19 / Interventions for functionally dependent adults and their caregivers during the COVID-19 pandemic

La pandemia de COVID-19 ha afectado a la población, perjudicando especialmente a los miembros de aquellos grupos sociales en situación de mayor vulnerabilidad. Estas poblaciones específicas, como aquellas con alguna dependencia funcional, podrían verse más afectadas por los efectos de la pandemia del COVID-19. Por lo tanto, el objetivo de este artículo fue describir las intervenciones para preservar la salud general, mantener la función y la independencia y prevenir la infección por COVID-19 para los adultos con dependencia funcional (ADF). Se realizó una búsqueda sistemática en bases de datos. Se revisaron los títulos y los resúmenes de cada publicación para determinar su relevancia. Dos revisores independientes accedieron a los artículos de texto completo para determinar su elegibilidad después de la selección inicial. Las búsquedas se realizaron en septiembre de 2021 y se actualizaron en enero y julio de 2022. La información encontrada se clasificó en 3 categorías: 1) ADF durante la pandemia de COVID-19; 2) ADF durante la pandemia de COVID-19 según una condición específica (condiciones neurológicas, discapacidades/deficiencias sensoriales y deterioro cognitivo), y 3) Adultos mayores con dependencia funcional. Los adultos con dependencia enfrentaron dificultades y barreras durante la pandemia por COVID-19. Las autoridades de cada país deben garantizar que los ADF tengan acceso a los servicios de rehabilitación en tiempos de crisis sanitaria. Además, es necesario aumentar la capacidad de los servicios de rehabilitación en tiempos de crisis como pandemias. De igual manera, se sugiere el fortalecimiento de estrategias como la telerehabilitación para evitar el deterioro o agravamiento de la funcionalidad de las personas dependientes. (AU)

The COVID-19 pandemic has affected the world population, especially people from social groups in a situation of greater vulnerability among people with some functional dependency. Therefore, the aim of this review was to describe interventions during the pandemic to preserve general health, maintain function and independence, and prevent COVID-19 infection for functionally dependent adults (FDA). A systematic search in databases was carried out. Titles and abstracts of each publication were reviewed for relevance. Full-text articles were accessed by two independent reviewers. The information found was classified into three categories: 1) FDA during the COVID-19 pandemic, 2) FDA during the COVID-19 pandemic according to a specific condition (neurological conditions, sensory disabilities/impairments, and cognitive impairment), and 3) Older adults with functional dependence. The FDAs have faced difficulties and barriers during the COVID-19 pandemic. Strengthening strategies such as telerehabilitation is suggested to avoid deterioration or aggravation of the functionality of dependent people. (AU)

Social isolation, regardless of living alone, is associated with mortality: the Otassha study.

Introduction: Social isolation has been recognized as a contributing factor to negative health outcomes. Although living alone is associated with health-related outcomes, existing findings are inconsistent. It is not the act of living alone that may predict poor health, but rather social isolation that can lead to increased mortality risk. This study investigated the combined associations of social isolation and living alone with mortality among community-dwelling older adults. Methods: We included older adults from Itabashi ward, Tokyo, who participated in comprehensive health checkups. Participants were categorized into four groups based on their social isolation status and living alone. The primary outcome was all-cause mortality, analyzed using Cox proportional hazards models. Results: Of the 1,106 participants (mean age 73, 42% male), 4.5% experienced both social isolation and living alone. This combination was associated with a worse prognosis regarding all-cause mortality (hazard ratio (HR): 2.08 [95% confidence interval (CI), 1.08-4. 00]). Those who were socially isolated but not living alone also showed a trend towards higher mortality risk (HR: 1.41 [95% CI, 0.90-2.20]). Contrastingly, those who were not socially isolated and lived alone did not show an increased mortality risk (HR: 0.81 [95% CI, 0.44-1.49]). Discussion and conclusion: Living alone is not inherently associated with a poor prognosis in older adults; however, social isolation was associated with a higher mortality risk. Healthcare providers should focus on enhancing social interactions and support for older adults because of their effects on health rather than solely addressing living arrangements to prevent adverse health events.

Anticoagulation Patterns Among Community-Dwelling Older Adults With Atrial Fibrillation.

