Quality of Life in Australian Adults Aged 50 Years and Over: Data Using the Schedule for the Evaluation of Individual Quality of Life (SEIQOL-DW).

OBJECTIVES: This study explored unique and personal domains associated with quality of life (QOL) in 153 mid-aged and older Australian adults over age 50, using an innovative measure of individualized QOL, the Schedule for the Evaluation of Individual Quality of Life (SEIQOL-DW). METHODS: Demographic measures as well as the SEIQOL-DW were administered. The qualitative responses on this scale were analyzed by Leximancer, a text analysis program that extracts semantic meaning and relational information automatically from text. RESULTS: For the sample as a whole, the most important QOL domain was found to be Relationships, followed by Family, Health, Activities, Community, Security, Beliefs, Independence and finally Wellbeing. When the sample was broken down into age bands for analysis, the most important domain theme was Family (50-59 year olds), Relationships (60-69 year olds), Relationships (70-79 year olds), and Health (80+ year olds). CONCLUSIONS: The wide range of concepts elicited in each domain via Leximancer underscores the argument for analyzing QOL in an individualized way, as it was clear from these concepts that different domains had unique meanings to each person. CLINICAL IMPLICATIONS: Understanding QOL at the level of which domains in an individual are important to QOL in later life is critical to providing services to both healthy aged as well as those with health and mental health needs. The SEIQOL-DW affords clinicians a unique tool with which to describe an individual's unique and relevant quality of life areas, and affords a way to measure change in these areas as a result of interventions.

Super-aging and social security for the most elderly in China.

This article is dedicated to an under-researched area, the demographic development and social welfare for the most elderly (aged ≥80 years) in The People's Republic of China. Based on national censuses conducted over the last six decades in China this study examined the development of the most elderly population in comparison with groups of younger elderly people. It is argued that population growth among the most elderly in China has occurred with unparalleled speed, a phenomenon referred to as second order aging. This study demonstrated that the proportion of individuals aged ≥80 years has increased more rapidly than any other age group among elderly people. Particular attention has been given to the issue of social security and social welfare for the most elderly based on the non-contributory old age allowances provided by various regions and provinces. A national unified program of social security for the most elderly in the population is still not in sight.

A cost of living longer: Projections of the effects of prospective mortality improvement on economic support ratios for 14 advanced economies.

The economic implications of increasing life expectancy are important concerns for governments in developed countries. The aims of this study were as follows: (i) to forecast mortality for 14 developed countries from 2010 to 2050, using the Poisson Common Factor Model; (ii) to project the effects of the forecast mortality patterns on support ratios; and (iii) to calculate labour force participation increases which could offset these effects. The forecast gains in life expectancy correlate negatively with current fertility. Pre-2050 support ratios are projected to fall most in Japan and east-central and southern Europe, and least in Sweden and Australia. A post-2050 recovery is projected for most east-central and southern European countries. The increases in labour force participation needed to counterbalance the effects of mortality improvement are greatest for Japan, Poland, and the Czech Republic, and least for the USA, Canada, Netherlands, and Sweden. The policy implications are discussed.

Condicionantes para el abordaje del aislamiento social y la soledad de adultos mayores no institucionalizados desde atención primaria de salud / Determinants for addressing social isolation and loneliness of non-institutionalized older adults from Primary Health Care

