Geriatrics, Volume 9, Issue 3 (June 2024) – 30 articles

Background: The importance of oral health in older adults, especially those in long-term care institutions (LTCIs), has been widely recognized. This study aimed to evaluate the sustainability of an oral health educational program (OHEP) for healthcare providers by measuring changes in their knowledge, attitudes, and practice (KAP) towards oral care provision 3 and 6 months after completing the OHEP. Methods: A pragmatic direct care nursing education trial with a control group was conducted to evaluate the sustainability of an OHEP by examining changes in KAP 3 and 6 months after the OHEP. The OHEP comprised both knowledge and skills related to oral care, whereas the control group received standard support in accordance with usual oral care practice. Results: The study included 20 healthcare providers in the intervention group and 20 in the control group. At 6 months post-OHEP, a significant difference in knowledge was observed between the two groups, with the intervention group maintaining a positive effect (mean 13.90). Conversely, the control group showed a significant decline in knowledge (from mean 14.25 to 12.10). Both groups showed an improvement in attitudes regarding oral health, with the intervention group exhibiting better results 3 months post-OHEP. Intervention group participants rated oral care as a higher priority. Conclusions: An OHEP program for LTCI direct care staff provides enhanced knowledge and attitudes toward oral health care. Regular training in direct care and additional support may be needed to sustain optimal effects on oral care practice. Full article

Several studies have reported subtle differences in cognition between individuals with subjective cognitive decline (SCD) compared to those with normal cognition. This study aimed to (i) identify these differences using discrepancy scores (e.g., categorial–phonemic verbal fluency performance) derived from neuropsychological tests in three cognitive domains (memory: Wechsler’s Word List and Digits; executive functions: Stroop and verbal fluency; and language: BNT and ECCO_Senior) and (ii) determine which discrepancy scores are significant for classification. Seventy-five older adults were included: 32 who were labeled SCD+ (age 71.50 ± 5.29), meeting Jessen et al.’s criteria, and 43 in the normal cognition group (SCD−; age 69.81 ± 4.62). Both groups completed a protocol including screening and the specified neuropsychological tests. No differences were found between the groups in their age, education, episodic memory, global cognitive state, or mood. Significant differences between the groups were observed regarding the discrepancy scores derived from BNT (naming) and ECCO_Senior (sentence comprehension). These scores accurately classified participants (71.6%), with ECCO_Senior having a primary role. ROC curves indicated a poor-to-fair model quality or diagnostic accuracy (AUC__BNT = 0.690; AUC__ECCO = 0.722). In conclusion, discrepancy scores in the language domain are important for distinguishing between individuals with SCD and normal cognition, complementing previous findings in this domain. However, given their relatively poor diagnostic accuracy, they should be used with caution as part of a more detailed neuro-psychological assessment. Full article

Older adults often experience poor oral functions, hindering rehabilitation post-acute disease treatment. However, characteristics of hospitalized patients who would benefit from professional oral-health management (POHM) have not been clarified. Therefore, we aimed to elucidate systemic and oral characteristics of patients requiring POHM during hospitalization in a convalescent hospital. This study included 312 participants admitted to the rehabilitation department of a convalescent hospital for a year. The patients were categorized according to POHM requirements (no-POHM group: 137 patients; POHM group: 175 patients) by discharge. Age, sex, primary disease at admission, Glasgow coma scale (GCS), Functional Independence Measurement (FIM), Mini nutritional assessment-short form (MNA-SF), Functional oral intake scale (FOIS), number of present and functional teeth, Oral Health Assessment Tool (OHAT) scores, and POHM details provided during patient hospitalization were compared. Binomial logistic-regression analysis identified patients requiring POHM as those who had suffered a stroke and had a low number of present teeth, poor overall oral health, low food form, and low motor skills at admission. A high percentage of POHM interventions comprised oral-hygiene care and denture treatment. In summary, patients whose oral health has deteriorated and those experiencing oral-intake difficulties upon admission to a convalescent hospital may require oral-health management. Full article

Even though Family and Community Nurses (FCNs) were introduced into the Italian healthcare system in 2000, to date, there is a substantial knowledge gap regarding the implementation of these professional figures within the Primary Care (PC) system. This scoping review aims to provide a comprehensive picture of the role of FCNs in managing older adults and the elderly with chronic conditions within the Italian PC system. A search on Medline, Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, Embase, and Scopus was conducted including studies published until 7 April 2023. Among 141 potential articles, only 4 met our inclusion criteria. Each of these studies attributed their findings to the presence of FCNs. They reported a significant decrease in the prevalence of several behaviours among patients diagnosed with hypertension, a reduction in metabolic complications among frail patients receiving home enteral nutrition, a decline in hospital readmissions or emergency services utilization among patients >65 years of ages with at least one chronic disease, and, notably, a high level of effectiveness in detecting major cardiovascular events in patients with cardiac implantable electronic devices. Despite the effectiveness of interventions managed by FCNs, comprehensive information and research on the integration of this role within the PC setting are still lacking in the Italian healthcare system. Full article

