Effects of Anxiety, Stress and Perceived Social Support on Depression and Loneliness Among Older People During the COVID-19 Pandemic: A Cross-Sectional Path Analysis.

During the COVID-19 pandemic, older people were exposed to high levels of anxiety and stress leading to loneliness and depressive disorders. The purpose of the present study was to investigate the effects of anxiety, positive coping, perceived social support, and perceived stress on depression and loneliness among older people during the COVID-19 pandemic. This was a cross-sectional online/telephone survey. A non-probability convenience sampling method was used. Participants were 112 people aged 60 years and above, without cognitive impairment, who experienced confinement (from March 2020 onward) and had access to the internet or telephone. A path analysis model showed a direct significant effect of anxiety on both, depression (ß = .68, P < .001) and perceived stress (ß = .65, P < .001), as well as an indirect effect of anxiety on loneliness via perceived stress (ß = .65) * (ß = .40); and social support (ß = -.21) * (ß = -.20). The model showed adequate fit χ2(df = 4) =5.972, P = .201; RMSEA = 0.066 (0.000, 0.169), CFI = 0.992; TLI = 0.970. Anxiety had a significant effect on depressive symptoms as well as on loneliness via perceived social support and perceived stress. According to our findings, in order to reduce depressive symptoms and perceived loneliness, it is essential to develop timely interventions that decrease levels of anxiety and stress and increase levels of perceived social support in older people, particularly when there are any restrictions, physical or contextual, that prevent face-to-face contact. This can be achieved by implementing preventive community-based programs, enhancing accessibility to mental health services, and collaborating with local support groups, among others.

Nutritional Interventions in Older Persons with Type 2 Diabetes and Frailty: A Scoping Systematic Review.

In the elderly, the coexistence of type 2 diabetes mellitus (T2DM) and frailty is frequent. Much has been described about pharmacological management and glycemic control goals. However, there is a knowledge gap in terms of the objectives and characteristics of interventions, especially nutritional ones, for this population. A scoping review was performed to document the objectives, characteristics, and results of nutritional interventions in older people with T2DM and frailty. The five-stage framework of Arksey and O'Malley was used, as was the PRISMA extension for scoping reviews. The results stand out for three trends, as follows: (1) experimental studies with multicomponent intervention physical exercise programs and nutritional programs based on educational processes or behavioral intervention; (2) observational studies with an association of the kind of diet assessed by scales and their relation to stages of frailty; (3) a review that updates recommendations on pharmacological and non-pharmacological, diet, exercise, management, as well as glucose control goals for diabetes in frail older persons. Finally, the evidence shows that management of T2DM in older adults with frailty requires goals and interventions tailored to their functional capacity and health condition. The exercise, diet, and education programs reviewed have demonstrated their effectiveness in improving physical performance, reducing the risk of frailty or progression to more advanced stages, and achieving better glycemic control.

Convergences and Divergences in the Burden of Disease in Older People Across The Organisation for Economic Cooperation and Development Countries.

BACKGROUND: The Organization for Economic Cooperation and Development (OECD) member states are heterogeneous in their social, economic, and health conditions. AIMS: a) to analyze age-specific mortality rate (ASMR) and age-specific disability-adjusted life year (DALY) rate among older people in countries by age groups (65-74 years and 75+ years) and sex, and b) to estimate the association between age-specific DALY rate with Socio-Demographic Index (SDI) and with Healthcare Access and Quality Index (HAQI). METHODS: Secondary analysis of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. The ASMR and the age-specific DALY rate were reported for the years 1990, 2005, and 2019. Correlation between age-specific DALY rate with SDI and HAQI was estimated. RESULTS: There were differences in the level and change in ASMR and the age-specific DALY rates among OECD countries. Overall, men had a higher rate for both age groups in both indicators. Although the rates have been reduced between 1990 and 2019, some countries stand out for continuing to have higher rates than countries with better socioeconomic levels. The disease burden profile also differed between adults aged 65-74 years and those aged 75+ years. In almost all cases, there was a negative and statistically significant correlation between the age-specific DALY rate with SDI and HAQI. CONCLUSIONS: The burden of mortality and DALY in OECD countries is convergent because they have decreased over time in all countries but diverge in the magnitude and speed of change.

