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1.
Home Healthc Now ; 40(1): 40-48, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34994719

RESUMO

Falls are a significant health problem in community-dwelling older adults, resulting in injuries, deaths, and increased healthcare costs. Falls were a quality concern for a Northeastern home care agency and this project aimed to evaluate the falls prevention process for older adults receiving home care services by determining potential root causes of falls and to identify a practice change. This quality improvement project used a root cause analysis methodology with a retrospective matched case-control design. Records of patients with falls were assessed for falls prevention process fidelity and compared with patients without a fall matched on the Missouri Alliance for Home Care-10 (MAHC-10) assessment, examining plan of care accuracy and patient fall risk factors. Findings indicated fidelity concerns in the fall prevention process, with gaps in care planning aligned with identified risk factors. Interventions to mitigate identified MAHC-10 risk factors on care plans were present less than 50% of the time for four of the six factors. Polypharmacy (7.46%) and pain affecting function (9.21%) were most frequently unaddressed risk factors in the care plan. Recommendations included implementation of a falls prevention pathway, including standardized falls risk assessment, universal falls precautions in the care plan with tailored interventions based on risk factors, and referral initiation when necessary.


Assuntos
Acidentes por Quedas , Serviços de Assistência Domiciliar , Acidentes por Quedas/prevenção & controle , Idoso , Humanos , Vida Independente , Estudos Retrospectivos , Análise de Causa Fundamental
2.
Br J Community Nurs ; 27(1): 28-30, 2022 Jan 02.
Artigo em Inglês | MEDLINE | ID: mdl-34990270

RESUMO

Pain is a complex and common issue within older adults. This complexity can be a direct result of comorbidities and the subsequent polypharmacy. The effective control of pain in older adults needs more than just pharmacological management. Non-pharmacological interventions have been demonstrated to be beneficial when combined with pain medications. This commentary critically appraises a systematic review that examines the effectiveness of non-pharmacological interventions for the management of pain in community dwelling older adults.


Assuntos
Vida Independente , Manejo da Dor , Idoso , Comorbidade , Humanos , Dor/prevenção & controle , Polimedicação
3.
Blood Press Monit ; 27(1): 1-8, 2022 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-34992202

RESUMO

OBJECTIVE: The present study aimed to analyze the association of 2-year changes in BMI and waist circumference with changes in blood pressure (BP) in a randomized sample of community-dwelling adults. METHODS: A sample of 331 middle-aged and older adults (mean age of 59.6 ± 17.3 years) was randomly selected. Measurements of SBP and DBP, BMI, and waist circumference were collected at baseline and after 2-year follow-up. Chronological age, sex, socioeconomic status, ethnicity, and self-reported medical diagnosis and use of medication for hypertension, diabetes, and high low-density lipoprotein-cholesterol were covariates. Multiple linear regression models were adopted for statistical analysis. RESULTS: SBP was positively associated with BMI (ß = 0.48, P = 0.013) and waist circumference (ß = 0.21, P = 0.005) at baseline and only with waist circumference at follow-up (ß = 0.20, P = 0.007). DBP was positively associated with BMI (ß = 0.31, P = 0.009) and waist circumference (ß = 0.12, P = 0.006) values at baseline and at follow-up (BMI ß = 0.42, P = 0.001; waist circumference ß = 0.18, P = 0.001). Only the 2-year changes in waist circumference were associated to changes in SBP (ß = 0.33, P = 0.013), regardless of confounding factors and BMI. CONCLUSION: It is suggested that waist circumference is the main factor for control over the time in strategies focused on BP management in adult population.


Assuntos
Hipertensão , Vida Independente , Adulto , Idoso , Pressão Sanguínea , Índice de Massa Corporal , Humanos , Pessoa de Meia-Idade , Fatores de Risco , Circunferência da Cintura
4.
BMC Health Serv Res ; 22(1): 5, 2022 Jan 02.
Artigo em Inglês | MEDLINE | ID: mdl-34974834

