International Journal of Environmental Research and Public Health

Editorial

3 pages, 285 KiB

Open AccessEditorial

Healthcare for Older Adults, Where Are We Moving towards?

by Francisco José Tarazona-Santabalbina, Sebastià Josep Santaeugènia Gonzàlez, José Augusto García Navarro and Jose Viña

Int. J. Environ. Res. Public Health 2021, 18(12), 6219; https://doi.org/10.3390/ijerph18126219 - 8 Jun 2021

Cited by 2 | Viewed by 2033

Abstract

Since the end of World War II, science has not stopped progressing [...] Full article

(This article belongs to the Special Issue Health Care for Older Adults)

Research

Jump to: Editorial, Review

13 pages, 3093 KiB

Open AccessArticle

A Machine Learning Approach for Investigating Delirium as a Multifactorial Syndrome

by Honoria Ocagli, Daniele Bottigliengo, Giulia Lorenzoni, Danila Azzolina, Aslihan S. Acar, Silvia Sorgato, Lucia Stivanello, Mario Degan and Dario Gregori

Int. J. Environ. Res. Public Health 2021, 18(13), 7105; https://doi.org/10.3390/ijerph18137105 - 2 Jul 2021

Cited by 8 | Viewed by 2957

Abstract

Delirium is a psycho-organic syndrome common in hospitalized patients, especially the elderly, and is associated with poor clinical outcomes. This study aims to identify the predictors that are mostly associated with the risk of delirium episodes using a machine learning technique (MLT). A [...] Read more.

Delirium is a psycho-organic syndrome common in hospitalized patients, especially the elderly, and is associated with poor clinical outcomes. This study aims to identify the predictors that are mostly associated with the risk of delirium episodes using a machine learning technique (MLT). A random forest (RF) algorithm was used to evaluate the association between the subject’s characteristics and the 4AT (the 4 A’s test) score screening tool for delirium. RF algorithm was implemented using information based on demographic characteristics, comorbidities, drugs and procedures. Of the 78 patients enrolled in the study, 49 (63%) were at risk for delirium, 32 (41%) had at least one episode of delirium during the hospitalization (38% in orthopedics and 31% both in internal medicine and in the geriatric ward). The model explained 75.8% of the variability of the 4AT score with a root mean squared error of 3.29. Higher age, the presence of dementia, physical restraint, diabetes and a lower degree are the variables associated with an increase of the 4AT score. Random forest is a valid method for investigating the patients’ characteristics associated with delirium onset also in small case-series. The use of this model may allow for early detection of delirium onset to plan the proper adjustment in healthcare assistance. Full article

(This article belongs to the Special Issue Health Care for Older Adults)

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19 pages, 1307 KiB

Open AccessArticle

Prescription Habits Related to Chronic Pathologies of Elderly People in Primary Care in the Western Part of Romania: Current Practices, International Recommendations, and Future Perspectives Regarding the Overuse and Misuse of Medicines

by Valentina Buda, Andreea Prelipcean, Carmen Cristescu, Alexandru Roja, Olivia Dalleur, Minodora Andor, Corina Danciu, Adriana Ledeti, Cristina Adriana Dehelean and Octavian Cretu

Int. J. Environ. Res. Public Health 2021, 18(13), 7043; https://doi.org/10.3390/ijerph18137043 - 1 Jul 2021

Cited by 5 | Viewed by 3670

Abstract

The European Commission’s 2019 report regarding the state of health profiles highlighted the fact that Romania is among the countries with the lowest life expectancy in the European Union. Therefore, the objectives of the present study were to assess the current prescription habits [...] Read more.