Association between Falls, Fear of Falling and Depressive Symptoms in Community-Dwelling Older Adults.

BACKGROUND: Longevity increases pose public health challenges, especially in managing falls and their psychological impacts on older adults. Limited evidence exists on the relationship between a fear of falling (FOF), previous falls, and depressive symptoms among community-dwelling older adults. OBJECTIVE: To evaluate the association between falls, FOF, and depressive symptoms in community-dwelling older adults. METHODS: This cross-sectional study, conducted in 2018, included 400 older adults from a Basic Health Unit in São Paulo, Brazil. The Geriatric Depression Scale (GDS-15) and the International Falls Efficacy Scale (FES-I) were used, along with self-report questionnaires on fall history. Linear and logistic regression were used to analyze the relationships between variables. RESULTS: The mean age was 75.2 (SD = 8.53) years, with 63.2% being female. Depressive symptoms were observed in 18.3% of the participants, while 90.5% reported a fear of falling (FOF). More than half (63.0%) experienced falls, with 49.5% occurring in the last year. Factors such as the female gender, negative health perceptions, and functional dependence were associated with depressive symptoms. Adjusted analyses indicated that both a fear of falling (FOF) (B = 0.043; p = 0.012) and a history of falls (B = 0.725; p = 0.015) were associated with depressive symptoms. CONCLUSIONS: Falls, FOF, and depressive symptoms are interlinked among older adults, underscoring the need for targeted interventions to improve their mental and physical health.

The experiences of daily smartphone use among older adults in Brazil: A grounded theory analysis.

Background: Digital inclusion of older people is an important agenda for the future and well-being of the older population, as it represents a form of social inclusion with significant gains for healthy aging. The present study aimed to understand the experiences of Brazilian older adults who use smartphones and the implications in their daily lives. Method: A qualitative study was developed using a constructivist grounded approach. Older people (≥60 years) with prior access to a smartphone were invited to participate in the study. Participation took place through semi-structured, audio-recorded interviews. Data collection and analysis occurred simultaneously using a constant comparative approach. Data management and analysis used the Atlas.ti® software. Results: Overall, 37 older people participated, with an average age of 70.60 ± 6.95 years, predominantly female (n = 33), white (n = 25), married (n = 26) and retired (n = 27). The first sample group included 27 older people with family support and the second group included 10 older people without family support (who lived alone in their homes). A core category emerged from the data analysis-"Expanding the personal and social development of older adults through smartphone communication"-around which three main categories emerged: 1) The smartphone as "a window to the world"; 2) The problem of misinformation and fake news on virtual networks; 3) Technological paradoxes in the use of smartphones. Conclusions: The digital transition associated with smartphone use brings unimaginable benefits to older adults who adopt positive habits to improve their well-being and expand their social connections, following efforts proposed by the Decade of Healthy Aging. However, older adults still face disparities and experience a significant digital divide, which represents a major challenge. Barriers to access are further aggravated in developing countries. We hope this study contributes to public health policies on digital inclusion and healthy aging.

Desserts Enriched with a Nanoemulsion Loaded with Vitamin D3 and Omega-3 Fatty Acids for Older People.

The food industry is challenged to develop nutritious and palatable foods that satisfy older people's needs. So, this work aimed to study the incorporation of nanoemulsions enriched with vitamin D3 and omega-3 fatty acids into two desserts (yogurt and fruit puree), characterizing their nutritional profile, viscosity, and color properties and evaluating their in vitro bioaccessibility and sensory response. The results showed that adding nanoemulsion modified the nutrition profile of desserts due to increasing lipids and calories. The desserts' physical properties were also affected, with a decrease in viscosity and a lightening of color. Regarding digestion, the enriched desserts presented a low release of free fatty acids (14.8 and 11.4%, respectively). However, fruit puree showed the highest vitamin D3 and omega-3 fatty acid in vitro bioaccessibility (48.9 and 70.9%, respectively). In addition, older consumers found this dessert more acceptable than yogurt due to the adequate intensity of its sensory attributes (aroma, flavor, sweetness, and consistency). Therefore, the fruit puree can be enriched with nanoemulsions loaded with vitamin D3 and omega-3 fatty acids to improve the bioaccessibility of lipid bioactive compounds and sensory performance, offering a health-enhancing option for older consumers.