RESUMO

BACKGROUND: Congestive heart failure (CHF) is a significant health problem in Australia, and disproportionately affects rural Australians. Management of CHF in Australia is heavily centred around the general practitioner (GP). Australian and international literature indicates there is a gap between current and best practice in CHF management. There is little known about the non-pharmacological aspects of management, or CHF management in a rural Australian context. This study aimed to identify what Australian GPs practicing in the Northern Rivers Region of New South Wales, Australia, perceived were the barriers and enablers in the non-pharmacological management of CHF amongst community dwelling patients, to inform healthcare access, resourcing and delivery in Australian rural environments. METHODS: Qualitative study involving a realist thematic analysis of data collected from semi-structured face-to-face interviews. RESULTS: Fifteen GPs and GP trainees participated. Four interlinked key themes underpinning GPs' experiences with non-pharmacological management of CHF were interpreted from the interview data: (1) resources, (2) complexity of heart failure, (3) relationships, and (4) patient demographics, priorities and views affect how patients engage with non-pharmacological management of CHF. CONCLUSION: Rural Australian GPs face considerable barriers to non-pharmacological management of CHF. The data suggests that increased rural Australian health services and community transportation, multidisciplinary management, and stronger professional networks have the potential to be invaluable enablers of CHF management. Further research exploring non-pharmacological management of CHF in other rural contexts may provide additional insights to better inform rural healthcare access and resourcing.


Assuntos
Clínicos Gerais , Insuficiência Cardíaca , Serviços de Saúde Rural , Austrália/epidemiologia , Insuficiência Cardíaca/terapia , Humanos , Vida Independente
5.
J Clin Nurs ; 31(1-2): 167-173, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34189796

RESUMO

OBJECTIVE: To evaluate the relationship between insomnia and multidimensional frailty. BACKGROUND: Frailty has major implications on adverse health outcomes of older adults. In recent years, multidimensional nature of frailty has been increasingly recognised. Many frail older adults also suffer from insomnia. METHODS: This was a cross-sectional observational study including 454 community-dwelling adults aged 60 and older. Insomnia was defined as a subjective experience of inadequate sleep duration or quality that affects social functioning during the day, based on the Athens Insomnia Scale (AIS), and multidimensional frailty was based on Tilburg Frailty Indicator (TFI). The STROBE checklist was used to guide the submission. RESULTS: Mean age was 69.1 years old, 211 (46.5%) of participants suffered from insomnia, and 185 (40.7%) of participants were frail. There was a significant relationship between insomnia and multidimensional frailty (physical, psychological and social dimensions). Insomnia was associated with frailty, adjusting for sociodemographic characteristics and comorbidity OR of 6.863 (95% CI: 4.237-11.116). CONCLUSION: Frailty was independently predicted by insomnia. Future researches should determine whether there is a causal relationship between insomnia and multidimensional frailty, with the ultimate goal of providing interventions to reverse or prevent frailty. RELEVANCE TO CLINICAL PRACTICE: This study emphasises the importance of assessment and treatment of insomnia, potentially contributing to the reversion and prevention of frailty in community-dwelling older adults.


Assuntos
Fragilidade , Distúrbios do Início e da Manutenção do Sono , Idoso , Estudos Transversais , Idoso Fragilizado , Fragilidade/epidemiologia , Avaliação Geriátrica , Humanos , Vida Independente , Pessoa de Meia-Idade , Distúrbios do Início e da Manutenção do Sono/complicações , Distúrbios do Início e da Manutenção do Sono/epidemiologia
6.
Arch Gerontol Geriatr ; 98: 104533, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34592680

RESUMO

BACKGROUND: Studies that examined changes in frailty in older populations have been increasing. However, frailty patterns are often portrayed as having single trajectories corresponding to age, and different courses of change in frailty and related factors remain unexplored. OBJECTIVES: We aimed to identify distinct frailty trajectories over time and examine the relationship of frailty trajectories with the sociodemographic and lifestyle-related factors among older Koreans. METHODS: We used data of 3160 community-dwelling Korean adults aged ≥65 years from the Korean Longitudinal Study of Aging (2006-2016). We conducted the analyses using group-based trajectory modeling, analysis of variance or chi-square tests, and multinomial logistic regression. RESULTS: We identified three frailty trajectory groups among older Koreans: no frailty, increasing frailty, and high frailty based on a deficit-related frailty measure. Each frailty trajectory group showed unique sociodemographic and lifestyle characteristics. Compared to individuals in the no frailty group, those in the increasing frailty group were more likely to be older, less educated, unemployed, current smokers, and current drinkers. Compared to those in the no frailty group, individuals in the high frailty group were more likely to be older, unemployed, current drinkers, and without regular exercise. CONCLUSIONS: Using longitudinal data over a 10-year period, we identified multiple frailty trajectories in a cohort of older Koreans, which highlights a significant heterogeneity in frailty development. Our findings suggest the importance of socioeconomic status in determining different patterns of frailty change and the role of lifestyle factors in delaying frailty.


