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1.
Medicine (Baltimore) ; 100(4): e24400, 2021 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-33530237

RESUMO

ABSTRACT: Frailty is a common geriatric condition due to aging, defined as a decrease in the functional reserve to maintain the homeostasis. As part of the aging process, body composition changes occur. This study investigated the relationship between body composition and frailty in a community-dwelling elderly Korean population.This cross-sectional cohort study analyzed data of 2,385 elderly participants (aged 70-84 years, 1131 males and 1254 females) of the Korean Frailty and Aging Cohort Study from 2016 to 2017. Body composition, including total and trunk fat masses and fat-free mass, were measured with dual-energy X-ray absorptiometry. Fat mass index (FMI), trunk fat mass index, and fat-free mass index (FFMI) represented total fat mass, trunk fat mass, and fat-free mass according to height. Based on the frailty index developed by Fried, we compared the frail and non-frail groups. Poor physical performance assessed with the short physical performance battery score of < 9 is considered frailty. To evaluate the relationship between the variables, simple and fully adjusted multivariable logistic regression analyses were performed according to sex.Among the participants, 462 (19.3%) were defined as the frail group, with a significantly high mean age of 77.9 ±â€Š4.0 years. In the logistic regression analysis of frailty based on body mass index (BMI) categories, underweight (BMI < 18 kg/m2) participants showed a high incidence of frailty in both sexes. BMI showed an association with frailty only in males. Lower FFMI was associated with a higher incidence of frailty in both sexes, which was statistically significant in the fully adjusted models. In the female, fat-related indexes including body fat percentage, FMI, and trunk fat mass index showed a significant association with poor physical performance. In contrast, males with low FFMI only showed a significant association with poor physical performance.Frailty was closely correlated with lower FFMI in both sexes. The poor physical performance associated with frailty correlated with fat-related body composition in females and fat-free mass in males, owing to the difference in body composition between the sexes. In the assessment of frailty, body composition and sex-related differences should be analyzed.


Assuntos
Idoso Fragilizado/estatística & dados numéricos , Fragilidade/epidemiologia , Vida Independente/estatística & dados numéricos , Desempenho Físico Funcional , Fatores Sexuais , Absorciometria de Fóton , Idoso , Idoso de 80 Anos ou mais , Composição Corporal , Índice de Massa Corporal , Estudos Transversais , Feminino , Fragilidade/fisiopatologia , Avaliação Geriátrica , Humanos , Modelos Logísticos , Masculino , Prevalência , República da Coreia/epidemiologia , Medição de Risco
2.
Aust J Gen Pract ; 50(1-2): 84-89, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33543170

RESUMO

BACKGROUND AND OBJECTIVES: Increasing age, male sex and various chronic conditions have been identified as important risk factors for poor outcomes from COVID-19. The aim of this study was to examine the prevalence of risk factors for poor outcomes due to COVID-19 infection in an older population. METHOD: The proportion of the population with one or more risk factors and the prevalence of individual risk factors and multiple risk factors were calculated among Department of Veterans' Affairs (DVA) clients aged ≥70 years. RESULTS: There were 103,422 DVA clients included. Of these, 79% in the community and 82% in residential aged care had at least one risk factor for poor outcomes from COVID-19. Hypertension was most prevalent, followed by chronic heart and airways disease. Over half had ≥2 risk factors, and one in five had ≥3 risk factors across multiple body systems. DISCUSSION: A substantial proportion of older Australians are at risk of poor outcomes from COVID-19 because of their multimorbid risk profile. These patients should be prioritised for proactive monitoring to avoid unintentional harm due to potential omission of care during the pandemic.


Assuntos
/mortalidade , Doença Crônica/mortalidade , Instituição de Longa Permanência para Idosos/estatística & dados numéricos , Vida Independente/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Austrália/epidemiologia , Feminino , Humanos , Masculino , Prevalência , Fatores de Risco
3.
BMC Public Health ; 21(1): 83, 2021 01 07.
Artigo em Inglês | MEDLINE | ID: mdl-33413218