Many middle-aged and older adults (MAOAs) do not engage in sufficient physical activity (PA), despite its well-documented benefits for healthy aging. Existing PA interventions often fail to reach or engage the target population effectively. This study investigates MAOAs’ preferences for recruitment strategies to optimize the reach and uptake of PA interventions, thereby enhancing their impact on healthy aging and public health. Qualitative interviews were conducted with 39 MAOA participants (69% female, mean age = 69.46, SD = 7.07), guided by McGuire’s Theory on Persuasive Communication. Factors related to the source, message content, channel, receiver characteristics and target behavior of recruitment strategies were analyzed. Our findings suggest a preference for trustworthy sources (e.g., healthcare professionals over commercial entities) and positive, non-ageist messaging. MAOAs vary in their channel preferences but emphasize the importance of personalization. Despite heterogeneity, MAOAs commonly perceive themselves as sufficiently active, indicating a need for improved knowledge on what constitutes sufficient PA, as well as easy enrollment or trying out interventions. Tailoring recruitment strategies to diverse MAOA segments based on age seems crucial for effective engagement. Future research could explore quantitative research into how communication factors relate to various target population characteristics. Full article

Previous research has found that lower limb muscle asymmetries increase with age and are linked to fall and injury risks. However, past studies lack a wide variety of muscle function modes and measures as well as comparison to a comparable younger age group. The purpose of this study was to examine age-related lower limb muscle function asymmetries across a variety of muscle action types and velocities in young and old adults. Lower limb balance, strength, power, and velocity were evaluated with concentric, isometric, isotonic, and eccentric muscle actions during a single-leg stance test and on single- and multi-joint dynamometers in 29 young (age = 21.45 ± 3.02) and 23 old (age = 77.00 ± 4.60) recreationally active men and women. Most (15 of 17) variables showed no statistical (p > 0.05) or functional (10% threshold) limb asymmetry for either age group. There was a significant main effect (p = 0.046; collapsed across groups) found for asymmetry (dominant > non-dominant) for the isotonic peak velocity variable. There was a significant (p = 0.010) group × limb interaction for single-joint concentric peak power produced at a slow (60 deg/s) velocity due to the non-dominant limb of the young group being 12.2% greater than the dominant limb (p < 0.001), whereas the old group was not asymmetrical (p = 0.965). The findings of this investigation indicate there is largely no age-related asymmetry of the lower limbs across a range of muscle function-related variables and modes, with a couple of notable exceptions. Also, the significant asymmetries for the isotonic peak velocity variable perhaps show the sensitivity of this uncommonly used measure in detecting minimally present muscle function imbalances. Full article

Ikigai—a Japanese concept that includes elements such as life’s purpose and meaning—has been reported to be associated with various systemic health conditions, such as the risk of developing physical dysfunction or death in older adults. However, there are no reports that comprehensively examine the psychological and social aspects of Ikigai. We attempted to clarify the characteristics of Ikigai by examining it from a biopsychosocial model using physical, psychological, and social perspectives through a cross-sectional study on sarcopenia, frailty and healthy life expectancy in a hilly and mountainous area of Japan. Koyadaira in Mima City, which is located in a hilly and mountainous region on Shikoku Island in Japan, was targeted. This cross-sectional study included 105 outpatients aged 65 and over, with an average age of 79.02 ± 6.91 years. Ikigai (self-rating score on a scale of 0 (no Ikigai) to 5 (the highest Ikigai)) participants’ level of physical activity (the Physical Activity Scale for the Elderly, PASE), degree of depression (the Geriatric Depression-15 Scale, GDS-15), cognitive function (the Mini-Mental State Examination, MMSE) and social isolation (the abbreviated Lubben Social Network Scale, LSNS-6) was assessed. Significant positive correlations were found between PASE and MMSE. The LSNS-6 significantly correlated with the MMSE and GDS-15. In a path model, out of four paths from PASE, GDS-15, MMSE, and LSNS-6 to Ikigai, the path from the GDS-15 alone was significant (correlation coefficient −0.271, p < 0.01). The adaptability of this model was good. This study indicates that depressive status has a large impact on Ikigai, along with physical, cognitive, and social conditions; thus, it is appropriate to consider that an affective psychological status, such as depressive symptoms, is a fundamental condition for having Ikigai. Full article

The aim of this study was to evaluate the influence of ultrasounds used in phacoemulsification during cataract surgery on the corneal structure and morphology in patients over 65 years. We compared the outcomes of phacoemulsification techniques in terms of corneal cell morphology in 77 patients over 65 years old and 43 patients under 65 years old. Corneal cell density, central corneal thickness and hexagonality were measured preoperatively and post-surgery (at 1 and 4 weeks) by specular microscopy. The effect of gender, axial length and anterior chamber depth on the parameters of corneal endothelium were evaluated. In both groups, a progressive decrease in endothelial cells was observed, starting from the first week post-surgery until the fourth postoperative week. The central corneal thickness increased in both groups with maximum values at the first week postoperatively, while their initial values were restored in the fourth week post-surgery, with no statistical difference between groups. Statistically significant differences were noticed in terms of cell hexagonality in the group over 65, showing smaller hexagonality at all preoperative and postoperative time points compared to group under 65. Our result highlights the importance of routine specular microscopy performed before surgery, regardless the age of the patients, with caution and careful attention to the phaco power intensity, ultrasound energy consumption and intraoperative manipulation of instruments, as well as proper use of viscoelastic substances to reduce corneal endothelium damage, especially in elderly patients. Full article