The European Commission’s 2019 report regarding the state of health profiles highlighted the fact that Romania is among the countries with the lowest life expectancy in the European Union. Therefore, the objectives of the present study were to assess the current prescription habits of general physicians in Romania related to medicines taken by the elderly population for chronic conditions in both urban and rural setting and to discuss/compare these practices with the current international recommendations for the elderly (American—Beers 2019 criteria and European—STOPP/START v.2, 2015 criteria). A total of 2790 electronic prescriptions for chronic pathologies collected from 18 community pharmacies in the western part of Romania (urban and rural zones) were included. All medicines had been prescribed by general physicians. We identified the following situations of medicine overuse: 15% of the analyzed prescriptions involved the use of nonsteroidal anti-inflammatory drugs (NSAIDs) for >2 weeks, 12% involved the use of a proton-pump inhibitor (PPI) for >8 weeks, theophylline was the bronchodilator used as a monotherapy in 3.17% of chronic obstructive pulmonary disease cases, and zopiclone was the hypnotic drug of choice for 2.31% of cases. Regarding the misuse of medicines, 2.33% of analyzed prescriptions contained an angiotensin-converting enzyme (ACE) inhibitor and an angiotensin II receptor blocker (ARB) for patients with renal failure in addition to vitamin K antagonists (AVKs) and NSAIDs in 0.43% of cases. Prescriptions for COX2 NSAIDs for periods longer than 2 weeks for patients with cardiovascular disorders accounted for 1.33% of prescriptions, and trihexyphenidyl was used as a monotherapy for patients with Parkinson’s disease in 0.18% of cases. From the included medical prescriptions, 32.40% (the major percent of 2383 prescriptions) had two potentially inappropriate medications (PIMs). Rural zones were found to be risk factor for PIMs. Decreasing the chronic prescription of NSAIDs and PPIs, discontinuing the use of hypnotic drugs, and avoiding potentially harmful drug–drug associations will have long term beneficial effects for Romanian elderly patients. Full article

(This article belongs to the Special Issue Health Care for Older Adults)

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13 pages, 965 KiB

Open AccessArticle

Prognostic Factors of 1-Year Postoperative Functional Outcomes of Older Patients with Intertrochanteric Fractures in Thailand: A Retrospective Cohort Study

by Nath Adulkasem, Phichayut Phinyo, Jiraporn Khorana, Dumnoensun Pruksakorn and Theerachai Apivatthakakul

Int. J. Environ. Res. Public Health 2021, 18(13), 6896; https://doi.org/10.3390/ijerph18136896 - 27 Jun 2021

Cited by 5 | Viewed by 3196

Abstract

Restoration of ambulatory status is considered a primary treatment goal for older patients with intertrochanteric fractures. Several surgical-related parameters were reported to be associated with mechanical failure without focusing on the functional outcomes. Our study examines the roles of both clinical and surgical [...] Read more.

Restoration of ambulatory status is considered a primary treatment goal for older patients with intertrochanteric fractures. Several surgical-related parameters were reported to be associated with mechanical failure without focusing on the functional outcomes. Our study examines the roles of both clinical and surgical parameters as prognostic factors on 1-year postoperative ambulatory outcomes, reaching a good functional outcome (the New Mobility Score: NMS ≥ 5) and returning to preinjury functional status at one year, of older patients with intertrochanteric fracture. Intertrochanteric fractures patients age ≥65 years who underwent surgical treatment at our institute between January 2017 and February 2020 were included. Of 209 patients included, 149 (71.3%) showed a good functional outcome at one year. The pre-injury ambulatory status (OR 52.72, 95%CI 5.19–535.77, p = 0.001), BMI <23 kg/m² (OR 3.14, 95%CI 1.21–8.13, p = 0.018), Hb ≥10 g/dL (OR 3.26, 95%CI 1.11–9.57, p = 0.031), and NMS at discharge ≥2 (OR 8.50, 95%CI 3.33–21.70, p < 0.001) were identified as independent predictors for reaching a good postoperative functional outcome. Only aged ≤80 (OR 2.34, 95%CI 1.11–4.93, p = 0.025) and NMS at discharge ≥2 (OR 6.27, 95%CI 2.75–14.32, p < 0.001) were significantly associated with an ability to return to preinjury function. To improve postoperative ambulatory status, orthopedic surgeons should focus more on modifying factors, such as maintaining the preoperative hemoglobin ≥10 g/dL and providing adequate postoperative ambulation training to maximize the patients’ capability upon discharge. While surgical parameters were not identified as predictors, they can still be used as guidance to optimize the operation quality. Full article

(This article belongs to the Special Issue Health Care for Older Adults)