RESUMO

BACKGROUND: During the outbreak of SARS-CoV-2 in Italy, infection among health-care professionals and in the context of welfare and health-care facilities was a significant concern. It is known that the elderly or those with concomitant pathologies are at greater risk of a serious evolution of the disease if affected by COVID-19 and that health workers are a category with greater exposure to SARS-CoV-2 infection. Until now, there has been little information on the epidemiological features and transmission dynamics of the COVID-19 outbreak which did not involve health-care professionals or social and health-care facilities. For this reason, this paper aims to describe the epidemiological characteristics of SARS-CoV-2 infection in the general population outside these semi-closed communities. METHODS: The study was designed by analyzing the data of the 1371 SARS-CoV-2 positive subjects observed in Sardinia up to 9 July, 2020 and whose data were available in the public health department. Statistical analysis and graphic representation were performed using STATA and Adobe Illustrator, respectively. RESULTS: Of the positive cases analyzed, 323 (23.5%) are health-care workers and 563 (41.1%) reside in social or health-care facilities. The number of positive cases among the general population (subjects who do not belong to these semi-closed communities), is 399 (29.1%), 208 females and 191 males. The estimated Case Fatality Rate stands at 5.0%, which is almost half the rate reported for all the SARS-CoV-2 positive cases (9.8%). The geographical distribution of positive cases differs considerably from the distribution of the totality of cases in Sardinia. CONCLUSIONS: This review provides an insight into the COVID-19 situation in the general community, ie not involving health-care professionals or social and health-care facilities. Understanding the evolving epidemiology and transmission dynamics of the outbreak outside of these semi-closed communities would provide appropriate information to guide intervention policy. The COVID-19 pandemic has exacerbated the vulnerability of our health-care system. Severe disruptions in care, medicine shortages and unequal access to health-care are but a few examples of the challenges faced by people living in Italy and Europe, highlighting the importance of evidence-based approaches in supporting the development of prevention and response strategies for future pandemics.


Assuntos
/epidemiologia , Instalações de Saúde , Pessoal de Saúde/estatística & dados numéricos , Instituições Residenciais , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Doenças Cardiovasculares/epidemiologia , Criança , Pré-Escolar , Doença Crônica , Comorbidade , Diabetes Mellitus/epidemiologia , Surtos de Doenças , Feminino , Instituição de Longa Permanência para Idosos , Hospitais , Humanos , Vida Independente/estatística & dados numéricos , Lactente , Itália/epidemiologia , Pneumopatias/epidemiologia , Masculino , Pessoa de Meia-Idade , Obesidade/epidemiologia , Pandemias , Distribuição por Sexo , Adulto Jovem
4.
Environ Health Prev Med ; 26(1): 9, 2021 Jan 18.
Artigo em Inglês | MEDLINE | ID: mdl-33461488

RESUMO

BACKGROUND: Life-space mobility is reflected in comprehensive longevity and health outcomes and is also an important indicator for preventing mortality and decline in well-being among older people. However, a comprehensive framework of life-space mobility and modifiable individual and environmental factors has not been well validated among community-dwelling independent older people, for primary prevention. We examined individual and environmental factors affecting life-space mobility among community-dwelling independent older people. METHODS: This cross-sectional study included 3500 community-dwelling independent older people randomly selected using the National Basic Resident Registration System in Japan. Life-space mobility was measured using the Japanese version of the Life-Space Assessment (LSA) instrument, which is used to assess an individual's pattern of mobility. Negative multivariate binomial regression analysis was performed in a final sample of 1258 people. Individual factors (including physical, mental, and social characteristics) and environmental factors (including the social and material environment) were measured and analyzed as potential factors. RESULTS: Negative multivariable binomial regression analysis, adjusted for demographics, showed that LSA score was associated with locomotive syndrome (ß = - 0.48, 95% confidence interval [CI] = - 0.24 to - 0.73), depression (ß = - 0.29, 95% CI = - 0.03 to - 0.55), health literacy (ß = 0.20, 95% CI = 0.39-0.01), and participation in community activities (ß = 0.23, 95% CI = 0.03-0.43) among individual factors, and receipt of social support (ß = - 0.19, 95% CI = 0.00 to - 0.38) and social network (ß = 0.29, 95% CI = 0.48-0.10) among environmental factors. CONCLUSIONS: Our findings suggest that modifiable individual factors and environmental factors are related to life-space mobility among community-dwelling older people.


Assuntos
Vida Independente/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Japão , Masculino
5.
Nutrients ; 13(2)2021 Jan 25.
Artigo em Inglês | MEDLINE | ID: mdl-33503860

RESUMO

This study aimed to investigate the impact of food insecurity and poor nutrient intake on the psychological health of middle-aged and older adults during the COVID-19 pandemic. A sub-sample of 535 individuals aged 52 years and above, from the earlier cohort and interventional studies (n = 4) from four selected states in Peninsular Malaysia, were recruited during the COVID-19 outbreak (April to June 2020). Telephone interviews were conducted by trained interviewers with a health sciences background to obtain participants' information on health status, physical activity, food security, and psychological health (General Health Questionnaire-12; normal and psychological distress). Univariate analyses were performed for each variable, followed by a logistic regression analysis using SPSS Statistics version 25.0. Results revealed food insecurity (OR = 17.06, 95% CI: 8.24-35.32, p < 0.001), low protein (OR = 0.981, 95% CI: 0.965-0.998, p < 0.05), and fiber intakes (OR = 0.822, 95% CI: 0.695-0.972, p < 0.05) were found to be significant factors associated with the psychological distress group after adjusting for confounding factors. The findings suggested that food insecurity and insufficiencies of protein and fiber intakes heightened the psychological distress during the COVID-19 pandemic. Optimal nutrition is vital to ensure the physical and psychological health of the older population, specifically during the current pandemic.