OBJECTIVES: To assess clinicians' prescribing practices for anticoagulation in older adults with atrial fibrillation or atrial flutter (AF/F) and determine factors common among those without anticoagulation. METHODS: We performed a community-based retrospective cohort study of adults aged 65 years and older with a history of nonvalvular AF/F to determine the rate of oral anticoagulation utilization. We also assessed for associations between anticoagulation use and comorbid conditions and common geriatric syndromes. RESULTS: A total of 3832 patients with a diagnosis of nonvalvular AF/F were included (mean [SD] age, 79.9 [8.4] years), 2693 (70.3%) of whom were receiving anticoagulation (51.7%, a vitamin K antagonist; 48.1%, a direct-acting oral anticoagulant). Patients with higher Elderly Risk Assessment index (ERA) scores, a surrogate for health vulnerability, received anticoagulation less often than patients with lower scores. The percentage of patients with a history of falling was higher among those who did not receive anticoagulation than among those who did (44.4% vs 32.8%; P < .001). Similarly, a diagnosis of dementia was more common in the no-anticoagulation group than the anticoagulation group (18.5% vs 12.7%; P < .001). CONCLUSIONS: A substantial proportion of older adults with AF/F do not receive anticoagulation. Those without anticoagulation had higher risk of health deterioration based on higher ERA scores and had a higher incidence of dementia and fall history. This suggests that the presence of geriatric syndromes may influence the decision to withhold anticoagulation.

A household survey of the prevalence of subjective cognitive decline and mild cognitive impairment among urban community-dwelling adults aged 30 to 65.

While it is possible to detect cognitive decline before the age of 60, and there is a report indicating that certain cognitive abilities peak in one's 30s, the evidence regarding cognitive problems in populations younger than 65 years is scarce. This study aims to (1) determine the proportion of community-dwelling adults with different cognitive status, and (2) determine the prevalence of neuropsychiatric behaviors. A population-based survey was conducted in Chiang Mai, Thailand. Individuals aged 30 to 65 were recruited and assessed for demographic data, memory complaints, cognitive performance, and neuropsychiatric symptoms using self-reported questionnaires. In a total of 539 participants, 33.95% had mild cognitive impairment (MCI), 7.05% had subjective cognitive decline (SCD), and 52.50% had neuropsychiatric symptoms. The risk of MCI increased with age, and neuropsychiatric symptoms were significantly higher in those with MCI or SCD than in those without (p < 0.001). The most common complaints were sleep problems, anxiety, and irritability. Screening for MCI in adults aged < 65 years might be useful. However, further investigation on the appropriate age to screen and the program's cost-effectiveness is suggested.

Prevalence of Motoric Cognitive Risk Syndrome Among Community-Dwelling Older Adults: A Systematic Review and Meta-Analysis.

PURPOSE: To systematically review the prevalence of motoric cognitive risk syndrome (MCR) among community-dwelling older adults and provide evidence-based support for policymakers planning health and social care policies. METHOD: Web of Science, PubMed, and Cochrane Library databases were searched for cross-sectional, prospective cohort, or population-based longitudinal studies of community-dwelling older adults aged ≥60 years with MCR from inception of the database through December 18, 2021. RESULTS: Seventeen studies were included. Pooled prevalence of MCR was found to be 10% (95% confidence interval [8%, 12%], I2 = 98.4%). Results of a subgroup analysis revealed a combined prevalence of MCR of 8.2% in males and 9.2% in females. Pooled prevalence of MCR was 9.7% in Asia and 10.2% in other regions. CONCLUSION: Prevalence of MCR in community-dwelling older adults is high. Our research may improve the epidemiological understanding of MCR, draw attention to older adults with MCR, and thus promote research of MCR and the formulation of relevant public health policies. With early identification and intervention of MCR, cognitive function can be improved, and the onset of dementia can be delayed or prevented. [Journal of Gerontological Nursing, 50(4), 16-24.].

A systems approach to assist policy action to prevent falls among community-dwelling older people in Australia.