Dynapenia and sarcopenia identify walking speed decline in women but not in men.

OBJECTIVE: To determine the best indicator of mobility decline between dynapenia, low skeletal muscle mass index (SMMI), and sarcopenia defined by the EWGSOP2 using different cutoff points for grip strength. METHODS: A longitudinal study was conducted with a follow-up of eight years, involving 2,680 individuals aged 60 and older who participated in the ELSA study with a walking speed greater than 0.8 m/s at baseline. Dynapenia was defined using different cutoff points for grip strength. SMMI was defined by the 20th percentile of the entire ELSA sample distribution and sarcopenia was defined based on the EWGSOP2, using different cutoff points for grip strength. Mobility was analysed using the walking speed test. RESULTS: Over time, the greatest decline in walking speed occurred in dynapenic women with grip strength < 17 kg (-0.005 m/s per year; 95 % CI: -0.01 to -0.001) and < 20 kg (-0.007 m/s per year; 95 % CI: -0.01 to -0.001). With regards to sarcopenia, the greatest walking speed decline occurred in women with probable sarcopenia when defined by grip strength < 17 kg [(-0.006 m/s per year; 95 % CI: -0.01 to -0.001) or grip strength < 20 kg (-0.007 m/s per year; 95 % CI: -0.01 to -0.001)]. Dynapenia in men as well as low SMMI and sarcopenia in men and women did not enable identifying the risk of mobility decline. CONCLUSION: Dynapenia and probable sarcopenia defined by grip strength < 17 kg and < 20 kg enabled identifying walking speed decline over time only in women.

Frailty identification and management among Brazilian healthcare professionals: a survey.

BACKGROUND: National and international guidelines on frailty assessment and management recommend frailty screening in older people. This study aimed to determine how Brazilian healthcare professionals (HCPs) identify and manage frailty in practice. METHODS: An anonymous online survey on the assessment and management of frailty was circulated virtually through HCPs across Brazil. RESULTS: Most of the respondants used non-specific criteria such as gait speed (45%), handgrip strength (37.6%), and comprehensive geriatric assessment (33.2%). The use of frailty-specific criteria was lower than 50%. The most frequently used criteria were the Frailty Index (19.1%), Frailty Phenotype (13.2%), and FRAIL (12.5%). Only 43.5% felt confident, and 40% had a plan to manage frailty. In the multivariate-adjusted models, training was the most crucial factor associated with assessing frailty, confidence, and having a management plan (p < 0.001 for all). Those with fewer years of experience were more likely to evaluate frailty (p = 0.009). Being a doctor increased the chance of using a specific tool; the opposite was true for dietitians (p = 0.03). Those who assisted more older people had a higher likelihood of having a plan (p = 0.011). CONCLUSION: Frailty assessment was heterogeneous among healthcare professions groups, predominantly using non-specific criteria. Training contributed to frailty assessment, use of specific criteria, confidence, and having a management plan. This data informs the need for standardized screening criteria and management plans for frailty, in association with increasing training at the national level for all the HCPs who assist older people.

Metabolic Syndrome and Positive Frailty Screening: A Cross-Sectional Study with Community-Dwelling Older Adults.