Assuntos
/epidemiologia , Estado Nutricional , Pandemias , Angústia Psicológica , Estresse Psicológico/epidemiologia , Idoso , /psicologia , Estudos Transversais , Feminino , Humanos , Vida Independente/economia , Vida Independente/psicologia , Vida Independente/estatística & dados numéricos , Malásia/epidemiologia , Masculino , Pessoa de Meia-Idade , Questionário de Saúde do Paciente/estatística & dados numéricos , Estresse Psicológico/diagnóstico , Estresse Psicológico/economia , Estresse Psicológico/psicologia
6.
CMAJ Open ; 9(1): E1-E9, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33436450

RESUMO

BACKGROUND: People with a recent history of homelessness are believed to be at high risk of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and, when infected, complications of coronavirus disease 2019 (COVID-19). We describe and compare testing for SARS-CoV-2, test positivity and hospital admission, receipt of intensive care and mortality rates related to COVID-19 for people with a recent history of homelessness versus community-dwelling people as of July 31, 2020. METHODS: We conducted a population-based retrospective cohort study in Ontario, Canada, between Jan. 23 and July 31, 2020, using linked health administrative data among people who either had a recent history of homelessness or were dwelling in the community. People were included if they were eligible for provincial health care coverage and not living in an institutionalized facility on Jan. 23, 2020. We examined testing for SARS-CoV-2, test positivity and complication outcomes of COVID-19 (hospital admission, admission to intensive care and death) within 21 days of a positive test result. Extended multivariable Cox proportional hazard models were used to estimate adjusted hazard ratios (HRs) in 3 time periods: preshutdown (Jan. 23-Mar. 13), peak (Mar. 14-June 16) and reopening (June 17-July 31). RESULTS: People with a recent history of homelessness (n = 29 407) were more likely to be tested for SARS-CoV-2 in all 3 periods compared with community-dwelling people (n = 14 494 301) (preshutdown adjusted HR 1.61, 95% confidence interval [CI] 1.22-2.11; peak adjusted HR 2.95, 95% CI 2.88-3.03; reopening adjusted HR 1.45, 95% CI 1.39-1.51). They were also more likely to have a positive test result (peak adjusted HR 3.66, 95% CI 3.22-4.16; reopening adjusted HR 1.76, 95% CI 1.15-2.71). In the peak period, people with a recent history of homelessness were over 20 times more likely to be admitted to hospital for COVID-19 (adjusted HR 20.35, 95% CI 16.23-25.53), over 10 times more likely to require intensive care for COVID-19 (adjusted HR 10.20, 95% CI 5.81-17.93) and over 5 times more likely to die within 21 days of their first positive test result (adjusted HR 5.73, 95% CI 3.01-10.91). INTERPRETATION: In Ontario, people with a recent history of homelessness were significantly more likely to be tested for SARS-CoV-2, to have a positive test result, to be admitted to hospital for COVID-19, to receive intensive care for COVID-19 and to die of COVID-19 compared with community-dwelling people. People with a recent history of homelessness should continue to be considered particularly vulnerable to SARS-CoV-2 infection and its complications.


Assuntos
Cuidados Críticos , Pessoas em Situação de Rua/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Vida Independente/estatística & dados numéricos , /isolamento & purificação , /diagnóstico , /prevenção & controle , /estatística & dados numéricos , Cuidados Críticos/métodos , Cuidados Críticos/estatística & dados numéricos , Feminino , Humanos , Masculino , Mortalidade , Ontário/epidemiologia , Medição de Risco , Índice de Gravidade de Doença , Populações Vulneráveis
7.
J Urol ; 205(1): 199-205, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32808855