Assuntos
Fragilidade , Idoso , Envelhecimento , Fragilidade/epidemiologia , Humanos , Vida Independente , Estudos Longitudinais , República da Coreia/epidemiologia
7.
Arch Gerontol Geriatr ; 98: 104535, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34601313

RESUMO

BACKGROUND: While anticholinergic use is associated with stroke, dementia and mortality, few have evaluated its potential link with falls. To determine the relationship between anticholinergic cognitive burden (ACB) and falls over five years using the Malaysian Elders Longitudinal Research (MELoR). METHODS: Community-dwelling adults aged 55 years and over were recruited through electoral roll sampling. Data obtained at baseline and follow-up (FU) at two and five years were included. Falls in the preceding 12 months were recorded. RESULTS: Of the 1499 individuals (mean (SD) age= 68.9(7.5) yrs and 53.3% female) with information on baseline ACB exposure, 575(38.4%) had ACB scores of 1-2 and 117(7.8%) had ACB scores ≥3. Differences in age, ethnicity, smoking status, diabetes, hypertension, cardiovascular disease, arthritis and education existed between ACB groups. Fall occurrence differed between ACB groups at recruitment (p = 0.004) and 2-year FU (p = 0.001) but not at 5-year FU (p = 0.053). Logistic regression revealed an independent association between ACB 1-2 and falls at baseline (odds ratio, OR (95% confidence interval, CI) =1.412(1.035-1.926)) and ACB≥3 and falls at 2-yr FU (OR (95%CI) =2.098(1.032-4.263)) following adjustment for confounders. CONCLUSION: Low level exposure to drugs with anticholinergic properties was associated cross-sectionally with falls, while exposure to higher levels were prospectively associated with falls at 2-year but not at 5-year FU. Future studies should determine whether avoidance of drugs with anticholinergic effects will lead to reduction in falls.


Assuntos
Antagonistas Colinérgicos , Vida Independente , Idoso , Antagonistas Colinérgicos/efeitos adversos , Cognição , Feminino , Humanos , Estudos Longitudinais , Masculino
8.
Arch Gerontol Geriatr ; 98: 104520, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34619629

RESUMO

BACKGROUND: Sarcopenia and polypharmacy are both prevalent conditions in the geriatric population, leading to poor quality of life and adverse outcomes. OBJECTIVE: To explore the evidence on the relationship between sarcopenia and polypharmacy and to summarize the findings and the gaps from the existing literature. METHOD: A systematic scoping review was conducted between March and May 2021, with no restriction on publication date, using the Arksey and O'Malley framework and reported according to PRISMA-ScR. Four bibliographic databases, PubMed, Web of Science, Scopus, Proquest One Academic, and four sources of gray literature were searched for studies written in English or Greek. Data were extracted quantitatively and using thematic analysis. RESULTS: Of the 397 initially retrieved records, 22 studies were finally included in this review, 20 published articles and 2 posters-presentations. Most of the studies used cross-sectional data. The relationship between sarcopenia and polypharmacy should be interpreted on the basis of the definition of polypharmacy, the diagnostic criteria of sarcopenia used, and the population setting. Sarcopenia or risk for sarcopenia are associated with polypharmacy or the number of medications in community-dwelling older adults, regardless of diagnostic criteria used for sarcopenia. CONCLUSION: There is an association between sarcopenia or risk for sarcopenia and polypharmacy or the number of medications in community-dwelling older adults but not among residents of nursing homes or inpatients. Specific widely accepted definitions of polypharmacy and sarcopenia, a consensus on the method of sarcopenia assessment, and prospective studies are needed to identify polypharmacy as a potential risk factor for sarcopenia.