OBJECTIVES: While systems thinking has gained recognition as an important approach in health policy and prevention research, its application in the context of fall prevention among community-dwelling older adults has been underutilised. Here, we build on the guiding principles of the systemic lens component of the Prevention System Change Framework to assess and identify potential changes that are required to facilitate policy action in the field of falls prevention. METHODS: We conducted a desktop search to identify policy documents encompassing falls prevention among community-dwelling older adults in Australia. Documents were considered eligible if they were published in the last 10 years and were authored or endorsed by federal or state government bodies. We collaboratively examined eligible documents to gain insights into the current policy landscape in falls prevention and to illustrate opportunities for action and the potential for strengthening partnerships. RESULTS: There is no current national policy on preventing falls in older adults in Australia. While we identified eight policy documents, none focused exclusively on falls prevention, indicating that falls are currently not perceived as a public health issue that warrants a dedicated policy framework. We identified a need for a comprehensive national policy that draws upon insights from various disciplines, suggests intersectoral collaboration, addresses health inequities and involves meaningful engagement with key stakeholders. Future falls prevention policies may benefit from clear governance structures and specific targets, along with mechanisms for monitoring and evaluating outcomes. CONCLUSION: Falls prevention is a pressing public health concern that requires dedicated policy resources. Adopting a systems-oriented approach can help reduce falls and their associated burdens on individuals and the healthcare system. Acknowledging the urgency and complexity of this challenge is a first, essential step toward crafting a comprehensive national falls prevention policy.

[Factors associated with oral frailty among community-dwelling older people -A comparison between those <75 and ≥75 years old].

PURPOSE: This study investigated the factors associated with oral frailty among community-dwelling older adults. In particular, we compared the factors between individuals in the young-old and old-old groups and clarified the differences between the two groups. METHODS: We measured the basic attributes, body composition, grip strength, gait function, oral function, cognitive function, and daily living function using the Kihon checklist in older people living independently in T City, Aichi Prefecture. The risk of oral frailty was assessed using the Oral Frailty Screening and Evaluation Form (OFI-8), and the measurement results were compared between two groups: those with and those without risk. To identify the factors associated with oral frailty, we performed a multivariate analysis with the risk of oral frailty as the dependent variable and a univariate analysis separately for the young-old and old-old groups. RESULTS: The mean age of the 100 subjects was 76.6±4.6 years old. Forty-four subjects were at risk of oral frailty, and 55 subjects were not at risk. The high-risk group had significantly higher rates of polypharmacy, depression, and a slow walking speed than the no-risk group. The risk factors associated with oral frailty were living alone, polypharmacy, and depression. The risk factors for oral frailty were a poor ambulatory function in the young-old and a poor ambulatory function, decline in the cognitive function, and depression in the old-old. CONCLUSIONS: The results of this study suggest that the risk factors for oral frailty differ between older individuals in the young-old and old-old groups and that age-appropriate support is necessary to prevent oral frailty in older people.

Physical activity and lung function association in a healthy community-dwelling European population.

BACKGROUND: The association of physical activity (PA) and lung function (LF) varies from no measurable effect to delayed LF decline. We assessed the association between accelerometery-assessed PA and LF in a sample of apparently healthy, community-dwelling subjects. METHODS: We included two cross-sectional studies using data from the PneumoLaus study (2014-17 and 2018-21), conducted in Lausanne, Switzerland. PA was assessed by accelerometry and categorised as inactivity, light, moderate or vigorous. Forced expiratory volume in 1 second (FEV1), forced volume capacity (FVC) and maximal mid-expiratory flow (MMEF) were measured by spirometry and expressed in percentage of predicted value (PV). RESULTS: Overall, 1'910 (54.7% women, 62.0 ± 9.7 years) and 1'174 (53.4% women, 65.8 ± 9.5 years) participants were included in the first and the second surveys, respectively. In both surveys, moderate and vigorous PA showed a weak but significant correlation with FEV1 in percentage (PV) (R = 0.106 and 0.132 for the first and 0.111 and 0.125 for the second surveys, p < 0.001). Similar correlations with FVC (p < 0.001) were found. Associations held irrespective of smoking status and remained after multivariable adjustment. Fewer associations were detected between LF and light PA or between MMEF and PA. CONCLUSION: Moderate and vigorous intensity PA are associated with increased LF regardless of smoking status in apparently healthy community-dwelling European population. These associations are statistically but not clinically significant due to the small correlation coefficients (R < 0.30), corresponding to a weak association.

Data-driven clustering approach to identify novel clusters of high cognitive impairment risk among Chinese community-dwelling elderly people with normal cognition: A national cohort study.