Background: Social innovation and gerontology develop a wide range of actions aimed at supporting and improving the needs of long-lived populations. Higher education institutions (HEIs) are drivers of change, and their potential to develop solutions through teaching students’ social innovation skills should be considered in the field of longevity. This article reports the results obtained by the Senior Innovation Lab (SIL) training initiative. Methods: Challenge-based learning, design thinking, and lean startup approaches were implemented in training 26 participants with the final aim of developing innovative solutions to previously identified long-lived population needs. Results: Final products were innovative ideas developed through collaboration between students, academic staff, and business employees, indicating the importance of adopting entrepreneurial approaches in academic teaching. The participants identified motivation and perseverance as the most relevant entrepreneurial skills and most of them also perceived that they possessed it. The participants also considered spotting opportunities (chance to add value) as the most desired skill throughout the whole experience. Conclusions: SIL’s assessment showed that social innovation methodologies contributed to the development of learning strategies, enabling potential solutions for the ageing challenges. Full article

Pragmatic trials aim to assess intervention efficacy in usual patient care settings, contrasting with explanatory trials conducted under controlled conditions. In aging research, pragmatic trials are important designs for obtaining real-world evidence in elderly populations, which are often underrepresented in trials. In this review, we discuss statistical considerations from a frequentist approach for the design and analysis of pragmatic trials. When choosing the dependent variable, it is essential to use an outcome that is highly relevant to usual medical care while also providing sufficient statistical power. Besides traditionally used binary outcomes, ordinal outcomes can provide pragmatic answers with gains in statistical power. Cluster randomization requires careful consideration of sample size calculation and analysis methods, especially regarding missing data and outcome variables. Mixed effects models and generalized estimating equations (GEEs) are recommended for analysis to account for center effects, with tools available for sample size estimation. Multi-arm studies pose challenges in sample size calculation, requiring adjustment for design effects and consideration of multiple comparison correction methods. Secondary analyses are common but require caution due to the risk of reduced statistical power and false-discovery rates. Safety data collection methods should balance pragmatism and data quality. Overall, understanding statistical considerations is crucial for designing rigorous pragmatic trials that evaluate interventions in elderly populations under real-world conditions. In conclusion, this review focuses on various statistical topics of interest to those designing a pragmatic clinical trial, with consideration of aspects of relevance in the aging research field. Full article

Background: Dementia is a significant health issue worldwide. Mild cognitive impairment (MCI) can transform into dementia over time. General practitioners (GPs) may be the first to notice the cognitive deficit; therefore, it is crucial for them to have access to a screening test that can be administered quickly and efficiently. We explored the Hungarian version of the Test Your Memory self-administered dementia screening test in general practice for the early detection of dementia and cognitive impairment. Methods: In the four Hungarian cities with medical universities, 368 patients over the age of 50 attending GPs filled out the questionnaire within the framework of our cross-sectional study. Results: The total scores of the test showed a significant correlation with education and type of occupation and a significant negative correlation with age. The results of this research showed that the clock drawing and recall subtest scores deteriorate at the earliest age. Conclusion: The test can be filled out in a GP’s office easily and two of its subtests can raise the possibility that patients may need further assessment, especially if they have symptoms, at an earlier age than the other subtests. Full article

Background: As the aging population grows, facing multifaceted health challenges and escalating care costs, equipping newly graduated nurses with the requisite skills for high-quality gerontogeriatric care becomes crucial. This study assesses the psychometric properties of a Gerontogeriatric Competency (GGC) scale to evaluate the competencies of newly graduated registered nurses (RNs). Methods: Using a convenience sampling approach, a nationwide, observational prospective cohort study was conducted among 272 newly graduated RNs. The evaluation framework included a sociodemographic questionnaire, three groups of questions targeting gerontogeriatric nursing education aspects, and the GGC scale, with 64 competencies. Construct validity (via confirmatory factor analysis), known-group validity and reliability (assessed by Cronbach’s α) were examined. Results: The confirmatory factor analysis (CFA) showed an adequate index fit: the ratio of chi-square to degrees of freedom (χ²/df) = 2.785, the goodness-of-fit index (GFI) = 0.579, confirmatory fit index (CFI) = 0.864, the parsimony goodness-of-fit index (PGFI) = 0.526, the parsimony confirmatory-of-fit index (PCFI) = 0.809, the root mean square error of approximation (RMSEA) = 0.087, and the modified expected cross-validation index (MECVI) = 24.418. Differences were observed in gerontogeriatric competencies based on curriculum inclusion, self-confidence, knowledge in caring for older adults, and satisfaction with the nursing program content. The Cronbach’s α coefficient was 0.992 for the overall scale and ranged from 0.935 to 0.983 for the GGC dimensions. Conclusions: The GGC scale is a valid and reliable tool for assessing the gerontogeriatric competencies of new graduate RNs, highlighting its potential to enhance education, training, and, ultimately, the quality of care provided to the older population. Full article