Background: Metabolic Syndrome is a set of disorders that characterized by the association of three or more risk factors, like the obesity central, dyslipidemia, borderline blood pressure, hyperglycemia, and the increase of triglycerides. However, these factors also can be associated with pathophysiology of frailty. Objectives: verifying whether the metabolic syndrome is associated to the positive frailty screening in the older people. Design: Cross-sectional study. Participants: 443 older people living in Rio Branco, Brazil. Setting: Data collection was carried out in two stages: a personal interview and blood collection. Measurements: The diagnosis of metabolic syndrome was based on the criteria of the Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults. The frailty screening was performed using subjective questions validated in a previous study. Descriptive statistics and multinomial logistic regression were used for data analyses. Results: There was a predominance of female older people (69.07%), aged between 60 and 79 years (87.13%), with an income greater than or equal to one minimum wage (72.09%), no cognitive decline (75.94%) and depressive symptoms (63.31%), independent for BADL (86.46%) and dependent for IADL (51.69%). From the total sample, 56.88% of the older people were identified as frail, 34.09% pre-frail and 9.03% non frail. The prevalence of metabolic syndrome was 51.69%. After adjusting by the independent variables, an association between metabolic syndrome and pre-frailty was observed, and older people with metabolic syndrome were more likely to be prefrail (RRR=2.36; 95%CI=1.08-5.18). Conclusion: The metabolic syndrome was associated to the increase chance of screening for prefrailty in the older people evaluated, which reinforces the needy to establish preventive measures in relation to the metabolic syndrome to avoid frailty in the older people.

Impact of a culturally adapted digital literacy intervention on older people and its relationship with health literacy, quality of life, and well-being.

Introduction: Older people are the group with the greatest digital gap, so their digital literacy is important to improve the conditions in which they age. Methods: A study was conducted with pre- and post-evaluation of a digital literacy (DL) intervention in people aged 60 years and over. A total of 56 participants (experimental group N = 32 and control group N = 24) were recruited for convenience in community centers. The intervention was adapted to the needs of the participants, there were five face-to-face sessions and remote reinforcement for three months, carried out by trained university students for five months. Sociodemographic variables such as self-perception of socioeconomic level and education, among others, were evaluated. The impact was assessed using the digital literacy scale (MDPQ16), indicators of frequency and types of internet and mobile phone use, health literacy (SAHLSA and NSV), quality of life (SF-12), hedonic well-being (Diener's SWLS and Cummins' PWI) and perceived social support using the Zimet scale. Results: The intervention had a significant impact with an effect size of r = 0.27 on digital literacy, separate t-test comparisons revealed a markedly significant change for digital literacy in the experimental group, before and after the pre-post t-test(31) = 3.56, p = 0.001, but not in the control group, t(23) = 0.082, p = 0.93. No direct impact on health literacy, health-related quality of life, and hedonic well-being was identified. We examined the indirect impact of change in digital literacy and found that it correlated with improvements in well-being and social support, as well as quality of life. Individuals with significant changes were detected and compared with those who did not change. Discussion: Evaluation that contributes by identifying elements for improvement in future interventions and discusses the importance of culturally adapting continuing education in older people.

There is no association between anxiety and lifestyle in older adults during the COVID-19 pandemic: A cross-sectional study.

Introduction and objective: The COVID-19 pandemic has caused mental health problems worldwide. Older people have been particularly affected by the lockdown as their health conditions have changed, although they have been kept in isolation to avoid exposure to contagion. We sought to determine the association between lifestyles and anxiety in older adults during the COVID-19 pandemic. Materials and methods: This study was cross-sectional. We enrolled 150 older adults of both sexes and with a history of chronic diseases from the municipality of El Agustino (Lima, Peru). The 20-item Geriatric Anxiety Scale and the 25-item Lifestyle Questionnaire on eating, physical activity, rest, and sleep were administered in Spanish during July-August 2021. Results: The mean age was 70.8 ± 8.1 years, 54.7% were male, and 75.3% practiced exercise. During the COVID-19 pandemic, 99.3% of the elderly had healthy lifestyles and 40% presented anxiety (mild, moderate, and severe anxiety in 26.7%, 8.7%, and 4.7%, respectively). We found no association between anxiety and lifestyle (p = 0.189), physical exercise was a predictor of lifestyle (p < 0.001) and we did not find predictors of anxiety symptoms (p > 0.05). Conclusions: Our results suggest that there was no link between anxiety symptoms and lifestyle in older adults during the lockdown. It is important to conduct in-depth research on factors associated with anxiety symptoms among older residents in other regions, focusing on population groups with the highest rates of infection and death from COVID-19.

Effect of frailty status on mortality risk among chilean community-dwelling older adults.