Assuntos
Polimedicação , Sarcopenia , Idoso , Estudos Transversais , Humanos , Vida Independente , Qualidade de Vida , Sarcopenia/epidemiologia
9.
Arch Gerontol Geriatr ; 98: 104536, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34634495

RESUMO

OBJECTIVE: This study assessed home health care use associated with Alzheimer's Disease and related dementias (ADRD) in US community dwelling older adults, including workforce, intensity, and cost outcomes. MATERIALS AND METHODS: Medical Expenditure Panel Survey (2010-2018) household and home care event files were used to identify adults ≥ 65 years with ADRD. Outcomes included home health care provider type, intensity of care use, and annual direct home care cost. All analyses applied person weights for national estimates. RESULTS: Among the 20,443 eligible older adults, 4.2% (n = 843) reported ADRD. Among all professional and non-professional health care workers, nurse practitioners (NPs, 38.5%) and home health care aids (35.6%) were most used. Comparing ADRD vs non-ADRD: the annual per-person average number of days in home care was 110 vs. 64 (p<0.001) and home care costs accounted for 30.8% vs. 7.5% of total health care costs. After adjusting for participants' characteristics, those with ADRD were more likely to use home health care (OR = 4.32, 95% CI=3.29 - 5.68) and showed 229% (95% CI = 175% - 297%) higher associated costs than controls (p<0.001). CONCLUSION: The study provides insight into the home care workforce. Of the professional workforce NPs were most often used and home care aides dominated the non-professional workforce. As expected, ADRD increased the likelihood and intensity of home health care utilization and associated direct home care costs significantly.


Assuntos
Doença de Alzheimer , Serviços de Assistência Domiciliar , Idoso , Doença de Alzheimer/epidemiologia , Doença de Alzheimer/terapia , Humanos , Vida Independente , Aceitação pelo Paciente de Cuidados de Saúde , Recursos Humanos
10.
Arch Gerontol Geriatr ; 98: 104537, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34649184

RESUMO

OBJECTIVES: To explore how age and sex affect the impacts of self-rated health, self-reported physical activities, physical function, and depressive symptoms on long-term mortality among community-dwelling middle-aged and older adults using a nationally representative population-based cohort study. METHODS: Data from 1550 study participants from the Social Environment and Biomarkers of Aging Study (SEBAS) were retrieved for analysis, and all participants were divided into four groups based on their age and gender. Middle aged participants were aged 53 to 64 years, and elderly subjects were ≥ 65 years old. Multivariate logistic regression models were applied to investigate the associations between age, sex, and self-reported disabilities of physical activities, physical function (activities of daily living (ADL) and instrumental activities of daily living (IADL) and depression. RESULTS: Although the self-reported health status was similar across different age- and sex-stratified subgroups, older women were at the highest risk in self-reported difficulty with physical activities (aOR 2.58 [1.55-4.28]) and difficulty with IADL (aOR 3.32 [2.20-5.03]) compared to men. After adjusting for living arrangement, residence locale, education levels, occupation, socioeconomic status, self-reported health, multimorbidity, impairments in daily activities, and depressive symptoms, older men were found to display the highest risk of mortality (aHR 2.06 [95% CI 1.45-2.93]). CONCLUSIONS: Although self-reported health was similar across different age and sex stratified subgroups, women (particularly older women) are significantly more likely to have worse physical and functional health than men. After adjusting for all confounding factors, men are at substantially greater risk for mortality despite reporting better health and functional performance.


Assuntos
Atividades Cotidianas , Caracteres Sexuais , Idoso , Estudos de Coortes , Feminino , Humanos , Vida Independente , Masculino , Pessoa de Meia-Idade , Autorrelato
11.
Arch Gerontol Geriatr ; 98: 104555, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34700134