Gratitude is a well-known and researched internal positive psychological resource. Empirical data, however, on the association between gratitude, meaning in life, and burden in family caregivers of persons with Alzheimer’s disease is scant. The aims of this study were to (1) investigate the relationships among these variables in a sample of family caregivers of persons with Alzheimer’s; and (2) determine if gratitude mediates the effects of perceived burden on meaning in life in this population. One-hundred and twenty-six adult family caregivers, most of whom were an intimate partner or adult child of a person with Alzheimer’s, completed the Gratitude Questionnaire-Six Item, the Meaning in Life Questionnaire, the Zarit Burden Inventory, and other relevant measures. A series of OLS regression models, guided by the caregiver stress process model, were conducted. These analyses demonstrated that gratitude was a predictor of the presence of meaning in life among the caregivers in this study even when other key variables were considered. Furthermore, analyses revealed that gratitude fully mediated the effects of caregiver burden on the presence of meaning in life in this sample. Thus, clinicians should consider gratitude as an important internal resource for cultivating meaning in life in this population, especially when caregiver burden is present. Gratitude-bolstering clinical interventions should be further developed and tested as both stand-alone and complimentary additions to empirically supported psychoeducational approaches for supporting health and well-being in this population. Full article

Background: Addressing informal caregivers’ needs is essential for ensuring quality healthcare and promoting citizen-centred care. This systematic review assessed current knowledge about programmes aimed at meeting the needs of informal caregivers of adults who are dependent on others for daily life activities. Methods: Following the PRISMA guidelines, the electronic databases EBSCOhost Research Platform, MEDLINE, CINAHL, Scopus, Web of Science and The Virtual Health Library were searched for randomized experimental studies published between 2012 and 2022 that implemented programmes addressing informal caregivers’ needs to improve their experiences, health, and well-being. Quality was assessed using the standardized critical evaluation tools from the Joanna Briggs Institute. Two independent investigators performed the eligibility assessment and data extraction. Quantitative data on the effectiveness of interventions were collected, and the content of each intervention was synthesized and aggregated into categories, through narrative synthesis. Results: The majority of the included studies (n = 16) were conducted in European countries and implemented a structured intervention programme compared to the provision of usual care. The studies were of fair to high methodological quality, with a higher risk of bias related to blinding. The results supported the achievement of favourable health outcomes among informal caregivers, namely improvements in mental health (n = 3) and quality of life (n = 3) and a decrease in psychological symptomatology (n = 5) and burden (n = 3). None of the interventions reported adverse outcomes; however, five studies did not describe significant differences in the outcomes assessed after the implementation of the programmes. Interventions focusing on training and educating caregivers (n = 14) and cognitive–behavioural strategies (n = 7) were the most common, while programmes focusing on emotional and psychological support as a resource to improve caregivers’ psychological outcomes were scarce. Conclusions: This systematic review adds to the growing body of evidence and insight showing that programmes that address informal caregivers’ needs seem to contribute to better physical and psychological health outcomes through the promotion of caregivers’ educational support and the implementation of cognitive–behavioural strategies. Future research should implement methodologically robust cross-country programmes tailored to informal caregivers’ physical, emotional, psychosocial, societal, and educational needs throughout the care trajectory. Full article

Diaphragm muscle dysfunction is increasingly recognized as a fundamental marker of several age-related diseases and conditions including chronic obstructive pulmonary disease, heart failure and critical illness with respiratory failure. In older individuals with physical frailty and sarcopenia, the loss of muscle mass and function may also involve the diaphragm, contributing to respiratory dysfunction. Ultrasound has recently emerged as a feasible and reliable strategy to visualize diaphragm structure and function. In particular, it can help to predict the timing of extubation in patients undergoing mechanical ventilation in intensive care units (ICUs). Ultrasonographic evaluation of diaphragmatic function is relatively cheap, safe and quick and can provide useful information for real-time monitoring of respiratory function. In this review, we aim to present the current state of scientific evidence on the usefulness of ultrasound in the assessment of diaphragm dysfunction in different clinical settings, with a particular focus on older patients. We highlight the importance of the qualitative information gathered by ultrasound to assess the integrity, excursion, thickness and thickening of the diaphragm. The implementation of bedside diaphragm ultrasound could be useful for improving the quality and appropriateness of care, especially in older subjects with sarcopenia who experience acute respiratory failure, not only in the ICU setting. Full article