Background: Cognitive impairment is a highly heterogeneous disorder that necessitates further investigation into the distinct characteristics of populations at varying risk levels of cognitive impairment. Using a large-scale registry cohort of elderly individuals, we applied a data-driven approach to identify novel clusters based on diverse sociodemographic features. Methods: A prospective cohort of 6398 elderly people from the Chinese Longitudinal Healthy Longevity Survey, followed between 2008-14, was used to develop and validate the model. Participants were aged ≥60 years, community-dwelling, and the Chinese version of the Mini-Mental State Examination (MMSE) score ≥18 were included. Sixty-nine sociodemographic features were included in the analysis. The total population was divided into two-thirds for the derivation cohort (n = 4265) and one-third for the validation cohort (n = 2133). In the derivation cohort, an unsupervised Gaussian mixture model was applied to categorise participants into distinct clusters. A classifier was developed based on the most important 10 factors and was applied to categorise participants into their corresponding clusters in a validation cohort. The difference in the three-year risk of cognitive impairment was compared across the clusters. Results: We identified four clusters with distinct features in the derivation cohort. Cluster 1 was associated with the worst life independence, longest sleep duration, and the oldest age. Cluster 2 demonstrated the highest loneliness, characterised by non-marital status and living alone. Cluster 3 was characterised by the lowest sense of loneliness and the highest proportions in marital status and family co-residence. Cluster 4 demonstrated heightened engagement in exercise and leisure activity, along with independent decision-making, hygiene, and a diverse diet. In comparison to Cluster 4, Cluster 1 exhibited the highest three-year cognitive impairment risk (adjusted odds ratio (aOR) = 3.31; 95% confidence interval (CI) = 1.81-6.05), followed by Cluster 2 and Cluster 3 after adjustment for baseline MMSE, residence, sex, age, years of education, drinking, smoking, hypertension, diabetes, heart disease and stroke or cardiovascular diseases. Conclusions: A data-driven approach can be instrumental in identifying individuals at high risk of cognitive impairment among cognitively normal elderly populations. Based on various sociodemographic features, these clusters can suggest individualised intervention plans.

Self-administration medication errors at home and its predictors among illiterate and low-literate community-dwelling older adults with polypharmacy: A negative binomial hierarchical regression.

BACKGROUND: Older adults with polypharmacy are more prone to medication errors. People with low educational attainment have more difficulties in taking their medications. OBJECTIVES: This study aimed to identify the extent of medication self-administration errors (MSEs) and the contributing factors among illiterate and low-literate community-dwelling older adults with polypharmacy. METHOD: The present cross-sectional study was conducted among people aged 60 and above. The data were collected using the sociodemographic, clinical, and Belief about Medicines Questionnaires (BMQ). To determine the extent of MSE, a medication error checklist was used. The negative binomial hierarchical regression model in the five blocks was performed. RESULTS: The final sample size was 276 people. The frequency of MSEs in the last 6 months was 69.2%. Sixteen percent of participants had made four or more mistakes. The most common MSEs were forgetting, improper taking of medications with food, improper timing, incorrect dosage (lower dose), and forgetting the doctor's instructions. Near 18% of participants reported adverse events following their mistakes. The significant predictors of MSEs were being completely illiterate (p = 0.021), the higher number of doctor visits per year (p = 0.014), irregularly seeing doctors (p < .001), the higher number of medications (p < .001), and having poor medication beliefs (p < .001). CONCLUSION: Despite the high prevalence of MSEs among older patients, practical strategies to deal with them at their homes have not been established among health systems. MSE as a multifactorial event can be caused by a collection of internal and external factors. Further studies to identify the role of patients, clinicians, procedures, and systems in developing MSEs as interconnected components are needed.

Dose-Responsive Impacts of Social Frailty on Intrinsic Capacity and Healthy Aging among Community-Dwelling Middle-aged and Older Adults: Stronger Roles of Social Determinants over Biomarkers.