Objetivo: Identificar los principales condicionantes que los profesionales de atención primaria indican a la hora de implementar y desarrollar intervenciones sobre el aislamiento y la soledad.Diseño: Investigación cualitativa con análisis Sistemático de Teoría Fundamentada y Diseño narrativo de tópicos.Emplazamiento: Desarrollada en 13 centros de atención primaria del Distrito Sanitario Córdoba y Guadalquivir, abarcando zonas urbanas y rurales.Participantes: Se identificaron 3 perfiles: medicina de familia/atención comunitaria, enfermería comunitaria y enfermería de gestión de casos. La selección se llevó a cabo entre aquellos que mostraron mayor motivación y compromiso con una intervención sobre aislamiento/soledad.Método: Muestreo intencional. El trabajo se fundamentó en entrevistas en profundidad individuales, en grupos focales y entrevistas dialógicas.Resultados :a) Persisten imágenes deformadas sobre la soledad/aislamiento social y el vivir solo que dificultan su identificación; b) Los principales determinantes disruptivos en la estructura y organización del sistema de atención tienen que ver con la ausencia de programas de detección, la hegemonía del modelo biomédico y el déficit de recursos (a la luz de este modelo); c) Los principales facilitadores se vinculan con el rol enfermero, privilegiado para estas intervenciones según los participantes; y, finalmente, d) Es necesario contar con componentes personales, tanto de la persona mayor como de los profesionales.Conclusiones: La intervención sobre el aislamiento social y la soledad en atención primaria está condicionada por factores, organizacionales y estructurales, profesionales y personales. Contar con ellos es fundamental a la hora de garantizar su factibilidad.

Objective: To identify the main conditioning factors that Primary Care professionals indicate when implementing and developing interventions on isolation and loneliness.Design: Qualitative research with grounded theory, systematic analysis and narrative design of topics.Location: Developed in 12 Primary Care centres of the Health District of Córdoba and Guadalquivir, covering urban and rural areas.Participants: Three profiles were identified: family medicine/community care, community nursing and case management nursing. The selection was carried out among those who showed greater motivation and commitment to an intervention on isolation/loneliness.Method: Purposive sampling. The work was based on individual in-depth interviews, focus groups and dialogic interviews.Results: (a) Distorted images persist about loneliness/social isolation and living alone that make it challenging to identify; (b) the main disruptive determinants in the structure and organization of the care system have to do with the absence of screening programs, the hegemony of the biomedical model and the deficit of resources (in light of this model); (c) the main facilitators are linked to the nursing role, privileged for these interventions according to the participants; and, finally, (d) personal components are necessary, both from the older adult and from the professionals.Conclusions: Intervention on social isolation and loneliness in Primary Care is conditioned by organizational and structural, professional and personal factors. It is essential to take them into account in order to guarantee their feasibility.

Changing criteria in old-age programs: the introduction of economic status and need for services.

For more than a decade, incremental changes have gradually eroded the traditional approach in many policies that have relied primarily on specific old-age categories to determine eligibility for public benefits and the amount of those benefits. These changes, and other recent policy proposals, have introduced need-based criteria as well as the principle of asking wealthier older persons to pay greater taxes or share more heavily in financing services and benefits than those older people who have less income and accumulated wealth. This discussion of such modifications in policies on aging begins with a depiction of the political context in which they have emerged. It then reviews the emergence of the new approaches, and concludes with commentary on the political viability of these and other possible changes in the mixture of criteria used in old-age benefit programs.

A contingency-based approach for assessing policies on aging.

This article assesses the demographic and ideological shifts reshaping aging policy and proposes an approach to rethinking the bases of aging-based and aging-related policy. This approach takes into account new and multiple patterns of need and well-being among the old and, as such, holds the promise of providing both a defense of and a rationale for a range of age-related benefits. As well, it opens the possibility of shifting responsibilities for well-being in old age among government, the private sector, and individuals themselves.

Beyond the family: informal support in later life.

This paper adopts the position that although the Canadian family is, and will continue to be an important source of support for its older members, there are limitations in its ability to do so. These limitations have to do with demographic and social changes occurring in contemporary society and highlight the importance of looking to alternative sources of support emerging in the literature as significant to people in their later years. These alternative sources of support which have potential importance for health and wellbeing in later life, have to a large extent been neglected by health care providers. It is suggested that health care practitioners expand the notion of family as the unit of care, which is central to their practice, to include sources of support beyond the immediate family.

Austerity and aging in the United States: 1980 and beyond.