INTRODUCTION: The study of frailty and its effect on the risk of mortality in older people is of utmost importance, but understanding the critical factors is still limited. Our main objective was to analyze the association of frailty with all-cause mortality in a prospective community cohort of older people. METHODS: A five-year longitudinal follow-up study was conducted with 1,174 community-dwelling older adults (men and women≥65 years old) from different Family Health Centers and community groups from Chile. We evaluated the functional risk, socioeconomic status, and anthropometric variables. The frailty status was evaluated by modified Fried criteria. RESULTS: The diagnosis of frailty was reached in 290 older adult participants, who had significantly increased 5-year all-cause mortality independently of age, sex, cognitive impairment, and socioeconomic status (adjusted HR 1.51, 1.06-2.15). CONCLUSION: Frailty is a predictor of increased mortality independently of age, sex, socio-economic and cognitive factors.

Incidence of Muscular Strength, Anthropometry, and Asymmetry in the General Index of Autonomy in Older Chilean Women / Incidencia de la Fuerza Muscular, Antropometría y Asimetría en el Índice General de Autonomía en Mujeres Mayores Chilenas

SUMMARY: Frailty affects the functional autonomy (FA) of older adults and could manifest itself in muscle imbalances in the limbs, resulting in a disparity in size and strength between them. In Chile, information on the relationship between muscle strength (MS) levels and FA asymmetries in older women is limited. This study related the levels of MS, anthropometric parameters, and asymmetries of the lower and upper limbs, with the FA of a group of older Chilean women. The study included 39 women who participated, and their FA was evaluated using the GDLAM index (IG). Based on the score obtained in the IG, they were classified by percentiles as Group 1 with favorable FA (P ≤ 50) and Group 2 with low FA (P > 50). Anthropometric parameters were BMI, fat percentage, bone mass, circumferences (arm, thigh, calf), diameters (humerus, femur) and upper/lower limb strength was evaluated to determine asymmetries. The differences between the covariates of both groups were evaluated using the student's t test and the Mann-Whitney test for independent samples. G1 presented less asymmetry (p > 0.05) in the lower limbs and greater calf circumference than G2 (p < 0.05). G1 presented greater bilateral strength (dominant and non-dominant limb) compared to G2 (p < 0.05). The covariates of age, anthropometry, MS, and lower/upper limb asymmetries influence FA in older women.

La fragilidad afecta la autonomía funcional (AF) de las personas mayores y podría manifestarse en desequilibrios musculares en los miembros, dando lugar a una disparidad de tamaño y fuerza entre ellos. En Chile, la información que relaciona los niveles de fuerza muscular (FM) y las asimetrías con la AF en mujeres mayores es limitada. Este estudio relacionó los niveles de FM, parámetros antropométricos y asimetrías de los miembros inferiores y superiores, con la AF de un grupo de mujeres mayores chilenas. Participaron 39 mujeres, cuya AF se evaluó mediante el índice GDLAM (IG). En función de la puntuación obtenida en el IG, se clasificaron por percentiles en Grupo 1 con AF favorable (P ≤ 50) y Grupo 2 con AF baja (P > 50). Los parámetros antropométricos fueron IMC, porcentaje de grasa, masa ósea, circunferencias (brazo, muslo, pantorrilla), diámetros (húmero, fémur) y se evaluó la fuerza de los miembros superiores/ inferiores para determinar asimetrías. Las diferencias entre las covariables de ambos grupos se evaluaron mediante la prueba t de student y la prueba de Mann-Whitney para muestras independientes. G1 presentó menor asimetría (p > 0,05) en los miembros inferiores y mayor perímetro de pantorrilla que G2 (p < 0,05). G1 presentó mayor fuerza bilateral (miembro dominante y no dominante) en comparación con G2 (p < 0,05). Las covariables de antropometría, FM y asimetrías de extremidades inferiores/superiores influyen en la AF en mujeres mayores.