RESUMO

OBJECTIVES: We examined the association between social frailty and depressive symptoms among community-dwelling older adults during the coronavirus disease 2019 pandemic. Additionally, we investigated whether home exercise habits moderated the impact of social frailty on depressive symptoms. METHODS: This cross-sectional study included 1,103 community-dwelling older adults (54.0% female, mean age [standard deviation] = 81.1 [5.0] years) from a semi-urban area of Japan who completed a mailed questionnaire survey in October 2020. Social frailty status was categorized as non-social frailty, pre-social frailty, and social frailty, which was assessed by financial difficulties, living alone, lack of social activity, and contact with neighbors. Depressive symptoms were defined as a Kessler 6 score ≥5. We performed a multivariable logistic regression analysis to examine the association between social frailty and depressive symptoms, and also conducted stratified analysis of home exercise habits during the pandemic. RESULTS: A total of 309 (28.0%) participants had depressive symptoms. Compared with non-social frailty, social frailty was associated with depressive symptoms (odds ratio [OR] = 1.80, 95% confidence interval [95%CI] = 1.16-2.79, p = 0.009). A similar relationship was observed in those who did not exercise at home (OR = 2.10, 95%CI = 1.14-3.84, p =0.017). However, no such relationship was observed in those who did exercise at home (OR = 1.50, 95%CI = 0.79-2.85, p =0.213). CONCLUSIONS: Social frailty was associated with a risk of depressive symptoms during the pandemic. In addition, our findings suggested that home exercise may buffer the association between social frailty and depressive symptoms.


Assuntos
COVID-19 , Fragilidade , Idoso , Estudos Transversais , Depressão/epidemiologia , Feminino , Idoso Fragilizado , Fragilidade/epidemiologia , Hábitos , Humanos , Vida Independente , Japão/epidemiologia , Masculino , Pandemias , SARS-CoV-2
12.
Arch Gerontol Geriatr ; 98: 104562, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34715458

RESUMO

BACKGROUND: Globally, lifestyles have changed to prevent the spread of coronavirus disease 2019 (COVID-19). Therefore, we aimed to understand health and lifestyle conditions associated with frailty transition over 6 months and devise a method for identifying frailty among community-dwelling older people during the COVID-19 pandemic. METHOD: This community-based prospective cohort study was conducted from May to July 2020 (baseline) and November 2020 to January 2021 (follow-up) in Japan, with 1,953 community-dwelling older people (≥65 years) at baseline. To identify transition from non-frailty at baseline to frailty at follow-up, the Frailty Screening Index was used. For predicting frailty transition, two self-reported questionnaires assessing health and lifestyle conditions were employed. RESULTS: Overall, 706 individuals returned the baseline and follow-up questionnaires. Among the 492 non-frail older people at baseline, there was a 9.8% increase in frailty transition. The adjusted model for frailty transition by age, sex, multimorbidity, and living arrangements indicated that forgetfulness (odds ratio [OR] 2.74, 95% confidence interval [CI]: 1.00 to 7.51), falls in the past year (OR 2.26, 95% CI: 1.08 to 4.74), and subjective leg muscle weakness (OR 1.83, 95% CI: 1.05 to 3.21) were predictors of frailty transition. The combination of age ≥75 years and subjective leg muscle weakness showed moderate sensitivity, specificity, and % accuracy (0.688, 0.696, and 69.5%, respectively). CONCLUSIONS: Approximately 10% of older people showed new transitions to frailty over 6 months during the COVID-19 pandemic. A combination of age and subjective leg muscle weakness is a feasible measure to optimally identify frailty transition.


Assuntos
COVID-19 , Fragilidade , Idoso , Idoso Fragilizado , Fragilidade/epidemiologia , Avaliação Geriátrica , Humanos , Vida Independente , Japão/epidemiologia , Pandemias , Estudos Prospectivos , SARS-CoV-2
13.
Arch Gerontol Geriatr ; 98: 104569, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34768160