According to the number of falls, fallers can be single (only one fall) or recurrent (two or more falls), with different risk profiles for loss of independence and frailty. The presence of risk factors in community-dwelling single- and recurrent fallers using a wearable fall-detection device, such as the Personal Emergency Response System (PERS), as part of a telemergency service, is still unknown. This article evaluates how using a PERS, within a telemergency service, helps identify risk profiles and assessment of any differences between non-fallers and fallers in community-dwelling older adults. A sub-group analysis was performed, dividing users into non-fallers (n = 226) and fallers (≥1 fall; n = 89); single-fallers (n = 66) and recurrent fallers (n = 23). Median age was higher in fallers (87.7 years vs. 86), whereas recurrent fallers were less independent, had fewer comorbidities, and had more low-extremity disabilities. The use of the PERS for medical problems (Adjusted OR = 0.31), excluding falls, support calls (Adjusted OR = 0.26), and service demands (Adjusted OR = 0.30), was significantly associated with a fall risk reduction. The findings suggest that the integration within a telemergency service may impact on fall-risk factors. Full article

This study investigated the relationship between subjective grip strength and physical function in community-dwelling older women. Subjective grip strength was assessed using a questionnaire, and physical function and body composition were compared between groups with strong and weak subjective grip strength. Additionally, the two groups were compared in those with mild cognitive impairment (MCI) and those with normal cognitive function, respectively. The results showed significant differences in grip strength (p < 0.001), 30 s chair–stand (CS-30) test (p = 0.039), timed up-and-go (TUG) test (p = 0.027), maximal gait speed (p = 0.029), and skeletal muscle mass (p < 0.001). Older adults with normal cognitive function showed significant differences in grip strength (p < 0.001), quadriceps muscle strength (p < 0.009), one-leg standing time (p = 0.041), CS-30 (p = 0.002), TUG (p = 0.014), gait speed (p = 0.006), and skeletal muscle mass (p = 0.003). Older adults with low subjective grip strength had lower physical function and skeletal muscle mass. However, no items showed significant differences between groups among older adults with MCI. Thus, subjective grip strength is an indicator of an overall decline in physical function and a reduction in skeletal muscle mass in older adults, and cognitive function should be considered when assessing subjective grip strength in older adults. Full article

Self-disclosure is the attitude of communicating one’s experiences and condition to others and is an indicator of mental health and an open personality. Frailty, characterized by reduced physical and psychological resistance, predicts the incidence of dependency and mortality. Although low self-disclosure may be associated with frailty, there is no scale to measure older adults’ self-disclosure. This cross-sectional study assessed the validity of a self-assessment self-disclosure questionnaire and examined the association between the content of self-disclosures to friends and acquaintances and frailty among community-dwelling older adults. A total of 237 adults aged ≥65 in Japan were surveyed using a mailed self-administered questionnaire in 2021. The self-disclosure scale consisted of 10 items and showed adequate validity. Participants were classified into a robust group (n = 117, women 57.3%) and a frailty group (n = 120, women 73.3%) using the Kihon Checklist. After adjusting for covariates, multivariate-adjusted logistic regression models revealed frailty was associated with lower self-disclosure of recent positive events, motivation and strengths (indicating strong points) in life, relationships with family and relatives, experiences of work and social activities, and financial status. The proposed questionnaire must still be further tested in other populations, but our initial results may contribute to preventing frailty and improving mental health among community-dwelling older adults. Full article

Although supervised and real-time telerehabilitation by videoconferencing is now becoming common for people with Parkinson’s disease (PD), its efficacy for balance and gait is still unclear. This paper uses a scoping approach to review the current evidence on the effects of telerehabilitation by videoconferencing on balance and gait for patients with PD. We also explored whether studies have used wearable technology during telerehabilitation to assess and treat balance and gait via videoconferencing. Literature searches were conducted using PubMed, ISI’s Web of Knowledge, Cochrane’s Library, and Embase. The data were extracted for study design, treatment, and outcomes. Fourteen studies were included in this review. Of these, seven studies investigated the effects of telerehabilitation (e.g., tele-yoga and adapted physiotherapy exercises) on balance and gait measures (e.g., self-reported balance, balance scale, walking speed, mobility, and motor symptoms) using videoconferencing in both assessment and treatment. The telerehabilitation programs by videoconferencing were feasible and safe for people with PD; however, the efficacy still needs to be determined, as only four studies had a parallel group. In addition, no study used wearable technology. Robust evidence of the effects of telerehabilitation by videoconferencing on balance and gait for patients with PD was not found, suggesting that future powered, prospective, and robust clinical trials are needed. Full article