RESUMO

PURPOSE: We compared short and long-term outcomes between nursing home residents and matched community dwelling older adults undergoing surgery for pelvic organ prolapse. MATERIALS AND METHODS: This retrospective cohort study evaluates women 65 years old or older undergoing different types of pelvic organ prolapse repairs (anterior/posterior, apical and colpocleisis) between 2007 and 2012 using Medicare claims and the Minimum Data Set for Nursing Home Residents. Long-stay nursing home residents were identified and propensity score matched (1:2) to community dwelling older individuals based on procedure type, age, race and Charlson score. Generalized estimating equation models were created to determine the relative risk of hospital length of stay 3 or more days, 30-day complications and 1-year mortality between the 2 groups. Kaplan-Meier curves were created comparing 1-year mortality between groups. RESULTS: There were 799 nursing home residents and 1,598 matched community dwelling older adults who underwent pelvic organ prolapse surgery and were included in our analyses. Nursing home residents demonstrated statistically significant increased risk for hospital length of stay 3 or more days (38.9% vs 18.6%, adjusted RR 2.1, 95% CI 1.8-2.4), 30-day complications (15.1% vs 3.8%, aRR 3.9, 95% CI 2.9-5.3) and 1-year mortality (11.1% vs 3.2%, aRR 3.5, 95% CI 2.5-4.8) compared to community dwelling older adults. Kaplan-Meier curves illustrated similar survival findings at 1 year (11.1%, 95% CI 9.0-13.3 vs 3.2%, 95% CI 2.3-4.1, p <0.0001). CONCLUSIONS: Despite matching on several characteristics, nursing home residents demonstrated worse short and long-term outcomes compared to community dwelling older adults, suggesting other key vulnerabilities exist that contribute additional surgical risk in this population.


Assuntos
Procedimentos Cirúrgicos em Ginecologia/efeitos adversos , Vida Independente/estatística & dados numéricos , Casas de Saúde/estatística & dados numéricos , Prolapso de Órgão Pélvico/cirurgia , Complicações Pós-Operatórias/epidemiologia , Demandas Administrativas em Assistência à Saúde/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Feminino , Procedimentos Cirúrgicos em Ginecologia/métodos , Humanos , Estimativa de Kaplan-Meier , Tempo de Internação/estatística & dados numéricos , Medicare/estatística & dados numéricos , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fatores de Risco , Estados Unidos/epidemiologia
8.
J Urol ; 205(1): 219-225, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32856986

RESUMO

PURPOSE: Little is known about the fall risk of older adults with overactive bladder, especially in the absence of urgency incontinence. We evaluated the impacts of overactive bladder with and without urgency incontinence (overactive bladder wet and overactive bladder dry) on the fall risk in older adults, and investigated the importance of overactive bladder as a predictor of falls by using tree based models. MATERIALS AND METHODS: This prospective cohort study included 630 community dwelling, independent older adults 75 years old or older who attended a health checkup in 2017 with a 1-year followup. The associations of overactive bladder dry and overactive bladder wet with a fall history, and future fall risk compared to no overactive bladder were assessed using logistic regression models. The contribution of overactive bladder as a predictor of falls was examined using a random forest and decision tree approach. RESULTS: Of the 577 analyzed participants (median age 79 years), 273 (47%) were men. The prevalence of overactive bladder dry and overactive bladder wet at baseline was 15% and 14%, respectively. Multivariable logistic regression analysis revealed that both overactive bladder dry and overactive bladder wet were associated with a higher likelihood of prior falls (adjusted ORs vs no overactive bladder 2.03 and 2.21, respectively; 95% CI 1.23-3.37 and 1.29-3.78, respectively). Among the 363 participants without a fall history, the adjusted ORs (95% CIs) of overactive bladder dry and overactive bladder wet for the occurrence of falls during the 1-year followup were 2.74 (1.19-6.29) and 1.35 (0.47-3.87), respectively. The tree based approach used for all participants showed that overactive bladder was an important predictor of falls in adults without a fall history, and the model had 83.6% accuracy and 81.8% AUC. CONCLUSIONS: Overactive bladder, even in the absence of urgency incontinence, is an important predictor of falls in older adults with a low absolute fall risk.


Assuntos
Acidentes por Quedas/estatística & dados numéricos , Vida Independente/estatística & dados numéricos , Bexiga Urinária Hiperativa/epidemiologia , Incontinência Urinária/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Japão/epidemiologia , Masculino , Prevalência , Estudos Prospectivos , Medição de Risco/estatística & dados numéricos , Fatores de Risco , Autorrelato/estatística & dados numéricos , Bexiga Urinária Hiperativa/complicações , Incontinência Urinária/complicações
9.
PLoS One ; 15(12): e0242911, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33326422