RESUMO

PURPOSE: The purposes of the study were: a) to investigate the prevalence of sarcopenia, obesity and sarcopenic obesity (SO) in older adults, b) to explore the effect of nutrition as mediator of the association between these entities and frailty. MATERIALS AND METHODS: Older adults (≥65 years) were evaluated based on European Working Group on Sarcopenia in Older People criteria for the presence/absence of sarcopenia. Obesity was diagnosed by using Zoico methodology. FRAIL scale was used to evaluate frailty and nutritional status was assessed with Mini Nutritional Assessment (MNA). RESULTS: Five-hundred-seventy individuals (68,9% female, mean age 74,41±6,57 years) were included. The prevalence of sarcopenia, obesity and SO were 18,6%, 28,9% and 11,2%, respectively. FRAIL scores were directly affected by having sarcopenia (ß: 0.42, 95% CI: (0.21-0.67), p<0.001) and SO (ß: 0.31, 95% CI: (0.06-0.59), p:0.015), whereas obesity had no direct effect on FRAIL (ß: 0.1, 95% CI: (-0.08-0.3), p:0.26). MNA was a mediator (ß: -0.35, 95% CI: (-0.12-(-0.08)), p<0.0001) in both sarcopenic (ß: -0.69, 95% CI: (-3.34-(-1.69)), p<0.0001) and SO patients (ß: -0.34, 95% CI: (-2.21-(-0.26)), p:0.013), but not in obese group (ß: -0.01, 95% CI: (-0.08-0.04). After the Bonferroni corrections,only sarcopenia had an association with frailty with MNA being the mediator. CONCLUSION: The findings revealed that the frailty rate was higher in sarcopenia (20,8%) and SO (17,2%) groups than obese (5,5%) group. Frailty was associated with sarcopenia and SO, but not with obesity. Nutritional status was found to be a mediator of the association between age-related muscle loss and frailty To the best of our knowledge, this is the first study to report the mediator of the associations between age-related muscle loss and frailty.


Assuntos
Fragilidade , Sarcopenia , Idoso , Estudos Transversais , Feminino , Idoso Fragilizado , Fragilidade/epidemiologia , Avaliação Geriátrica , Humanos , Vida Independente , Masculino , Músculos , Estado Nutricional , Sarcopenia/epidemiologia
14.
Arch Gerontol Geriatr ; 98: 104570, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34773874

RESUMO

BACKGROUND: General health conditions in older adults, including their mental health, differ greatly based on their physical health conditions rather than age. Thus, we evaluated how lifestyle factors, which included eating and living, affected depressive symptoms in older adults based on their physical frailty status. METHODS: We included older adults aged 70-84 years from the Korean Frailty and Aging Cohort Study (KFACS). Based on their eating and living patterns, we classified them into four groups: "lived and ate with others," "lived alone yet ate with others," "lived with others yet ate alone," and "lived and ate alone." Depressive symptoms and physical frailty were measured using the Korean version of the Geriatric Depression Scale and modified version of the Cardiovascular Health Study (CHS) Frailty Index, respectively. RESULTS: A total of 2,702 participants, 11.4% lived with others yet ate alone, and 19.7% lived and ate alone. For robust older adults, after adjusting for variables, the "ate alone" group was significantly related with depressive symptoms, and the "lived and ate alone" group showed a higher risk of depressive symptoms. In the prefrail to frail participants, the "lived and ate alone" group was at a higher risk of depressive symptoms. CONCLUSION: Eating and living alone are key risk factors for depressive symptoms in community-dwelling older adults regardless of their physical frailty status. Therefore, social interventions are needed for both physically frail and healthy older adults to support their eating patterns and increase opportunities for social interaction.


Assuntos
Depressão , Fragilidade , Idoso , Envelhecimento , Estudos de Coortes , Estudos Transversais , Depressão/epidemiologia , Idoso Fragilizado , Fragilidade/epidemiologia , Avaliação Geriátrica , Humanos , Vida Independente , República da Coreia/epidemiologia
15.
Maturitas ; 155: 54-62, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34876249

RESUMO

BACKGROUND: Emerging evidence has shown that charged metabolites, such as amino acids, may play an important role in the pathogenesis of various metabolic disorders, many of which women in the postmenopausal period are at high risk of developing. This study examined the metabolic profile of middle-aged Japanese women to investigate alterations in charged metabolites induced by menopausal transition. METHODS: The participants were 1193 female residents aged 40-60 at the baseline survey of the Tsuruoka Metabolomics Cohort Study. We investigated the cross-sectional association of menopausal status with 94 metabolomic biomarkers assayed in fasting plasma samples via capillary electrophoresis time-of-flight mass spectrometry using linear regression analysis. RESULTS: Among the participants, 529 were premenopausal, 132 were in menopausal transition (MT), and 532 were postmenopausal. Significant differences were found in age, blood pressure, glucose and lipid levels, and smoking and drinking habits among the three groups. The concentrations of 5 metabolites in the MT group and 15 metabolites in the postmenopausal group were significantly higher than those in the premenopausal group after adjusting for confounding factors. When classified into pathways, these metabolites were related to the tricarboxylic cycle, urea cycle, and homocysteine metabolism, some of which are linked to arteriosclerosis. CONCLUSION: Multiple charged metabolites were associated with women's menopausal status, showing a gradual increase as women shifted from pre-, to peri-, to postmenopause. These findings might reflect the early changes behind the increased risk of dyslipidemia, diabetes, cardiovascular disease, and osteoporosis in later life.