Pain, particularly musculoskeletal (MSK) and multi-site pain, significantly impacts activities of daily living (ADL) in the elderly, leading to a decline in overall quality of life (QoL). This study, comprising 7490 participants, (mean age: 69 ± 10; females: 57%) from the sixth wave of the Korean Longitudinal Study of Aging (KLoSA), aimed to assess the association between self-reported pain and ADL impairment among the elderly population. Notably, 62% of participants reported experiencing pain, with back pain being the most prevalent (36%) and stomachache the least (0.39%). A majority (61%) of individuals reported MSK-related pain. Additionally, 20% reported pain at one site and 0.03% experienced pain at 12 sites. ADL impairment was observed in 376 (5.0%) participants. Compared to those without pain, participants reporting moderate and severe pain had higher odds of ADL impairment [2.31 (95% CI, 1.66–3.21) and 2.98 (95% CI, 1.95–4.53), respectively]. Pain experienced in the shoulder, arm, wrist, back, hip, leg, and ankle had a significant association with ADL impairment, with ORs ranging from 2.66 (95% CI, 1.80–3.93; hip pain) to 1.36 (95% CI 1.07–1.72; back pain). Furthermore, multi-site pain was associated with higher ADL impairment [1–6 sites: OR: 1.49 (95% CI, 1.11–2.01); 7–12 sites: OR: 7.16 (95% CI, 3.60–14.26)]. These findings underscore the importance of addressing MSK and multi-site pain through targeted interventions, potentially enhancing ADL and contributing to an improved QoL among the elderly population. Full article

Background: The diagnosis of depression in dementia patients leads to an increase in the burden of the disease. To treat depression in this patient group, antidepressants are frequently used; however, there is not any proof of their therapeutic effectiveness, and their use may be potentially harmful. This narrative review aims to summarize the existing evidence regarding the role of antidepressants in treating depression in dementia patients. Main text: A search was conducted in the PubMed, Excerpta Medica database (EMBASE), and Cochrane databases for randomized controlled trials and meta-analyses wherein antidepressants were given to dementia sufferers to address depression. Fifteen randomized controlled trials and seven meta-analyses were identified. Most well-designed blinded placebo-controlled trials reported a lack of effectiveness of antidepressants in treating depression in dementia patients. Among the seven metanalyses, two reported good efficacy of Selective serotonin reuptake inhibitors (SSRIs). However, two major Cochrane reviews reported little or no effectiveness and increased side effects of antidepressants in dementia patients. Conclusion: There is robust evidence regarding the lack of efficacy of antidepressants in treating depression in dementia patients. However, further well-designed Randomized controlled trials (RCTs,) using scales with good validity and reliability to diagnose depression in dementia patients, sufficient sample sizes, and detailed adverse effect profiles may help determine the rationale for their use. Full article

Background: With increased life expectancy, the coexistence of functional impairment and multimorbidity can negatively impact life quality and coherence in geriatric individuals. The self-report 10-item Internal Coherence (ICS) measures how individuals cope with and make sense of disease-specific life challenges. The aim of this study was to validate the ICS in a sample of geriatric individuals. Methods and Procedure: In a cross-sectional study, geriatric individuals with and without chronic diseases were recruited. A factor analysis with principal component extraction (PCA) and a structural equation model (SEM) was conducted to assess the ICS factor structure in a geriatric sample. To measure convergent validity, the following scales were used: Short Health Survey (SF-12), Karnofsky Performance Index (KPI), Trait autonomic regulation (Trait aR), Sense of Coherence Scale (SOC), and Geriatric Depression Scale (GDS). Results: A sample of n = 104 (70–96 years of age) patients with Diabetes Mellitus Type 2 (n = 22), cancer diseases (n = 31) and healthy controls (n = 51) completed the ICS. PCA and SEM yielded the original two-factor solution: 1. Inner resilience and coherence and 2. Thermo coherence. Overall internal consistency for this cohort was satisfying (Cronbach’s α with r_α = 0.72), and test-retest reliability was moderate (r_rt = 0.53). ICS scores were significantly correlated to all convergent criteria ranging between r = 0.22 * and 0.49 ** (p < 0.05 *; p < 0.01 **). Conclusion: Study results suggest that the ICS appears to be a reliable and valid tool to measure internal coherence in a geriatric cohort (70–96 years). However, moderate test-retest reliability prompts the consideration of potential age-effects that may bias the reliability for this specific cohort. Full article

Bone quality is an essential factor determining bone strength. However, the relationship between physical activity (PA) and bone quality remains unclear. This study aimed to ascertain the relationship between bone quality and PA using a cortical bone quantitative ultrasound device that measures components of bone quality. In this cross-sectional study, bone quality was assessed in community-dwelling older adults by measuring the cortical speed of sound (cSOS) at the mid-tibia using a quantitative ultrasound device. Using a wrist-worn accelerometer, we calculated the daily duration of moderate-to-vigorous physical activity (MVPA) and light physical activity (LPA) based on estimated METs from the accelerometer data, without differentiating between types of activities. A multiple regression analysis was performed to examine the association between PA and the cSOS. The participants’ physical activity averaged 42.0 min/day for MVPA and 483.6 min/day for LPA. No significant association was observed between PA and bone quality in either men or women in the crude models. Furthermore, PA was not significantly correlated with the cSOS in the models adjusted for age, body mass index, nutrient intake, number of medications, and kidney disease. This study was a cross-sectional study which focused on the association between bone quality in older adults and their current amount of PA. The cSOS, as a measure of bone quality, was not associated with PA in men or women. Higher amounts of daily PA, as estimated from metabolic equivalents with an accelerometer, may not necessarily maintain or improve bone quality in older adults. This study does not rule out the potential for a positive association between PA levels or types and bone quality in younger or middle-aged individuals. It was specifically targeted at older adults, and its findings should not be generalized to younger populations. Further longitudinal studies are required to better understand the relationship between PA and bone quality. Full article