Study of the clinical profile of older patients with bipolar disorder in a tertiary care center in the Midwest of Brazil / Estudo do perfil clínico de pacientes idosos com transtorno bipolar em um centro terciário do Centro-Oeste do Brasil

Objective: This study aimed to describe the clinical and psychiatric characteristics of older outpatients with bipolar disorder (BD), including psychiatric history (age of onset of symptoms, length of time with the illness, and number of psychiatric hospitalizations), mood state, and cognitive function. Methods: This was a cross-sectional study where clinical and demographic data were obtained by a psychiatric interview with each patient and family members as well as by a review of medical records. The sample consisted of 20 individuals aged 60 years or older with a diagnosis of BD type I according to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition. Descriptive data analysis was performed, with categorical variables expressed as absolute and relative frequencies. Results: No patient had manic or depressive symptoms at the time of the evaluation; 15 (75.0%) had an early onset while 5 (25.0%) had a late onset of the disease. Nine patients (45.0%) showed no cognitive decline whereas 11 (55.0%) showed mild cognitive impairment. Conclusions: This study presents an understudied group of patients with BD. Considering the personal impact and burden on the health system related to this psychiatric condition, it is recommended that further studies be conducted in this area to better evaluate this growing population. (AU)

Effects of endurance training combined with blood flow restriction on functionality in older adults: a systematic review / Efeitos do treinamento de resistência combinado com restrição de fluxo sanguíneo na funcionalidade de idosos: uma revisão sistemática

The aim of this review was to verify the effects of aerobic exercise combined with blood flow restriction on older adult functionality. Systematic searches were performed in PubMed, Web of Science, and Embase between July and December 2023. Randomized studies with participants aged ≥ 60 years who were evaluated before and after the experimental protocols were included. We registered this systematic review at the International Prospective Register (PROSPERO CRD42022347205). The search strategy identified 2698 studies, four of which were included in the review, with 80 participants. The results suggested that aerobic exercise combined with blood flow restriction increased performance on specific functional tests. However, these results should be interpreted with caution due to the low-to-moderate study quality, as well as the low number of participants and studies. In conclusion, aerobic exercise and blood flow restriction may increase functional capacity in older adults. Further studies are needed to confirm such findings. (AU)

Intrinsic capacity and hospitalization among older adults: a nationally representative cross-sectional study.

PURPOSE: Monitoring intrinsic capacity (IC) in community-dwelling older people can be potentially used to alert for adverse health outcomes. However, whether there is an association between IC and hospitalization has yet to be fully explored. This study aimed to investigate the association of the IC composite measure and its 5 domains with hospitalization in the previous year and length of hospital stay. METHODS: We conducted cross-sectional analyses using data from a representative sample of community-dwelling adults (≥ 65 years). We assessed the IC domains (vitality, locomotor, cognitive, sensory, and psychological) using validated self-reported information and performance tests. We calculated standardized estimated scores (z scores) for IC composite measure and domains and conducted multivariate logistic and ordinal regressions. The primary outcomes were hospitalizations in the previous year and length of hospital stay. RESULTS: In a sample of 5354 participants (mean age = 73 ± 6 years), we found that participants with high IC composite z scores were less likely to have experienced hospitalization in the previous year (OR = 0.51; 95% CI = 0.44-0.58). Among those who were hospitalized, high IC scores were associated with short stays (OR = 0.87; 95% CI = 0.80-0.95). Cognitive and psychological domains were associated with hospitalizations, and the locomotor domain was related to length of hospital stay. The vitality domain was associated with both outcomes. CONCLUSION: IC as a composite measure was associated with previous hospitalizations and length of stay. IC can help clinicians identify older people prone to adverse outcomes, prompting preventive integrated care interventions.

Environmental pollution and health in Chilean older adults: Impact on quality of life and functional autonomy.

Background and Aims: Due to increased urbanization and industry, environmental pollution is a serious public health concern. Globally, the quality of life is particularly lowered by exposure to high amounts of particulate matter (PM). Chile has five industrial zones with high pollution levels, called "sacrifice zones." However, the effect of polluted air on the quality of life and functional autonomy (FA) of older people living in industrial zones with high pollution levels is unknown. Therefore, this study aimed to determine the quality of life and FA differences between Chilean older women (OW) living in areas with lower and higher PM levels. Materials and Methods: Seventy-two OW volunteered for this study. The sample was divided into Zone 1 (PM2.5 ≤ 15 µg/m3, n = 36) and Zone 2 (PM2.5 > 15 µg/m3, n = 36). The variables were quality of life-assessed through the SF-36v2.0 questionnaire, and FA-assessed through the GDLAM protocols. Differences between zones were tested by Student's t-test and Mann-Whitney test, both for independent samples (p < 0.05). Results: All eight dimensions of quality of life were lower in Zone 2, of which the role emotional (RE) showed significant differences between zones (p < 0.05). Performance on the GDLAM protocols and the FA index were lower in Zone 2 (p ˃ 0.05). Conclusion: OW in Zone 2 showed lower quality of life and FA. PM could affect the older population's physical and mental health and, therefore, the quality of life.