Assuntos
Vida Independente , Menopausa , Estudos de Coortes , Estudos Transversais , Feminino , Humanos , Japão , Metabolômica , Pessoa de Meia-Idade
16.
Hypertension ; 79(1): 24-32, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34689594

RESUMO

Current evidence is insufficient to support different hypertension treatment targets in older adults. We evaluated whether frailty modifies the association between systolic blood pressure (SBP) and 8-year all-cause mortality in community-dwelling older adults. Longitudinal data from the ActiFE Ulm study (Activity and Function in the Elderly in Ulm; Germany) was collected. The association between SBP and mortality was analyzed using Cox proportional hazards models adjusted for age, sex, education, smoking, alcohol consumption, sleep disturbance, diastolic blood pressure, and antihypertensive medications, evaluating the presence of effect modification by frailty according to a frailty index based on the accumulation of deficits. Among 1170 participants (median age 73.9 years, 41.6% women), the prevalence of history of hypertension was 53.8% (median SBP, 144.0 mm Hg [interquartile range, 135.0-149.5], median diastolic blood pressure 78.0 mm Hg [interquartile range, 71.0-86.5]). The median follow-up time was 8.1 years, detecting 268 deaths. We identified 251 (21.5%, 114 deaths) frail participants (frailty index ≥0.2). Effect modification by frailty was detected. Among non-frail a J-shaped association was found with hazard ratio, 4.01 (95% CI, 1.13-14.28) for SBP<110 mm Hg, hazard ratio, 0.92 (95% CI, 0.53-1.59) for SBP 140-150 mm Hg, and hazard ratio, 1.98 (95% CI, 0.75-5.27) for SBP≥160 mm Hg. For frail older adults, a tendency toward lower risk among those with SBP≥130 mm Hg was observed. Our results suggest the presence of effect modification by frailty indicating a possible protective effect for elevated SBP in frail older adults with respect to all-cause mortality even after adjusting for diastolic blood pressure and antihypertensive treatment.


Assuntos
Pressão Sanguínea/fisiologia , Idoso Fragilizado , Fragilidade/mortalidade , Hipertensão/mortalidade , Idoso , Idoso de 80 Anos ou mais , Anti-Hipertensivos/uso terapêutico , Feminino , Fragilidade/fisiopatologia , Humanos , Hipertensão/tratamento farmacológico , Hipertensão/fisiopatologia , Vida Independente , Masculino , Sono/fisiologia , Taxa de Sobrevida
17.
J Appl Gerontol ; 41(1): 4-11, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34365856

RESUMO

Despite high enthusiasm surrounding the rollout of the COVID-19 vaccine, some older adults continue to remain hesitant about its receipt. There is limited evidence on vaccine hesitancy among community-dwelling older adults. In this study, we examine the prevalence and predictors (particularly the role played by information sources) of vaccine hesitancy in this group. We use the Medicare Current Beneficiary Survey and employ multivariable logistic regression models to explore this. Relative to those relying on regular news, those depending on health care providers (HCPs), social media, other internet/webpages, and family/friends as the main information source on COVID-19 expressed higher negative vaccine intent. The high negative intent with HCPs as the main information source should be interpreted with caution. This could be reflective of the timing of the survey and changing attitude toward the vaccine among HCPs themselves.