RESUMO

BACKGROUND: The prevalence of cognitive impairment or dementia is of public health concern globally. Accurate estimates of this debilitating condition are needed for future public health policy planning. In this study, we estimate prevalence and modifiable risk factors for cognitive impairment by sex over approximately 16 years. METHODS: Canadian Study of Health and Aging (CSHA) baseline data conducted between 1991-1992 were used to measure the prevalence of cognitive impairment and dementia among adults aged 65+ years. The standard Modified Mini-Mental State Examination (3MS) was used for the screening test for cognitive impairment. We compared the CSHA data with Canadian Community Health Survey-Healthy Aging (CCHS-HA) conducted between 2008-2009. The CCHS-HA used a four-dimension cognitive module to screen for cognitive impairment. Only survey community-dwelling respondents were included in the final sample. After applying exclusion criteria, final samples of (N = 8504) respondents in the CSHA sample and (N = 7764) respondents for CCHS-HA sample were analyzed. To account for changes in the age structure of the Canadian population, prevalence estimates were calculated using age-sex standardization to the 2001 population census of Canada. Logistic regression analyses were used to examine predictors of cognitive impairment. A sex stratified analysis was used to examine risk factors for cognitive impairment in the survey samples. RESULTS: We found that prevalence of cognitive impairment among respondents in CSHA sample was 15.5% in 1991 while a prevalence of 10.8% was reported in the CCHS-HA sample in 2009, a 4.7% reduction [15.5% (CI = 14.8-16.3), CSHA vs 10.8% (CI = 10.1-11.5), CCHS-HA]. Men reported higher prevalence of cognitive impairment in CSHA study (16.0%) while women reported higher prevalence of cognitive impairment in CCHS-HA (11.6%). In the multivariable analyses, risk factors such as age, poor self-rated health, stroke, Parkinson's disease, and hearing problems were common to both cohorts. Sex differences in risk factors were also noted. CONCLUSIONS: This study provides suggestive evidence of a potential reduction in the occurrence of cognitive impairment among community-dwelling Canadian seniors despite the aging of the Canadian population. The moderating roles of improved prevention and treatment of vascular morbidity and improvements in the levels of education of the Canadian population are possible explanations for this decrease in the cognitive impairment.


Assuntos
Disfunção Cognitiva/epidemiologia , Vida Independente/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Canadá/epidemiologia , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , Prevalência , Fatores de Risco , Distribuição por Sexo
10.
PLoS One ; 15(12): e0243548, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33326452

RESUMO

As older adults in an early stage (prefrailty) of frailty may return to a healthy state, it is necessary to examine the prevention of prefrailty. In this context, the number and types of social participation activities associated with physical prefrailty in community-dwelling older adults have remained relatively unexplored. This cross-sectional study investigates this issue by analyzing 616 participants living in Okinoshima, Shimane, a rural area of Japan, in 2019. Frailty was assessed using the 5-item frailty phenotype (unintentional weight loss, self-reported exhaustion, weakness, slow walking speed, and low physical activity). Data on social participation were obtained using a questionnaire based on participants' level of involvement with volunteer groups, sports clubs/groups, neighborhood associations, religious organizations/groups, and community elderly salons; their answers were categorized as "yes" if they answered "several times per year or more" and "no" if they answered "never." Binominal logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (CI) of prefrailty by the number or types of social participation activities, adjusted for gender, age, body mass index, smoking, medication-taking, educational attainment, working status, and living arrangement. Of the 616 participants, 273 (44.3%) and 28 (4.5%) had prefrailty and frailty, respectively. The analysis showed that the number of social participation activities was significantly associated with lower odds of prefrailty (OR = 0.83; 95% CI, 0.74-0.94). Regarding the types of social participation, sports clubs/groups were associated with lower odds of prefrailty (OR = 0.47; 95% CI, 0.31-0.73). Participation in neighborhood associations was associated with prefrailty/frailty (OR = 0.57; 95% CI, 0.37-0.86). These results suggest that increasing the number of social participation activities or involvement in sports clubs/groups and neighborhood associations may be important to prevent physical prefrailty in the older population.


Assuntos
Idoso Fragilizado/psicologia , Fragilidade/prevenção & controle , Participação Social/psicologia , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Exercício Físico , Fadiga , Feminino , Idoso Fragilizado/estatística & dados numéricos , Fragilidade/fisiopatologia , Humanos , Vida Independente/estatística & dados numéricos , Japão/epidemiologia , Modelos Logísticos , Masculino , Autorrelato , Inquéritos e Questionários , Perda de Peso
11.
JAMA Netw Open ; 3(12): e2030090, 2020 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-33320267