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11 pages, 2217 KiB

Open AccessArticle

The Significance of Posterior Occlusal Support of Teeth and Removable Prostheses in Oral Functions and Standing Motion

by Kyosuke Oki, Yoichiro Ogino, Yuriko Takamoto, Mikio Imai, Yoko Takemura, Yasunori Ayukawa and Kiyoshi Koyano

Int. J. Environ. Res. Public Health 2021, 18(13), 6776; https://doi.org/10.3390/ijerph18136776 - 24 Jun 2021

Cited by 6 | Viewed by 3069

Abstract

The purpose of this study was to evaluate the effect of posterior occlusal support of natural teeth and artificial teeth on oral functions and standing motion. Patients who had been treated with removable prostheses were enrolled as the subjects. Their systemic conditions (body [...] Read more.

The purpose of this study was to evaluate the effect of posterior occlusal support of natural teeth and artificial teeth on oral functions and standing motion. Patients who had been treated with removable prostheses were enrolled as the subjects. Their systemic conditions (body mass index (BMI) and skeletal muscle mass index (SMI)) were recorded. The subjects were classified into two groups according to a modified Eichner index: B1–3 (with posterior occlusal support) and B4C (without posterior occlusal support). Maximum occlusal force (MOF), masticatory performance (MP), and standing motion (sway and strength) were evaluated for cases with and without removable prostheses. There were no significant differences in BMI and SMI between the B1–3 group and the B4C group. The subjects with removable prostheses demonstrated significantly higher values in MOF, MP, and sway and strength than the subjects without removable prostheses. The comparison of oral functions between the B1–3 group and the B4C group revealed that the positive effect of posterior occlusal support of natural teeth and removable prostheses and the significant positive effects of posterior occlusal support on standing motion were partly observed in these comparisons. Posterior occlusal support of natural teeth and even of removable prostheses may contribute to the enhancement of oral functions and standing motion. Full article

(This article belongs to the Special Issue Health Care for Older Adults)

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9 pages, 625 KiB

Open AccessArticle

Association between Occupational Dysfunction and Social Isolation in Japanese Older Adults: A Cross-Sectional Study

by Keisuke Fujii, Yuya Fujii, Yuta Kubo, Korin Tateoka, Jue Liu, Koki Nagata, Shuichi Wakayama and Tomohiro Okura

Int. J. Environ. Res. Public Health 2021, 18(12), 6648; https://doi.org/10.3390/ijerph18126648 - 21 Jun 2021

Cited by 4 | Viewed by 3438

Abstract

We clarified the relationship between occupational dysfunction and social isolation among community-dwelling adults. We used a self-administered questionnaire with a cross-sectional study for 2879 independently living older adults in Kasama City, Japan. Participants responded to a self-reported questionnaire in November 2019. Occupational dysfunction [...] Read more.

We clarified the relationship between occupational dysfunction and social isolation among community-dwelling adults. We used a self-administered questionnaire with a cross-sectional study for 2879 independently living older adults in Kasama City, Japan. Participants responded to a self-reported questionnaire in November 2019. Occupational dysfunction and social isolation were assessed. The participants were classified into two groups: healthy occupational function group, and occupational dysfunction group. To examine the relationship between occupational dysfunction and social isolation, we performed a logistic regression analysis with social isolation as a dependent variable and occupational dysfunction as an independent variable. In the crude model, the occupational dysfunction group had a higher risk of social isolation than the healthy occupational function group (odds ratio (OR) = 2.04; 95% confidence interval (CI), 1.63–2.55; p < 0.001). In the adjusted model, the occupational dysfunction group had a higher risk of social isolation than the healthy occupational function group (OR = 1.51; 95% CI, 1.17–1.94; p = 0.001). The results showed that occupational dysfunction was significantly associated with social isolation. These results can be used in constructing a support method for social isolation from a new perspective. Full article

(This article belongs to the Special Issue Health Care for Older Adults)

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19 pages, 353 KiB

Open AccessArticle

“Not Alone in Loneliness”: A Qualitative Evaluation of a Program Promoting Social Capital among Lonely Older People in Primary Health Care

by Laura Coll-Planas, Dolors Rodríguez-Arjona, Mariona Pons-Vigués, Fredrica Nyqvist, Teresa Puig and Rosa Monteserín

Int. J. Environ. Res. Public Health 2021, 18(11), 5580; https://doi.org/10.3390/ijerph18115580 - 23 May 2021

Cited by 8 | Viewed by 4292

Abstract

The weekly group-based program “Paths: from loneliness to participation” was conducted face-to-face over 15 sessions by nurses, social workers and volunteers in primary care in Catalonia (Spain) to alleviate loneliness among older people by promoting peer support and participation in community assets. We [...] Read more.