This study aimed to quantify and compare ladder use ability and behavior in younger and older men and women from three ladder use behavior experiments. The experimental tasks comprised (1) changing a lightbulb on a household stepladder under two cognitive demands (single and dual task), (2) clearing a simulated roof gutter on a straight ladder and (3) querying ladder choice in different exigency scenarios. Ladder use ability and behavior data were captured from recorded time, performance, motion capture and user choice data. In addition, this study surveyed ladder use frequency and habitual behaviors. The experimental findings indicate that older adults require more time to complete ladder tasks; younger adults display riskier ladder use behaviors; men and women display similar ladder use ability; and men are more willing to climb riskier ladders. The survey found older adults to report more frequent ladder use than younger adults, and men use straight ladders more frequently than women. These results suggest that the reported higher ladder fall rates experienced by older adults and men are linked to increased ladder use exposure and riskier ladder choice. This knowledge can help guide population-specific interventions to reduce ladder falls in both young and older people. Full article

Legal representatives take a major role in healthcare decisions with and for people with dementia, but only a minority has a qualification in this field. The aim was to evaluate the efficacy of the PRODECIDE education program for legal representatives. In a prospective randomized controlled trial, legal representatives (volunteers and professionals, representing at least one person with dementia) were allocated (1:1 computer-generated block randomization) to the intervention (PRODECIDE education program) and control (standard care) groups. The primary outcome measure was knowledge, operationalized as the understanding of decision-making processes and in setting realistic expectations. Only data entry and analyses were blinded. A process evaluation in a mixed methods design was performed. We enrolled 218 legal representatives, and 216 were included in the primary analysis (intervention n = 109, control n = 107). The percentage of correct answers in the knowledge test post intervention was 69.0% in the intervention and 43.4% in the control group (difference 25.6%; CI 95%, 21.3 to 29.8; p < 0.001). In the comparison of professional and voluntary representatives, professionals had 13.6% (CI 95%, 8.0 to 19.2; p < 0.001) more correct answers. The PRODECIDE education program can improve the knowledge of legal representatives, an important prerequisite for evidence-based, informed decision-making. Full article

Cardiovascular diseases (CVDs) reflect a huge and diversified condition that influences patient quality of life (QoL) both in the physical and mental aspects, especially in older adults who often present comorbidities and may be affected by cognitive decline. The concept of cognitive reserve (CR), which is built through life course experiences, has widely been considered a protective factor against cognitive decline, while the results of QoL in the field of CVDs are still controversial. In particular, there is a lack of evidence that explicitly explores the effects of CR on the QoL in CVD cases since studies have considered only single CR proxies (e.g., education) or specific cardiovascular conditions. Moreover, none of them have considered the motor reserve (MR), another recent concept that considers the amount of physical activity carried out during a lifespan. Its potential role in preventing age-related diseases has been observed, but more clarification is needed given the importance of the physical component in CVDs. The present state-of-the-art review aims to (i) examine how the literature conceives CR and its proxies in CVDs relating to QoL and (ii) integrate the concept of MR in this framework. Implications for clinical practice will also be discussed. Full article

Background: Cerebrovascular hemodynamic impairment has been reported in Alzheimer’s disease (AD). We performed a systematic review and meta-analysis to investigate changes in cerebral blood flow (CBF) in AD patients. Methods: Data were obtained by searching MEDLINE and Scopus for all investigations published between 1 January 2011 and 1 November 2021, comparing the cerebrovascular hemodynamic between AD patients and cognately healthy age-matched controls, using transcranial Doppler (TCD) ultrasound. Results: Twelve studies, based on 685 patients [395 with AD and 290 age-matched cognitively healthy controls, with a mean age of 71.5 and 72.1 years, respectively] were included in the analysis. A random effect model revealed that AD patients, in the proximal segments of the middle cerebral artery (MCA), have a significantly lower CBF velocity, compared to controls (MD: −7.80 cm/s, 95%CI: −10.78 to −5.13, p < 0.0001, I² = 71.0%). Due to a significant Egger’s test (t = 3.12, p = 0.008), a trim-and-fill analysis was performed, confirming the difference (MD: −11.05 cm/s, 95%CI: –12.28 to −9.82, p < 0.0001). Meta-regression analysis demonstrated that the mean CBF at the proximal MCA was directly correlated with arterial hypertension (p = 0.03) and MMSE score (p < 0.001), but inversely correlated with age (p = 0.01). In AD patients, the pulsatility index was significantly higher compared to controls (MD: 0.16, 95%CI: 0.07 to 0.25, p < 0.0001, I²: 84.5%), while the breath-holding index test results were significant lower (MD: −1.72, 95%CI: −2.53 to −0.91, p < 0.001, I²: 85.4%). Conclusions: AD patients have a significant impairment in relation to their cerebrovascular perfusion, suggesting that cerebrovascular hemodynamic deterioration, evaluated using TCD, may be a useful diagnostic tool. Full article