RESUMO

Importance: The vast majority of older adults desire to age in their communities, and it is not clear what helps them be successful at aging in place. Objective: To investigate the comparative effectiveness of community-designed and community-implemented peer-to-peer (P2P) support programs vs standard community services (SCS) to promote health and wellness in at-risk older adults. Design, Setting, and Participants: This comparative effectiveness study involved a longitudinal cohort of adults aged 65 years and older conducted between 2015 and 2017. The setting was 3 communities in which community-based organizations delivered P2P services to older adults in California, Florida, and New York. Participants in the P2P group and in the SCS group were matched at enrollment into the study according to age, sex, and race/ethnicity at each site. Data analysis was performed from October 2018 to May 2020. Exposures: P2P support was provided by trained older adult volunteers in the same community. They provided support targeted at the needs of the older adult they served, including transportation assistance, check-in calls, social activities, help with shopping, and trips to medical appointments. Main Outcomes and Measures: Rates of hospitalization, urgent care (UC) and emergency department (ED) use, and a composite measure of health care utilization were collected over 12 months of follow-up. Results: A total of 503 participants were screened, 456 participants were enrolled and had baseline data (234 in the SCS group and 222 in the P2P group), and 8 participants had no follow-up data, leaving 448 participants for the main analysis (231 in the SCS group and 217 in the P2P group; 363 women [81%]; mean [SD] age, 80 [9] years). Participants in the P2P group more often lived alone, had lower incomes, and were more physically and mentally frail at baseline compared with the SCS group. After adjusting for propensity scores to account for baseline differences between the 2 groups, there was a statistically significant higher rate of hospitalization in the P2P group than in the SCS group (0.68 hospitalization per year vs 0.44 hospitalization per year; risk ratio, 1.54; 95% CI, 1.14-2.07; P = .005) during the 12 months of observation. There were no significant differences between the 2 groups in the rates of ED or UC visits or composite health care utilization over the 12 months of the study. Conclusions and Relevance: P2P support was associated with higher rates of hospitalization but was not associated with other measures of health care utilization. Given that this is not a randomized clinical trial, it is not clear from these findings whether peer support will help older adults age in place, and the topic deserves further study.


Assuntos
Redes Comunitárias , Vida Independente/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Sistemas de Apoio Psicossocial , Idoso , Idoso de 80 Anos ou mais , Assistência Ambulatorial/estatística & dados numéricos , Estudos de Coortes , Redes Comunitárias/organização & administração , Redes Comunitárias/estatística & dados numéricos , Pesquisa Comparativa da Efetividade , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Grupo Associado , Estados Unidos
12.
Artigo em Inglês | MEDLINE | ID: mdl-33317015

RESUMO

This study identified the pathways chosen by people with severe physical disabilities (PWSPD) in South Korea and Japan in using community care throughout their life and compared their experiences while navigating these pathways from their perspective. A concurrent nested mixed-method design was adopted. Quantitative data analysis included pathway mapping of facilities and services used throughout their lives. For qualitative data, interpretative phenomenological analysis (IPA) was applied. Eleven South Korean (congenital 7, acquired 4) and nine Japanese (congenital 6, acquired 3) participants were surveyed and interviewed. Pathway mapping was conducted by classifying the participants into focus groups. South Korean participants took nine years more than the Japanese participants to reach independence and showed different pathway characteristics. Superordinate themes from the IPA provided insight into the differences in experiences between PWSPD of the two countries: (1) accessibility and continuity of medical services; (2) experience of vocational training; (3) way and degree of social support for independent living; (4) care planning for receiving comprehensive services. In developing a community care model for the PWSPD to accelerate their time to independence, the government should strive for accessibility and connectivity of medical services, strengthen vocational training, social support for independent living, and information provision for the PWSPD.


Assuntos
Redes Comunitárias , Pessoas com Deficiência , Vida Independente , Acontecimentos que Mudam a Vida , Redes Comunitárias/estatística & dados numéricos , Pessoas com Deficiência/estatística & dados numéricos , Humanos , Vida Independente/estatística & dados numéricos , Japão , República da Coreia
13.
Ann Agric Environ Med ; 27(4): 621-629, 2020 Dec 22.
Artigo em Inglês | MEDLINE | ID: mdl-33356070

RESUMO

INTRODUCTION: In Poland, the number of the oldest-old people is increasing. The prevalence of health problems increases with age, which expands the cost of medical and social care. Therefore, there is a need to assess factors affecting the level of disability and quality of life in order to modify them. MATERIAL AND METHODS: The study was carried out in a group of 498 people aged 80 and over who live in community in south-eastern Poland. The researchers collected socio-demographic and health data, the WHODAS 2.0 questionnaire was used to assess disability and functioning. Quality of life was studied using the WHOQOL-BREF questionnaire. RESULTS: The general average level of disability was 37.41, with women having a higher level of general disability than men (38.94 vs. 33.94). The highest levels of disability occurred in areas such as mobility, life activity and participation. Statistically, a significantly higher level of disability develops in women who are older, with lower education, social involvement, not able to get help from other people and having more chronic diseases. In men, disability increased with age and greater number of chronic illnesses. The general quality of life of the study group was average (62.53) and comparable for both genders. The lowest quality of life was found in the domain of physical health. A significantly lower quality of life appeared in lonely people, with more chronic diseases, lower education, physical and social inactivity, as well as a lack of help from other people and non-adjustment to the environment. CONCLUSIONS: Factors affecting the disability and quality of life of the oldest-old people should be considered in developing senior health policy in Poland.