This paper presents a critical examination of the past and future direction of social policies for the aged in the United States. The definitions of the social problem of old age and of the appropriate policy solutions for this problem have reflected the ups and downs of the U.S. economy and the shifting bases of political power during the past thirty years. In the 1980s, three dominant definitions of reality are shaping public policy for the elderly: (a) the perception of fiscal crisis and the necessity for reduced federal expenditures; (b) the perception that national policies should give way to decentralization and block grants; and (c) the perception of old age as an individual problem. It is argued that old age policy in the United States reflects a two-class system of welfare in which benefits are distributed on the basis of legitimacy rather than on the basis of need.

Old age security in rural China: there is a long way to go.

OBJECTIVE: We aimed to examine the current developments and challenges confronted by old age security in rural China. DATA SOURCES: This study is based on the data from PubMed, Elsevier, Wiley, EBSCO, EMBASE, SCI Expanded, ProQuest, Google, and CNKI which is the most informative database in Chinese. STUDY SELECTION: Articles were selected with the search terms "rural", "China", "old", "older", or "elder", "elderly", or "aged", "aging", "security", "culture", "value", "medical insurance" or "community based medical insurance" or "cooperative medical scheme". Related websites and yearbooks were searched as well. RESULTS: The socio-economic development has made the burden of traditional care for the rural elderly heavier than ever, and new challenges are emerging in rural communities, such as poor economic, deteriorating natural environment and health crisis. CONCLUSIONS: The governments should improve the scale and caliber of rural old age security and strengthen regulations with great efforts in developing the rural economy and protecting the natural environment of rural communities.

Tratamiento del dolor en el anciano: opioides y adyuvantes / Drug treatment invasive joint in osteoarthritis

En pacientes seleccionados, los opioides pueden proporcionar una adecuada analgesia en el marco de un abordaje integral. Se ha revisado la utilización de opioides fuertes en ancianos con dolor oncológico o no oncológico. Se ha demostrado eficacia en dolor músculo-esquelético a corto plazo y algunos tipos de dolor neuropático. No obstante, no se dispone de datos sobre eficacia y seguridad a largo plazo. Aunque los antidepresivos tricíclicos son eficaces para el dolor neuropático, sus efectos anticolinérgicos suponen un problema para el anciano. Antiepilépticos como gabapentina y pregabalina son eficaces para el dolor neuropático y mejor tolerados. La administración tópica de algunos fármacos mejora la tolerabilidad de los mismos (AU)

There is a small number of primary studies relating to opioid use in older people. In carefully selected and monitored patients, opioids may provide effective pain relief as part of comprehensive pain management strategy. Use of strong opioids in the management of chronic, severe cancer and non-cancer pain in older people has been reviewed. Studies have demonstrated short-term efficacy in persistent musculoskeletal pain and various neuropathic pains. However, longer-term efficacy and safety data are lacking. Some adjuvant drugs should be considered for older people with neuropathic. Although tricyclic antidepressants have good efficacy, anticholinergic side effects are often problematic for older people. Anti-epileptic drugs such asgabapentin or pregabalin, are effective for neuropathic pain and are probably better tolerated. Topical administration may have improved tolerability than other routes of administration and may be preferable for elderly (AU)

Safety and security of older persons in Tehran, Iran: a sociological appraisal of elder abuse.

The article explores and evaluates the quality of life, safety, and security of elderly people in Tehran City in Iran. In that, different dimensions of material and social well-being, and abuse of people of the age 65 and above, are assessed. Besides the human rights, the dignity, and the gradual decline of the elderly's social security are reflected. The research also aims to study the elder age-groups in order to find out how these people gradually lose their physical and mental reliance, and as a result, how their dependence on others and various services enhances. The method of research mainly being empirical, it is preceded by theoretical and literature review. Five hundred elderly people were randomly selected for the study. Findings suggest that the aging pyramid shrinks and narrows at the age of 65 or even before in the present study. Research reached the conclusion that the young elderly with new needs and expectations are highly different from those of their pervious generations.