OBJECTIVE: The intricate relationship between social determinants, e.g., social frailty, biomarkers and healthy aging remains largely unexplored, despite the potential for social frailty to impact both intrinsic capacity (IC) and functional ability in the aging process. DESIGN: Retrospective longitudinal cohort study. SETTING AND PARTICIPANTS: Participants aged 50+ years from the Social Environment and Biomarkers of Aging Study (SEBAS) in Taiwan, stratified into three age groups: 50-64, 65-74 and 75+. MEASUREMENTS: Social frailty was defined based on a score derived from four domains: exclusion from general resources, social resources, social activity, and fulfillment of basic social needs. The scores were categorized as score=0 (no social frailty), 1 (social pre-frailty), and 2+ (social frailty). Multivariable logistic regression and Cox proportional hazard models were employed to examine the dose-responsive relationship between social frailty, low IC, functional and psychological health, and mortality. RESULTS: Of 1015 study participants, 24.9% and 7.9% were classified as social pre-frailty and social frailty, respectively. No significant differences were observed in most biomarkers between those with social frailty and those without. A dose-responsive relationship was found between social frailty and increased risk of low IC (social pre-frailty: aOR 2.20 [95% CI 1.59-3.04]; social frailty: 5.73 [3.39-9.69]). Similar results were found for functional and psychological health. However, no significant association between social frailty and all-cause mortality was found at the 4-year follow-up (social pre-frailty: aHR 1.52 [95% CI 0.94-2.43]; social frailty: 1.59 [0.81-3.09]). CONCLUSIONS: The significant association between social frailty and low IC, functional limitations, cognitive declines, and depressive symptoms underscores the pressing need for research on intervention strategies to enhance healthy aging in the lifespan course.

Loneliness Predicts Progression of Frailty in Married and Widowed, but Not Unmarried Community Dwelling Older Adults.

BACKGROUND: Loneliness is highly prevalent among older adults and is associated with frailty. Most studies consider loneliness in isolation without consideration for structural and functional measures of social relationships - and longitudinal studies are scarce. OBJECTIVES: This study examined longitudinal associations between loneliness and frailty and analyzed how structural and functional social measures influence these associations. DESIGN: Linear mixed effects models examined longitudinal associations between loneliness and frailty assessed with the frailty index (scale 0-100). Models were adjusted for baseline age, gender, education, depressive symptoms, global cognition, and structural (e.g., social network, marital status), and functional social measures (e.g., social, cognitive, and physical activity, and social support). PARTICIPANTS: Loneliness and frailty data from 1,931 older adults without dementia at baseline from the Rush Memory and Aging Project were examined (mean age 79.6 ± 7.7 years, 74.9% female). MEASUREMENTS: Baseline loneliness assessed by the de Jong Gierveld Loneliness Scale was the predictor of interest. RESULTS: Frailty increased significantly over a mean follow-up period of 4.6 years. Effects of loneliness on frailty were modified by marital status. Loneliness predicted an additional accumulation of 0.37 and 0.34 deficits on the frailty index per year in married and widowed individuals respectively, compared to those who were not lonely (married: p=0.009, CI 0.09, 0.64; widowed: p=0.005, CI 0.1, 0.58). Loneliness did not predict frailty progression in unmarried individuals. CONCLUSIONS: Loneliness predicts frailty progression, highlighting the importance of social determinants on physical health in aging.

Serum Creatinine-Cystatin C Based Screening of Sarcopenia in Community Dwelling Older Adults: A Cross-Sectional Analysis.

OBJECTIVES: To compare the discriminative capabilities for the manifestation of sarcopenia or physical frailty between serum creatinine- and cystatin C-derived indices among community-dwelling older adults. DESIGN: Cross-sectional study. SETTING: Primary Care and Community. PARTICIPANTS: We utilized a subset of data from the Frail Elderly in the Sasayama-Tamba Area (FESTA) study, which was initiated in 2015 to gather comprehensive information on various health-related parameters among community-dwelling older individuals (age ≥65 years). MEASUREMENTS: Five serum creatinine-cystatin C based indices including the Sarcopenia Index, the serum creatinine/cystatin C ratio, the disparity between serum cystatin-C-based and creatinine-based estimated GFR, the total body muscle mass index (TBMM), and the prediction equation for skeletal muscle mass index (pSMI) were employed. Sarcopenia and physical frailty were identified based on the Asian Working Group for Sarcopenia criteria and the revised Japanese version of the Cardiovascular Health Study criteria, respectively. The receiver operating characteristic (ROC) and logistic regression analyses were performed to assess the discriminative abilities of these tools. RESULTS: In the analysis of 954 participants, 52 (5.5%) were identified with sarcopenia and 35 (3.7%) with physical frailty. Regarding sarcopenia discrimination, TBMM and pSMI both exhibited area under the curve (AUC) values exceeding 0.8 for both men and women. Concerning the identification of physical frailty, AUC values ranged from 0.61 to 0.77 for males and 0.50 to 0.69 for females. In the multivariate logistic regression analyses, only TBMM and pSMI consistently displayed associations with sarcopenia, irrespective of sex (P<0.001, respectively). On the other hand, no consistent associations were observed between the indices and physical frailty. CONCLUSIONS: This study provides a robust association of a serum creatinine- and cystatin C-derived indices, especially TBMM and pSMI, with sarcopenia among community-dwelling older adults. Conversely, the application of these indices for the screening of physical frailty has its constraints, necessitating further investigation.