Assuntos
Pessoas com Deficiência/estatística & dados numéricos , Vida Independente/estatística & dados numéricos , Qualidade de Vida , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Vida Independente/psicologia , Masculino , Polônia
14.
BMJ Open ; 10(10): e040341, 2020 10 13.
Artigo em Inglês | MEDLINE | ID: mdl-33051236

RESUMO

INTRODUCTION: Local activities that functioned to prevent frailty in the elderly have been suspended or reduced as a countermeasure against COVID-19. As a result, frailty rates are expected to increase, and frailty is expected to worsen as a secondary problem associated with COVID-19 countermeasures. Therefore, this study aims to determine the extent of frailty in the elderly associated with lifestyle changes implemented as COVID-19 countermeasures, to ascertain actual lifestyle changes and clarify the existence of Corona-Frailty. We will also conduct Corona-Frailty screening to verify the effect of support provided as feedback to supporters of the elderly. METHODS AND ANALYSIS: The survey target area is Takasaki City, Gunma Prefecture, Japan. Phase I aims to verify the short-term effects of COVID-19. A questionnaire will be distributed to 465 community-dwelling elderly people, and responses will be obtained by post. Frailty will be evaluated using the Frailty Screening Index. Respondents who are frail and have had many changes in their lifestyle will be screened as high-risk people, and feedback will be provided to local supporters. The aim of Phase II will be to verify the long-term effects of COVID-19 and the effect of screening. A similar survey will be distributed twice after the first survey, once after 6 months and again after 1 year and the frailty rate will be tested. Furthermore, out of the subjects identified with frailty in Phase I, the progress of those who were screened and those who were not screened will be compared between groups. ETHICS AND DISSEMINATION: This study has been approved by the Research Ethics Committee of the Takasaki University of Health and Welfare (approval number: 2009). The results of this study will be reported to the policymaker, presented at academic conferences and published in peer-reviewed journals. TRIAL REGISTRATION NUMBER: UMIN000040335.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Idoso Fragilizado/estatística & dados numéricos , Fragilidade/epidemiologia , Avaliação Geriátrica/métodos , Vida Independente/estatística & dados numéricos , Estilo de Vida , Pneumonia Viral/epidemiologia , Atividades Cotidianas , Idoso , Envelhecimento/fisiologia , Comorbidade , Estudos Transversais , Feminino , Humanos , Masculino , Pandemias , Inquéritos e Questionários
15.
Environ Health Prev Med ; 25(1): 46, 2020 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-32873231

RESUMO

BACKGROUND: Preventing the need for long-term care (LTC) by identifying physical function risk factors are important to decrease the LTC burden. The objective of this study was to investigate whether grip strength and/or walking speed, which are components of the frailty definition, are associated with LTC in community-dwelling older and oldest people. METHODS: The participants were 1098 community-dwelling older and oldest people who had not received LTC at the baseline. The endpoint was receiving LTC after the baseline survey. The independent variables were grip strength and walking speed, and participants were divided into two groups based on these variables. The confounding factors were age, sex, the Japanese version of the Montreal Cognitive Assessment (MoCA-J), hypertension, diabetes mellitus, stroke, joint diseases, living alone, body mass index, and serum albumin. We calculated the hazard ratio of receiving LTC using the Cox proportional hazard model. RESULTS: Among the 1098 participants, 107 (9.7%) newly received LTC during the follow-up. Regarding the physical function, only slow walking speed was significantly correlated with LTC after adjusting for all confounding factors except the MoCA-J score (HR = 1.74, 95% CI = 1.10-2.75, P = .018). However, slow walking speed was still a risk factor for LTC after adjusting for the MoCA-J score and other confounding factors (HR = 1.64, 95% CI = 1.03-2.60, P = .037). CONCLUSIONS: The findings from this study may contribute to a better understanding of slow walking speed as a factor related to LTC, which might be a criterion for disability prevention and could serve as an outcome measure for physical function in older people.


Assuntos
Exercício Físico , Vida Independente/estatística & dados numéricos , Assistência de Longa Duração/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Japão , Masculino , Modelos de Riscos Proporcionais
17.
J Urol ; 204(6): 1305-1311, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32924780