Background: People living with dementia (PLWD) may experience substantial cognitive decline as the disease progresses, which interferes with their daily activities. This study aimed to assess physical activity (PA) performance and care dependency (CD) and identify factors related to PA among PLWD. Methods: We conducted a cross-sectional study in 63 PLWD from National Geriatrics Hospital, Vietnam, from 2021 to 2023. We used the Mini Nutritional Assessment (MNA), International Physical Activity Questionnaire (IPAQ), and Care Dependency Scale (CDS) to assess the nutritional status and the levels of PA and CD, respectively. We used the Mann–Whitney test to compare the differences in the PA types and CD levels between dementia levels and a multivariable logistics regression model to analyze factors related to PA. Results: More than half of the subjects had mild dementia. In total, 35% of the PLWD had a low level of PA, and 46.3% were completely independent of care. The mean score in each CDS aspect of the subjects with moderate/severe dementia was statistically significantly lower than that of those with mild dementia (p ≤ 0.05). Lower dependency (OR = 0.9; 95% CI = 0.88–0.99) and malnutrition (OR = 15.4; 95% CI = 1.18–20.21) were associated with insufficient PA in the PLWD. Conclusion: Formal caregivers and healthcare workers should encourage PLWD to perform physical activities at any level and personalize the development of tailored and nutritional care strategies for each individual. Full article

Prior research has suggested that resistance exercise may result in a temporary decrease in vascular function, as measured by flow-mediated dilation (FMD), among untrained young individuals. However, the immediate impact of combined elastic and weight resistance training on older adults remains insufficiently explored. We assessed vascular function before, after, and 30 min after acute exercise under three resistance conditions to evaluate whether a combination of weight and elastic resistance exercises has an acute effect on vascular function in older adults. Fourteen older adults (65.6 ± 2.9 years) executed three sets of 12 repetitions at 65% of one repetition maximum (1 RM) of the bench press (BP) exercise. Testing was performed on three separate days as follows: (1) barbell alone (BA); (2) barbell plus elastic bands (10% of 65% 1 RM) (BE10); and (3) barbell plus elastic bands (20% of 65% 1 RM) (BE20). A two-way (time × condition) repeated measures analysis of variance was employed to assess the time and condition effects on flow-mediated dilation (FMD) and pulse wave velocity (PWV). At 0 min post-exercise, FMD was significantly higher during BE10 than during BA (p < 0.05); however, at 30 min post-exercise, no significant difference (p ≥ 0.05) was observed between the three conditions. In each condition, FMD results did not differ significantly at different times (p ≥ 0.05). For FMD, the main effect of the condition (F[2,26] = 3.86, p = 0.034) and that of the time and condition (F[4,52] = 3.66, p = 0.011) were significant. For PWV, only the difference between the BA and BE10 conditions was significant at 0 min (p < 0.05). PWV increased from baseline in the BA condition (p < 0.05) but not significantly in the BE10 and BE20 conditions (p ≥ 0.05). Therefore, BA, BE10, and BE20 demonstrated various changes in vascular function. Long-term training intervention studies are needed to validate these findings. Full article

As little evidence is available, we report the oral health of neurogeriatric inpatients and the association with hematological parameters representing systemic health. We performed a cross-sectional investigation of 30 patients undergoing neurogeriatric early rehabilitation and excluded systemic inflammation as a trigger for oral infection (C-reactive protein >5 mg/dL). Outcomes included oral health and hygiene status and routine laboratory parameters. Patients (mean age 79 ± 6 years, mean comorbidities 7 ± 3, and mean Barthel Index at hospital admission 31 ± 18) had impaired oral health (mean 18 ± 7 of their own teeth, elevated plaque indices (2.5 ± 0.4), and bleeding on probing (26 ± 17)), representing short- and long-term reduced oral hygiene. Twenty-four (80%) patients had periodontitis. Laboratory parameters for inflammation, nutrition, and anemia did not correlate with oral health parameters (p > 0.05). The number of teeth correlated moderately with total protein (Spearman’s rank correlation coefficient (r_s) = 0.524; p = 0.003). Plaque indices correlated weakly with number of teeth (r_s = −0.460; p = 0.010) and periodontitis diagnosis (r_s = 0.488; p = 0.006). Thus, highly vulnerable neurogeriatric inpatients had reduced oral health and hygiene independent of laboratory parameters, representing a high-risk population for oral health problems even without clinically proven systemic infection. This should be considered in future interprofessional therapy planning. Full article