The weekly group-based program “Paths: from loneliness to participation” was conducted face-to-face over 15 sessions by nurses, social workers and volunteers in primary care in Catalonia (Spain) to alleviate loneliness among older people by promoting peer support and participation in community assets. We aimed at exploring participants’ experiences of loneliness and participation prior to the program and its perceived benefits. The qualitative design was descriptive-interpretative. Data were collected through three focus groups and 41 interviews applying a semistructured topic guide involving 26 older participants, six professionals and nine volunteers. Participant-observation of all sessions involved the 38 older people who started the program. A thematic content analysis was applied. Older persons with diverse profiles of loneliness and participation explained different degrees of decrease in loneliness, an increase in participation in local community assets, companionship, peer support and friendship, and an empowerment process. Successful cases reported improvements in mental wellbeing and recovering the sense that life was worth living. Loneliness persisted among some widowed participants and vulnerabilities hampered some benefits. Participants, professionals and volunteers reported different degrees of success in older people to alleviate loneliness by enhancing social relationships and activities through complex processes interrelated with health and socioeconomic factors. Full article

(This article belongs to the Special Issue Health Care for Older Adults)

14 pages, 2251 KiB

Open AccessArticle

Reliability, Validity, and Feasibility of the Frail-VIG Index

by Anna Torné, Emma Puigoriol, Edurne Zabaleta-del-Olmo, Juan-José Zamora-Sánchez, Sebastià Santaeugènia and Jordi Amblàs-Novellas

Int. J. Environ. Res. Public Health 2021, 18(10), 5187; https://doi.org/10.3390/ijerph18105187 - 13 May 2021

Cited by 15 | Viewed by 3368

Abstract

The study aimed to assess the reliability of the scores, evidence of validity, and feasibility of the Frail-VIG index. A validation study mixing hospitalized and community-dwelling older people was designed. Intraclass correlation coefficient (ICC) was used to assess the inter-rater agreement and the [...] Read more.

The study aimed to assess the reliability of the scores, evidence of validity, and feasibility of the Frail-VIG index. A validation study mixing hospitalized and community-dwelling older people was designed. Intraclass correlation coefficient (ICC) was used to assess the inter-rater agreement and the reliability. The construct validity of the Frail-VIG index with respect to the Frailty Phenotype (FP) was evaluated by calculating the area under the receiver operating characteristic curve (AUC-ROC). Convergent validity with the Clinical Frailty Scale (CFS) was assessed using Pearson’s correlation coefficients. The feasibility was evaluated by calculating the average time required to administer the Frail-VIG index and the percentage of unanswered responses. A sample of 527 older people (mean age of 81.61, 56.2% female) was included. The inter-rater agreement and test–retest reliability were very strong: 0.941 (95% CI, 0.890 to 0.969) and 0.976 (95% CI, 0.958 to 0.986), respectively. Results indicated adequate convergent validity of the Frail-VIG index with respect to the FP, AUC-ROC 0.704 (95% CI, 0.622 to 0.786), and a moderate to strong positive correlation between the Frail-VIG index and CFS (r = 0.635, 95% CI, 0.54 to 0.71). The Frail-VIG index administration required an average of 5.01 min, with only 0.34% of unanswered responses. The Frail-VIG index is a reliable, feasible, and valid instrument to assess the degree of frailty in hospitalized and community-dwelling older people. Full article

(This article belongs to the Special Issue Health Care for Older Adults)

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17 pages, 1764 KiB

Open AccessArticle

Predictive Model of Gait Recovery at One Month after Hip Fracture from a National Cohort of 25,607 Patients: The Hip Fracture Prognosis (HF-Prognosis) Tool

by Cristina González de Villaumbrosia, Pilar Sáez López, Isaac Martín de Diego, Carmen Lancho Martín, Marina Cuesta Santa Teresa, Teresa Alarcón, Cristina Ojeda Thies, Rocío Queipo Matas, Juan Ignacio González-Montalvo and on behalf of the Participants in the Spanish National Hip Fracture Registry