RESUMO

PURPOSE: Most international practice guidelines recommend screening for chronic kidney disease among older men with lower urinary tract symptoms. However, prior studies supporting these guidelines are insufficient due to incomplete assessments of kidney function and inadequate adjustment for confounding factors. MATERIALS AND METHODS: We conducted a cross-sectional study among 5,530 American men older than 65 years in the multicenter Osteoporotic Fractures in Men Study. Chronic kidney disease was defined per international guidelines as estimated glomerular filtration rate less than 60 ml/minute/1.73 m2 based on serum creatinine or cystatin C, or urinary albumin-to-creatinine ratio 30 mg/gm or greater. Lower urinary tract symptoms were assessed with the American Urological Association Symptom Index. Associations were estimated using multivariable linear and modified Poisson regression models. RESULTS: Chronic kidney disease prevalence was 16% among 5,530 men with serum creatinine, 24% among 1,504 men with serum cystatin C and 14% among 1,487 men with urinary albumin-to-creatinine measurements. Lower urinary tract symptoms were not associated with lower estimated glomerular filtration rate based on serum creatinine or cystatin C. Although symptom severity was modestly associated with a higher prevalence of chronic kidney disease in age/site adjusted analyses, confidence intervals were wide and associations using all 3 definitions were not statistically significant after adjustment for important confounders, including cardiovascular disease and analgesic use. CONCLUSIONS: Lower urinary tract symptoms are not independently associated with multiple measures of kidney dysfunction or prevalence of chronic kidney disease among older community dwelling men. Our results do not support recommendations for kidney function testing among older men with lower urinary tract symptoms.


Assuntos
Vida Independente/estatística & dados numéricos , Sintomas do Trato Urinário Inferior/epidemiologia , Insuficiência Renal Crônica/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Albuminúria/diagnóstico , Fatores de Confusão Epidemiológicos , Creatinina/sangue , Creatinina/urina , Estudos Transversais , Cistatina C/sangue , Taxa de Filtração Glomerular/fisiologia , Humanos , Sintomas do Trato Urinário Inferior/complicações , Sintomas do Trato Urinário Inferior/diagnóstico , Sintomas do Trato Urinário Inferior/fisiopatologia , Masculino , Prevalência , Insuficiência Renal Crônica/sangue , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/etiologia , Índice de Gravidade de Doença , Micção/fisiologia
18.
PLoS One ; 15(9): e0237432, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32886657

RESUMO

Using multilevel logistic regression to analyse management data of reablement episodes collected by Essex County Council, a UK local authority, this article identifies constraining and enabling factors for successful reablement. Overall, 59.5% of reablement clients were classed as able to care for themselves when assessed after 13 weeks following the reablement intervention (N = 8,118). Several age-related, disability, referral, and social factors were found to constrain reablement, but some of the largest constraining effects were neighbourhood deprivation as measured through the Index of Multiple Deprivation and, particularly, unfavourable geodemographic profiles as measured through Experian Mosaic consumer classifications. The results suggest that in order to optimise reablement, programmes should consider broader social and environmental influences on reablement rather than only individual and organisational aspects. Reablement might also be better tailored and intensified for client groups with particular underlying disabilities and for those displaying specific geodemographic characteristics.


Assuntos
Atividades Cotidianas , Necessidades e Demandas de Serviços de Saúde , Enfermagem Domiciliar/organização & administração , Vida Independente/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Feminino , Enfermagem Domiciliar/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Reino Unido
20.
PLoS One ; 15(8): e0237166, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32745148

RESUMO

This study aims to clarify the factors associated with the gradual withdrawal from society in older adults. We defined the stages of follow-up difficulty based on four follow-up surveys on non-respondents of longitudinal mail surveys in community-dwelling older adults to examine the main factors associated with the stages of follow-up difficulty. We conducted a follow-up mail survey (FL1) with respondents of a baseline survey, and three more follow-up surveys with the non-respondents of each previous survey: simplified mail (FL2), postcard (FL3), and home visit surveys (FL4). The respondents of each follow-up survey were defined as a stage of follow-up difficulty; their characteristics concerning social participation and interaction at baseline in each stage were analyzed. The number of respondents in the FL1, FL2, FL3, and FL4 stages and non-respondents (NR) were as follows: 2,361; 462; 234; 84; and 101, respectively. Participation in hobby groups in FL2 and FL3, sports groups in FL4, and neighborhood association and social isolation in NR were significantly associated with the stage of follow-up difficulty. Based on these results, we conclude that the following factors are associated with each stage of follow-up difficulty: 1) a decline in instrumental activities of daily living in the FL2 and FL3 stages, 2) dislike for participating in physical activity such as sports in the FL4 stage, and 3) social isolation, not even belonging to a neighborhood association due to low social interaction in the NR group.


Assuntos
Atividades Cotidianas , Envelhecimento/psicologia , Vida Independente/estatística & dados numéricos , Perda de Seguimento , Comportamento Social , Idoso , Idoso de 80 Anos ou mais , Envelhecimento/fisiologia , Participação da Comunidade , Feminino , Seguimentos , Humanos , Estudos Longitudinais , Masculino , Inquéritos e Questionários/estatística & dados numéricos
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