Paciente anciano con diabetes mellitus y fragilidad. ¿Asociación siempre presente? / Elderly patients with diabetes mellitus and frailty. Association always present?

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Herramientas de valoración geriátrica en Servicios de Geriatría españoles / Geriatric assessment tools in Spanish Geriatric Departments

Introducción. La valoración geriátrica integral (VGI) es la principal herramienta de trabajo de los geriatras, aunque una encuesta del año 2000 encontró que se realizaba de manera heterogénea en los Servicios de Geriatría de España. Por ello nos propusimos realizar una nueva encuesta que pusiera de manifiesto las tendencias a este respecto en los últimos 13 años. Material y métodos. Estudio descriptivo transversal de los resultados de una encuesta estructurada a los responsables de 39 Servicios y Unidades de Geriatría de España, 27 con acreditación docente, realizada durante el primer semestre de 2013, sobre las herramientas de VGI empleadas en los distintos niveles asistenciales. Resultados. La tasa de respuesta de la encuesta fue del 97,4%. El 78,4% (n = 29) de los centros reconoció emplear diferentes herramientas según el nivel asistencial. Los índices de Barthel y Lawton fueron las herramientas de valoración funcional más empleadas en todos los Servicios y niveles asistenciales, aunque la velocidad de marcha y la escala de Tinetti fueron muy usadas en Hospital de día y en consultas externas. Las escalas más utilizadas en la valoración mental fueron el Mini Mental State Examination y el Mini Examen Cognoscitivo (97,4%), seguidos por test de valoración afectivo-conductual (86,8%) y severidad del deterioro cognitivo (84,2%). En las urgencias del 43,2% de los hospitales encuestados se emplearon herramientas de VGI, siendo la más usada el índice de Barthel, y el 69,4% de los dispositivos de Atención Primaria de las áreas de salud de los hospitales encuestados empleaba herramientas de VGI, siendo de nuevo las más empleadas el índice de Barthel e índice de Lawton (38,9%). La mayoría de los Servicios encuestados sigue pensando que los principales dominios que deben ser evaluados en una VGI son el funcional, mental y social, siendo otros dominios importantes la nutrición, comorbilidad, caídas y úlceras. Conclusiones. La VGI se sigue realizando de manera heterogénea en los diferentes Servicios de Geriatría españoles, aunque se aprecian tendencias hacia un mayor empleo del índice de Barthel, mayor adecuación de los instrumentos al nivel asistencial y mayor valoración de nuevos dominios como la fragilidad, nutrición o comorbilidad (AU)

Introduction. Comprehensive Geriatric Assessment (CGA) is the main measurement tool used by Geriatricians. A 2000 survey demonstrated great variability in the tools used for CGA among Spanish Geriatric Departments. A new survey to detect 13-year trends in the use of CGA tools in our country is presented. Material and methods. Descriptive study using a structured questionnaire on the use of CGA tools in different levels of care sent to the Heads of 39 Spanish Geriatric Departments or Services (27 with postgraduate teaching in Geriatrics) during the first three months of 2013. Results. The response rate was 97.4%. It was found that 78.4% (29 centers) used different tools depending on the level of care. Barthel and Lawton index were the most used functional assessment tools in all Departments and across all geriatric levels, although gait speed and Tinetti scale were frequently used in Day Hospital and Outpatient clinics. The Mini Mental State Exam and its Spanish version Mini Examen Cognoscitivo were the most used mental scales (97.4%), followed by tools for assessing depression-behavior (86.8%) and severity of cognitive impairment tools (84.2%). CGA tools were used in 43.2% of the emergency departments of the hospitals surveyed, being the most frequent. More than two-thirds (69.4%) of the Departments reported that their affiliated Primary Care centers used CGA tools, with the Barthel and Lawton again being indexes the most used. Most of the responding Departments considered that the main domains of CGA are functional, mental and social status. Nutrition, comorbidity, falls and pressure ulcers are other important domains. Conclusions. There is still a great variability in the CGA tools being used in Spanish Geriatric Departments, although there is a trend towards a greater use of Barthel index, greater adaptation of tools to each level of care, and increasing assessment of new domains like frailty, nutrition or comorbidity (AU)