Int. J. Environ. Res. Public Health 2021, 18(7), 3809; https://doi.org/10.3390/ijerph18073809 - 6 Apr 2021

Cited by 14 | Viewed by 3440

Abstract

The aim of this study was to develop a predictive model of gait recovery after hip fracture. Data was obtained from a sample of 25,607 patients included in the Spanish National Hip Fracture Registry from 2017 to 2019. The primary outcome was recovery [...] Read more.

The aim of this study was to develop a predictive model of gait recovery after hip fracture. Data was obtained from a sample of 25,607 patients included in the Spanish National Hip Fracture Registry from 2017 to 2019. The primary outcome was recovery of the baseline level of ambulatory capacity. A logistic regression model was developed using 40% of the sample and the model was validated in the remaining 60% of the sample. The predictors introduced in the model were: age, prefracture gait independence, cognitive impairment, anesthetic risk, fracture type, operative delay, early postoperative mobilization, weight bearing, presence of pressure ulcers and destination at discharge. Five groups of patients or clusters were identified by their predicted probability of recovery, including the most common features of each. A probability threshold of 0.706 in the training set led to an accuracy of the model of 0.64 in the validation set. We present an acceptably accurate predictive model of gait recovery after hip fracture based on the patients’ individual characteristics. This model could aid clinicians to better target programs and interventions in this population. Full article

(This article belongs to the Special Issue Health Care for Older Adults)

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17 pages, 2155 KiB

Open AccessArticle

Bibliometric Analysis on Research Trend of Accidental Falls in Older Adults by Using Citespace—Focused on Web of Science Core Collection (2010–2020)

by Boyuan Chen and Sohee Shin

Int. J. Environ. Res. Public Health 2021, 18(4), 1663; https://doi.org/10.3390/ijerph18041663 - 9 Feb 2021

Cited by 25 | Viewed by 6261

Abstract

The present study aimed to identify the trends in research on accidental falls in older adults over the last decade. The MeSH (Medical Subject Headings) and entry terms were applied in the Web of Science Core Collection. Relevant studies in English within articles [...] Read more.

The present study aimed to identify the trends in research on accidental falls in older adults over the last decade. The MeSH (Medical Subject Headings) and entry terms were applied in the Web of Science Core Collection. Relevant studies in English within articles or reviews on falls in older adults were included from 2010 to 2020. Moreover, CiteSpace 5.6.R5 (64-bit) was adopted for analysis with scientific measurements and visualization. Cooper Cyrus, Stephen R Lord, Minoru Yamada, Catherine Sherrington, and others have critically impacted the study of falls in older adults. Osteoporosis, dementia, sarcopenia, hypertension, osteosarcopenia, traumatic brain injury, frailty, depression, and fear of falling would be significantly correlated with falls in older adults. Multiple types of exercise can provide effective improvements in executive cognitive performance, gait performance, quality of life, and can also lower the rates of falls and fall-related fractures. Fall detection, hospitalization, classification, symptom, gender, and cost are the current research focus and development direction in research on falls in older adults. The prevention of falls in older adults is one of the most important public health issues in today’s aging society. Although lots of effects and research advancements had been taken, fall prevention still is uncharted territory for too many older adults. Service improvements can exploit the mentioned findings to formulate policies, and design and implement exercise programs for fall prevention. Full article

(This article belongs to the Special Issue Health Care for Older Adults)

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9 pages, 331 KiB

Open AccessArticle

Association of Social Frailty with Physical Health, Cognitive Function, Psychological Health, and Life Satisfaction in Community-Dwelling Older Koreans

by Hana Ko and SuJung Jung

Int. J. Environ. Res. Public Health 2021, 18(2), 818; https://doi.org/10.3390/ijerph18020818 - 19 Jan 2021

Cited by 41 | Viewed by 4152

Abstract

Social frailty affects various aspects of health in community-dwelling older adults. This study aimed to identify the prevalence of social frailty and the significance of its association with South Korean older adults’ health status and life satisfaction. This study involved a secondary data [...] Read more.