Identifying Frailty in Administrative Databases: A Narrative Review.

Frailty is a state of increased vulnerability that can lead to premature death. While various clinical tools effectively measure frailty in individual care, their applicability at the population-level is limited. However, in the era of big-data, administrative databases serve as valuable sources for medication-based research and population surveillance. This narrative scoping review synthesizes the literature on tools used within administrative databases to detect frailty in community-dwelling older adults. The 17 identified publications explore four tools that meet the criteria of the Rockwood and Mitnitski frailty index model. Despite variations in the deficits they incorporate, all tools appear to be valuable for identifying frailty and predicting the risk of adverse events. Using those tools within administrative databases can be useful for research and surveillance purposes.

Safety profile of hypnotics or sedatives on community-dwelling older adults aged 75 or older in Japan: A retrospective propensity-matched cohort study.

OBJECTIVE: The purpose of the study is to assess if daily use of hypnotics increases mortality, aspiration pneumonia and hip fracture among relatively healthy individuals aged 75 years or older who lead independent lives in the community. METHOD AND PATIENTS: Of the adults aged 75 years or older residing in Hokkaido prefecture of Japan (n = 705,538), those who did not meet several exclusion criteria were eligible for generating propensity score-matched cohorts (n = 214,723). Exclusion criteria included co-prescribed medications acting on the central nervous system, diagnoses of malignant neoplasm, dementia, depression, etc. We compared 33,095 participants who were prescribed hypnotics for daily use (hypnotic group) with a propensity score-matched cohort without a prescription (control group). Participants were followed for more than 42 months. RESULTS: During the 42-month follow-up period, the incidence of the three outcome measures in the hypnotics group was significantly higher than that in the control group (aspiration pneumonia p < 0.001, hip fracture p = 0.007, and all-cause mortality p < 0.001). Sensitivity analyses utilizing inverse probability weighting demonstrated hazard ratios of 1.083 [1.023-1.146] for mortality, 1.117 [1.014-1.230] for aspiration pneumonia, and 1.720 [1.559-1.897] for hip fracture. Meanwhile, the attribute risk differences were 2.7, 1.5, and 1.0 per 1000 patient-years, respectively. CONCLUSIONS: Although daily use of hypnotics increased the risk of three events, their attribute risk differences were fewer than 3.0 per 1000 patient-years. The results will help provide guidance on whether it is reasonable to prescribe hypnotics to geriatric population aged 75 or older leading independent lives in the community. CLINICAL TRIAL REGISTRATION: UMIN-CTR UMIN000048398.

Development and validation of health-oriented personal evaluation for the community-dwelling older person based on the International Classification of Functioning, Disability and Health.

BACKGROUND: The International Classification of Functioning, Disability and Health (ICF) offers a standardized international terminology to operationalize function management across multiple domains, but the summary score of the ICF qualifier scale provides limited information on the comparison of personal abilities and functioning difficulties. OBJECTIVES: To enhance the interpretative power of the ICF-based Health-oriented Personal Evaluation for the community-dwelling older person (iHOPE-OP) scale through the implementation of the item response theory (IRT) modelling. METHODS: This cross-sectional, multi-centre study administrated 161 ICF categories (58 on body functions, 15 on body structures, 60 on activities or participation and 28 on environmental factors) to evaluate the functional level of 338 older citizens (female = 158, male = 180) residing in community or supportive living facilities. The validation process encompassed assessing the IRT model fitness and evaluating the psychometric properties of the IRT-derived iHOPE-OP scale. RESULTS: The age of participants ranged from 60 to 94.57, with the mean age of 70. The analysis of non-parametric and parametric models revealed that the three-parameter logistic IRT model, with a dichotomous scoring principle, exhibited the best fit. The 53-item iHOPE-OP scale demonstrated high reliability (Cronbach's α = 0.9729, Guttman's lambda-2 = 0.9749, Molenaar-Sijtsma Statistic = 0.9803, latent class reliability coefficient = 0.9882). There was a good validity between person abilities and the Barthel Index (p < .001, r = .83), as well as instrumental activities of daily living (p < .001, r = .84). CONCLUSIONS: IRT methods generate the reliable and valid iHOPE-OP scale with the most discriminable and minimal items to represent the older person's functional performance at a comprehensive level. The use of the Wright map can aid in presby-functioning management by visualizing item difficulties and person abilities. IMPLICATIONS FOR PRACTICE: Considering the intricate and heterogeneous health status of older persons, a single functional assessment tool might not fulfil the need to fully understand the multifaceted health status. For use in conjunction with the IRT and ICF framework, the reliable and valid iHOPE-OP scale was developed and can be applied to capture presby-functioning. The Wright map depicts the distribution of item difficulties and person abilities on the same scale that facilitates person-centred goal setting and tailors intervention.