Assuntos
Vacinas contra COVID-19 , COVID-19 , Idoso , Humanos , Vida Independente , Medicare , SARS-CoV-2 , Estados Unidos
18.
Res Aging ; 44(1): 73-82, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-33550934

RESUMO

OBJECTIVES: Despite known benefits of productive aging, it is unclear what explains time allocation in productive activities. We investigated whether productive engagement in older people can be explained by their age, health, socioeconomic status, and perceived life expectancy in Hong Kong. METHODS: We interviewed 390 community-dwelling older persons for their health and perceived life expectancy, followed by a 7-day ecological momentary assessment to record their activities. RESULTS: A total of 366 participants who completed the study (age 75 ± 8.3 years; 79% women) reported an average perceived life expectancy of nearly 10 years. The majority (59%) engaged in productive activities. Estimates of the structural equation model (RMSEA = 0.046) showed that age and health were associated with productive engagement, mediated by perceived life expectancy. DISCUSSION AND IMPLICATIONS: Future efforts in promoting productive aging and related research should include interventions addressing perceived life expectancy, a potentially modifiable factor.


Assuntos
Envelhecimento , Avaliação Momentânea Ecológica , Idoso , Idoso de 80 Anos ou mais , Eficiência , Feminino , Humanos , Vida Independente , Expectativa de Vida , Masculino
19.
Health Soc Care Community ; 30(1): 114-123, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-33825264

RESUMO

Evidence exists relating to music-based initiatives and positive health outcomes for people living with dementia who can access them. Yet, knowledge about the impact of 'music-making' on the well-being of community-dwelling people with dementia is limited. Much of the existing evidence about the benefits of music is focused on care home settings where initiatives can be readily applied as part of a weekly schedule of activities. Therefore, this initiative aimed to provide opportunities to participate in music-making, to increase social interaction and ultimately well-being in a community environment. Ten music-making session were scheduled for community-dwelling people living with dementia and care-partners, once a month between September 2019 and March 2020. Three sessions did not take place due to Covid19. Eighteen participants consented to take part including seven people living with dementia, five care-partners and six former care-partners. Baseline semi-structured interviews explored the lived experience of music and expectations of the upcoming music-making cafes. Self-report questionnaires captured 'in the moment' experiences of each music-making cafe. Follow-up semi-structured interviews explored the impact of music-making on participants' self-reported well-being. Interviews were transcribed verbatim and analysed thematically. The findings demonstrate that participating in the music-making café benefitted the self-reported well-being of participants in three ways: first, a sense of camaraderie that enabled the facilitation of connections with others; second, creating opportunities to 'level the playing field' by always assuming a person's strengths and abilities; and third, group participation in music-making meets a need for meaningful musical experiences. We conclude that participating in music-making is a powerful medium to promote well-being for community-dwelling people living with dementia and care-partners.


Assuntos
COVID-19 , Demência , Música , Humanos , Vida Independente , SARS-CoV-2
20.
Health Soc Care Community ; 30(1): 253-263, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-33894087

RESUMO

Falls impose substantial health and economic burdens on older adults. Over half of falls in older adults occur at home, with many involving bathroom areas. Limited information is available on the presence of bathroom modifications for those who experience them. Therefore, we examined factors associated with bathroom modifications among older adults with at least one fall in the United States. We analysed the nationally representative 2016 Medicare Current Beneficiary Survey Public Use File of Medicare beneficiaries aged ≥65 years with ≥1 fall (n = 2,404). A survey-weighted logistic model was used to examine associations between bathroom modifications and factors including socio-demographic characteristics, health-related conditions, and fear of falling. Among Medicare beneficiaries with ≥1 fall, 55.5% had bathroom modifications and 50.1% had repeated falls (≥2 falls). Approximately 40.2% of those with repeated falls had no bathroom modifications. In the adjusted model, non-Hispanic Blacks (odds ratio [OR] = 0.38; p < 0.001) and Hispanics (OR = 0.64; p = 0.039) had lower odds of having bathroom modifications than non-Hispanic Whites. Fear of falling and activities of daily living limitations had incremental impacts on having bathroom modifications. This study highlights the need to improve disparities in bathroom modifications for non-Hispanic Black and Hispanic Medicare beneficiaries, including those with repeated falls. With the aging population and growing number of older minorities in the United States, reducing these disparities is vital for fall prevention efforts and aging-in-place.


Assuntos
Vida Independente , Toaletes , Atividades Cotidianas , Idoso , Estudos Transversais , Medo , Humanos , Medicare , Estados Unidos
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