Social frailty affects various aspects of health in community-dwelling older adults. This study aimed to identify the prevalence of social frailty and the significance of its association with South Korean older adults’ health status and life satisfaction. This study involved a secondary data analysis of the 2017 National Survey of Older Koreans. From the 10,299 respondents of the survey, 10,081 were selected with no exclusion criteria. Multiple regression analyses were conducted to identify the factors related to life satisfaction. Compared with the robust and social prefrailty groups, the social frailty group had higher nutritional risk (χ² = 312.161, p = 0.000), depressive symptoms (χ² = 977.587, p = 0.000), cognitive dysfunction (χ² = 25.051, p = 0.000), and lower life satisfaction (F = 1050.272, p = 0.000). The results of multiple linear regression, adjusted for sociodemographic and health-related characteristics, indicated that social frailty had the strongest negative association with life satisfaction (β = −0.267, p = 0.000). However, cognitive function was significantly positively associated with life satisfaction (β = 0.062, p = 0.000). Social frailty was significantly correlated with physical, psychological, and mental health as well as life satisfaction in community-dwelling older South Koreans. Therefore, accounting for the social aspect of functioning is an essential part of a multidimensional approach to improving health and life satisfaction in communities. Full article

(This article belongs to the Special Issue Health Care for Older Adults)

13 pages, 534 KiB

Open AccessArticle

Depressive Symptoms, Fatigue and Social Relationships Influenced Physical Activity in Frail Older Community-Dwellers during the Spanish Lockdown due to the COVID-19 Pandemic

by Laura M. Pérez, Carmina Castellano-Tejedor, Matteo Cesari, Luis Soto-Bagaria, Joan Ars, Fabricio Zambom-Ferraresi, Sonia Baró, Francisco Díaz-Gallego, Jordi Vilaró, María B. Enfedaque, Paula Espí-Valbé and Marco Inzitari

Int. J. Environ. Res. Public Health 2021, 18(2), 808; https://doi.org/10.3390/ijerph18020808 - 19 Jan 2021

Cited by 53 | Viewed by 7337

Abstract

Due to the dramatic impact of the COVID-19 pandemic, Spain underwent a strict lockdown (March–May 2020). How the lockdown modified older adults’ physical activity (PA) has been poorly described. This research assesses the effect of the lockdown on PA levels and identifies predictors [...] Read more.

Due to the dramatic impact of the COVID-19 pandemic, Spain underwent a strict lockdown (March–May 2020). How the lockdown modified older adults’ physical activity (PA) has been poorly described. This research assesses the effect of the lockdown on PA levels and identifies predictors of sufficient/insufficient PA in frail older community-dwellers. Community-dwelling participants from the +ÀGIL Barcelona frailty intervention program, suspended during the pandemic, underwent a phone-assessment during the lockdown. PA was measured before and after the lockdown using the Brief Physical Activity Assessment Tool (BPAAT). We included 98 frail older adults free of COVID-19 (mean age = 82.7 years, 66.3% women, mean Short Physical Performance Battery = 8.1 points). About one third of participants (32.2%) were not meeting sufficient PA levels at the end of the lockdown. Depressive symptoms (OR = 0.12, CI95% = 0.02–0.55) and fatigue (OR = 0.11, CI95% = 0.03–0.44) decreased the odds of maintaining sufficient PA, whereas maintaining social networks (OR = 5.07, CI95% = 1.60–16.08) and reading (OR = 6.29, CI95% = 1.66–23.90) increased it. Living alone was associated with the reduction of PA levels (b = −1.30, CI95% = −2.14–−0.46). In our sample, pre-lockdown mental health, frailty-related symptoms and social relationships were consistently associated with both PA levels during-lockdown and pre-post change. These data suggest considering specific plans to maintain PA levels in frail older community-dwellers. Full article

(This article belongs to the Special Issue Health Care for Older Adults)

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22 pages, 6410 KiB

Open AccessArticle

Thermal Sensation in Older People with and without Dementia Living in Residential Care: New Assessment Approaches to Thermal Comfort Using Infrared Thermography

by Charmaine Childs, Jennifer Elliott, Khaled Khatab, Susan Hampshaw, Sally Fowler-Davis, Jon R. Willmott and Ali Ali

Int. J. Environ. Res. Public Health 2020, 17(18), 6932; https://doi.org/10.3390/ijerph17186932 - 22 Sep 2020

Cited by 16 | Viewed by 4974

Abstract

The temperature of the indoor environment is important for health and wellbeing, especially at the extremes of age. The study aim was to understand the relationship between self-reported thermal sensation and extremity skin temperature in care home residents with and without dementia. The [...] Read more.