Longitudinal changes in life-space mobility and autonomy in participation outdoors among Finnish community-dwelling older adults from pre-COVID-19 to through the pandemic.

BACKGROUND: Among older people, community mobility was reduced at the beginning of the COVID-19 pandemic, but the longer-term changes are unclear. AIMS: To study lower extremity performance and car driving as predictors of changes in older adults' life-space mobility, autonomy in participation outdoors, and the risk of developing restricted life-space mobility from 2017 to 2022. METHODS: Life-space mobility (scoring range 0-120) and autonomy in participation outdoors (scoring range 0-20) were assessed in community-dwelling individuals (n = 657) in 2017-2018 (baseline age 75, 80, or 85 years), during the first wave of COVID-19 in 2020, and in 2021-2022. Lower extremity performance was assessed using the Short Physical Performance Battery, and car driving was self-reported at baseline. Data were analysed using generalized estimating equations and Cox regression. RESULTS: During the first wave of COVID-19 in 2020, life-space mobility decreased on average by 10.3 (SD 21.6) points and partially recovered in 2021-2022 (+ 2.7, SD 21.8). The same pattern was observed for autonomy in participation outdoors. Non-drivers and those with impaired lower extremity performance had a 2.4-to-3.6-fold adjusted risk of developing restricted life-space mobility over the follow-up period compared to drivers with intact lower extremity performance. CONCLUSIONS: For older people, the recovery of community mobility was incomplete after the restrictions stemming from the pandemic were lifted. Older adults with impaired lower extremity performance and who did not drive were particularly vulnerable to developing restricted life-space mobility, a situation that could lead to social isolation and reduced well-being.

Comparing Sensitivity, Specificity, and Accuracy of Fall Risk Assessments in Community-Dwelling Older Adults.

Purpose: The US Centers for Disease Control and Prevention (CDC) has implemented the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) initiative. This initiative provides an algorithm for fall risk screening. However, the algorithm has the potential to overcategorize individuals as high risk for falling upon initial screening, which may burden clinicians with the task of recategorizing individuals after follow-up testing. Therefore, this study aimed to compare the accuracy, sensitivity, and specificity of fall risk appraisal between the STEADI, Short Fall-Efficacy Scale International (FES-I), and portable balance system (BTrackS) assessments in community-dwelling older adults. Patients and Methods: This cross-sectional analysis included 122 community-dwelling older adults, comprising 94 women and 28 men. Center-of-pressure postural sway was assessed using the BTrackS, fear of falling was assessed using the Short FES-I questionnaire, and all participants completed the STEADI checklist. Each assessment categorized participants as either high or low fall risk and fall risk appraisal was compared between groups using McNemar tests. Results: The STEADI checklist (high risk: n = 62; low risk: n = 60) significantly differed in fall risk appraisal compared to the BTrackS (high risk: n = 44; low risk: n = 78; p = 0.014) and the Short FES-I (high risk: n = 42; low risk: n = 80; p = 0.002). Compared to the BTrackS, the STEADI checklist had a specificity of 62.8%, sensitivity of 70.5%, and accuracy of 65.6%. Compared to the Short FES-I, the STEADI checklist had a specificity of 67.5%, sensitivity of 81.0%, and accuracy of 72.1%. Conclusion: The STEADI checklist appears to overcategorize individuals as high fall risk more frequently than direct assessments of postural sway and fear of falling. Further research is needed to examine potential improvements in accuracy when combining the STEADI checklist with direct assessments of postural sway and/or fear of falling.