Actividades Instrumentales de la Vida Diaria en Personas Mayores atendidas en la red de Atención Primaria de Salud en la comuna de Chillán Viejo-Chile / Instrumental activities of daily living of older people cared for at the Primary Health Care network in the commune of Chillan Viejo-Chile

Justificación. Estadísticas nacionales e internacionales demuestran que los equipos de salud tendrán que responder a la necesidad de cuidado de las personas mayores, reconociendo la trascendencia de la capacidad funcional como variable de evaluación de su estado de salud. Objetivo. Determinar características de las personas mayores que pueden influir en su capacidad funcional según las Actividades Instrumentales de la Vida Diaria. Diseño. Estudio cuantitativo, descriptivo-correlacional de corte transversal. Resultados. De 136 individuos estudiados (61% mujeres) y una edad promedio de 73,28 ± 6,77 años, se observó que las Actividades Instrumentales de la Vida Diaria dependen significativamente de: nivel de alfabetización (p=0,002), nivel de instrucción (p=0,024), participación comunitaria (p=0,007), estado nutricional (p=0,028) y depresión (p=0,018). Conclusión. Factores sociales, físicos y mentales se relacionan con la funcionalidad de las personas mayores. Es primordial la generación de políticas públicas de protección a este grupo de la población, con un enfoque multidisciplinario y sistémico (AU)

Justification. National and International statistics show that health teams will have to respond to the needs of caring for older people, considering the implication of the functional capacity as a variable of evaluation of their health condition. Objective. To determine those characteristics in older people that may influence their functional capacity, according to the Instrumental Activities of Daily Living. Design. Quantitative, descriptive-correlational cross sectional study. Results. Out of 136 individuals studied (61% female) and an average age of 73,28 ± 6,77 years old, it was observed that the Instrumental Activities of Daily Living depend significantly on: literacy level (p=0,002), instruction level (p=0,024), community participation (p=0,007), nutritional status (p=0,028) and depression (p=0,018). Conclusion. Social, physical and mental factors relate to the functionality of older people. It is fundamental to create public policies to protect this group in the population, with a cross functional and systemic approach (AU)

Efficacy and cost-effectiveness of second-line chemotherapy in elderly patients with advanced gastric cancer

Purpose. Second-line chemotherapy has been shown to benefit patients with advanced gastric cancer (AGC), extending the overall survival (OS) and progression-free survival (PFS). This study aimed to assess the efficacy and cost-effectiveness of second-line treatment for elderly patients with AGC. Methods. Medical records and follow-up information of elderly patients (≥70 years) with AGC who received second-line chemotherapy were collected. A Markov model comprising three health states PFS, progressive disease and death was developed to simulate the process of AGC. Cost was calculated from the perspective of Chinese society. Sensitivity analyses were applied to explore the impact of essential variables. Results. Forty-three elderly patients with AGC receiving second-line chemotherapy were included in our study. The median OS was 6.0 months (95% confidence interval (CI) 3.90-8.10) and PFS was 3.1 months (95% CI 1.38-4.82). No treatment-related death occurred. The most frequently drug-related grade 3/4 AEs were diarrhea (2.3%), leukopenia (16.3%) and nausea (7.0%). The incremental cost-effective ratio was $18,223.75/QALY for second-line chemotherapy versus BSC, which was below the threshold of 3× the per capita GDP of China, $23,970.00. Conclusion. Second-line chemotherapy was an optimal strategy for elderly AGC patients in China from the efficacy and cost-effectiveness perspective (AU)

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