The Relationship Between Mental health, Metacognition, and Emotion Regulation in Older People.

OBJECTIVES: It is unclear if using emotion regulation strategies can help manage the effects of anxiety and depression on metacognitive strategies in older people. This study aimed to verify the effect of emotion regulation in the interaction between mental disorders and metacognition. METHODS: A mediation analysis was performed to assess the role of emotion regulation in the interaction between mental disorders and metacognition in older people. RESULTS: Without mediator control, higher scores indicating mental disorder are associated with reduced metacognition scores. When mediators are added to the model, the mediation effect was significant. An indirect effect of anxiety and depression on metacognition was mediated by cognitive reappraisal to a greater extent than emotional suppression. CONCLUSIONS: Cognitive reappraisal reduced the impact of anxiety and depression on metacognition in older adults. CLINICAL IMPLICATIONS: Including cognitive reappraisal techniques in anxiety and depression intervention plans can be beneficial for improving older people's metacognition functioning.

Experience of hope in older people with chronic illness: A meta-synthesis.

BACKGROUND: The increase in life expectancy has contributed to an increase in the number of older people, but this population has to learn to live with at least one chronic illness. Thus, hope has become an important resource for the older adult to face the repercussions of chronic illness. OBJECTIVE: To synthesise qualitative evidence on the experience of hope in older people with chronic illness. METHODS: This meta-synthesis included qualitative studies which present the experiences of hope in older people diagnosed with at least one chronic illness. The searches were made from six databases, guided by the SPIDER tool. The identified articles were then independently screened by two reviewers. The results were analysed according to the thematic synthesis approach. RESULTS: Eighteen articles were included, and four analytical themes were constructed. The results allow us to understand that older people live with long-term conditions and hope for an ordinary life. To react to new changes and to maintain hope, they create goals that motivate them in daily life. The treatment is initially seen as a salvation, but the information acquired with the evolution of the illness modifies this perception. In addition, the uncertainty about the success of the treatment creates conflict in their hope. In the support and care of older people in the new context of illness, meaningful relationships strengthen hope most of the time. There is still the hope of being reconciled with death, but there are times when suffering overcomes the hope of living. CONCLUSIONS: This meta-synthesis highlights that the experience of hope in older people is dynamic and influenced by the context of changes related to illness, treatment, significant relationships and proximity to death. IMPLICATIONS FOR PRACTICE: A better understanding of the role and characteristics of hope in older people with chronic illness may help to develop more effective interventions to promote and maintain hope.

Access to dental services in an elder population of African descent in Brazil.

OBJECTIVES: We investigated access to dental services and associated factors in a community of Quilombola older people. BACKGROUND: Quilombola populations are groups of individuals descended from black Africans subjected to slavery during part of Brazilian history. As marginalised and neglected individuals, they have high rates of negative indicators and require further attention to the social determinants that affect their health reality. MATERIALS AND METHODS: A cross-sectional quantitative study was conducted in the Quilombola community of Castainho, in the Northeast region of Brazil. In this community, 34 older people aged between 65 and 74 resided. We collected self-report data on sociodemographic and economic characteristics, along with oral examinations by the researchers. The primary dependent variable was regular access to dental services. Statistical analysis used Fisher's exact test (P = .05). RESULTS: Among the 32 participants in the final sample, 18.8% (n = 6) reported accessing dental services in the previous 6 months. Self-declared individuals of mixed race, with positive self-assessment of oral health, and those who did not self-perceive the need for treatment had lower rates of regular access to dental services (P < .05). CONCLUSION: Use of dental services by older Quilombola people is low, and there are differences by ethnicity and individual perception of oral health.