Fall risk assessments are crucial for preventative care in older adults. However, the demands of clinical practice require an accurate and time-efficient method. The U.S Centers for Disease Control and Prevention (CDC) has implemented a fall risk checklist through the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) initiative. However, the STEADI checklist might cost clinicians more time than expected, as some patients initially classified as high risk for falling may not actually be at high risk. This leads to unnecessary follow-up assessments. In this study, we compared the STEADI checklist to direct measures of postural sway (balance) using the BTrackS system and fear of falling using the Short FES-I survey to determine how they differed in classifying community-dwelling older adults as high versus low fall risk. Our results show that the STEADI checklist classifies older adults as high risk more frequently than the BTrackS and Short FES-I. Considering that the follow-up assessments for a high-risk classification by the STEADI checklist include a balance test, we suggest that combining a balance test such as the BTrackS with a questionnaire or checklist may yield better screening outcomes and accurately identify high-risk individuals in a timely manner. Further research is needed to determine the effectiveness of this combination and to establish a true gold standard method for fall risk appraisal.

The global prevalence of and risk factors for fear of falling among older adults: a systematic review and meta-analysis.

BACKGROUND: As a common psychological problem among older adults, fear of falling was found to have a wide range prevalence in different studies. However, the global prevalence of it was unknown and a lack of the large sample confirmed its risk factors. OBJECTIVES: To report the global prevalence of fear of falling and to explore its risk factors among older adults for further developing precise interventions to systematically manage FOF. DESIGN: A systematic review and meta-analysis was conducted by PRISMA guidelines. METHODS: Searches were conducted in PubMed, Web of Science, EMBASE, the Cochrane Library and the manual search in August 20, 2022, updated to September 2, 2023. Observational studies published in English were included and two researchers independently screened and extracted the data. Fixed or random effects mode was used to estimate the pooled prevalence of and risk factors for fear of falling. Heterogeneity resources were analyzed by subgroup and sensitivity analysis. Publication bias was assessed through funnel plots, Egger's test and Begg's test. RESULTS: A total of the 153 studies with 200,033 participants from 38 countries worldwide were identified. The global prevalence of fear of falling was 49.60%, ranging from 6.96-90.34%. Subgroup analysis found the estimates pooled prevalence of it was higher in developing countries (53.40%) than in developed countries (46.7%), and higher in patients (52.20%) than in community residents (48.40%). In addition, twenty-eight risk factors were found a significant associations with fear of falling, mainly including demographic characteristics, physical function, chronic diseases and mental problems. CONCLUSION: The global prevalence of FOF was high, especially in developing countries and in patients. Demographic characteristics, Physical function, chronic diseases and mental problems were a significant association with FOF. Policy-makers, health care providers and government officials should comprehensively evaluate these risk factors and formulate precise intervention measures to reduce FOF. TRIAL REGISTRATION: The study was registered in the International Database of Prospectively Registered Systematic Reviews (PROSPERO): CRD42022358031.

Psychometric properties evaluation of the Advance Care Planning Readiness Scale for community-dwelling older adults with chronic diseases residing in suburban counties within the Chinese context.

AIM: To evaluate the psychometric properties of the Advance Care Planning Readiness Scale (ACPRS-C) within the context of community-dwelling older adults with chronic diseases residing in suburban counties in China. DESIGN: Descriptive, cross-sectional survey. METHODS: The research method employed in this study is characterized as a methodological study. Self-reported survey data were collected among community-dwelling older adults with chronic diseases residing in suburban counties in China. Including the following psychometric characteristics, item analysis was performed using the decision value method and Pearson's correlation analysis. Content validity was assessed through expert panel evaluation. The internal consistency of the questionnaire was determined by calculating Cronbach's alpha coefficient and corrected item-total correlation. Additionally, confirmatory factor analysis (CFA) was utilized to assess the construct validity of the ACPRS-C. RESULTS: A total of 228 older adults participated in this psychometric study from August to October 2023. The item content validity index ranged from 0.80 to 1.00, while the scale content validity index was 0.945. The scale demonstrated excellent internal consistency (Cronbach's alpha = 0.931), and the correlation between items and total score was satisfactory. The structural validity was deemed robust (CFA model fit: chi-square/df = 1.121, comparative fit index = 0.992). CONCLUSION: The ACPRS-C is a scale with strong psychometric properties to assess the ACP readiness within the context of community-dwelling older adults with chronic diseases residing in suburban counties in China. Its reliability and validity hold considerable significance for both research and clinical practice.