The temperature of the indoor environment is important for health and wellbeing, especially at the extremes of age. The study aim was to understand the relationship between self-reported thermal sensation and extremity skin temperature in care home residents with and without dementia. The Abbreviated Mental Test (AMT) was used to discriminate residents to two categories, those with, and those without, dementia. After residents settled and further explanation of the study given (approximately 15 min), measurements included: tympanic membrane temperature, thermal sensation rating and infrared thermal mapping of non-dominant hand and forearm. Sixty-nine afebrile adults (60–101 years of age) were studied in groups of two to five, in mean ambient temperatures of 21.4–26.6 °C (median 23.6 °C). Significant differences were observed between groups; thermal sensation rating (p = 0.02), tympanic temperature (p = 0.01), fingertip skin temperature (p = 0.01) and temperature gradients; fingertip-wrist p = 0.001 and fingertip-distal forearm, p = 0.001. Residents with dementia were in significantly lower air temperatures (p = 0.001). Although equal numbers of residents per group rated the environment as ‘neutral’ (comfortable), resident ratings for ‘cool/cold’ were more frequent amongst those with dementia compared with no dementia. In parallel, extremity (hand) thermograms revealed visual temperature demarcation, variously across fingertip, wrist, and forearm commensurate with peripheral vasoconstriction. Infrared thermography provided a quantitative and qualitative method to measure and observe hand skin temperature across multiple regions of interest alongside thermal sensation self-report. As an imaging modality, infrared thermography has potential as an additional assessment technology with clinical utility to identify vulnerable residents who may be unable to communicate verbally, or reliably, their satisfaction with indoor environmental conditions. Full article

(This article belongs to the Special Issue Health Care for Older Adults)

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14 pages, 945 KiB

Open AccessArticle

The Prevalence of Anticholinergic Drugs and Correlation with Pneumonia in Elderly Patients: A Population-Based Study in Taiwan

by Chien-Ying Lee, Yih-Dih Cheng, Wei-Yuan Cheng, Tung-Han Tsai and Kuang-Hua Huang

Int. J. Environ. Res. Public Health 2020, 17(17), 6260; https://doi.org/10.3390/ijerph17176260 - 28 Aug 2020

Cited by 9 | Viewed by 3210

Abstract

Anticholinergic drugs may increase the risk of serious respiratory infection, especially in the elderly. The study aims to investigate the prevalence of anticholinergic drugs and the correlation of incident pneumonia associated with the use of anticholinergic drugs among the elderly in Taiwan. The [...] Read more.

Anticholinergic drugs may increase the risk of serious respiratory infection, especially in the elderly. The study aims to investigate the prevalence of anticholinergic drugs and the correlation of incident pneumonia associated with the use of anticholinergic drugs among the elderly in Taiwan. The study population was 275,005 elderly patients aged ≥65 years old, selected from the longitudinal health insurance database (LHID) in 2016. Among all the elderly patients, about 60% had received anticholinergic medication at least once. Furthermore, the study selected elderly patients who had not been diagnosed with pneumonia and had not received any anticholinergic drugs in the past year in order to evaluate the correlation between pneumonia and anticholinergic drugs. The study excluded elderly patients who died or had received related drugs of incident pneumonia during the study period and selected elderly patients receiving anticholinergic drugs as the case group. Propensity score matching (PSM) on a 1:1 scale was used to match elderly patients that were not receiving any anticholinergic drugs as the control group, resulting in a final sample of 32,215 patients receiving anticholinergic drugs and 32,215 patients not receiving any anticholinergic drugs. Conditional logistic regression was used to estimate the association between anticholinergic drugs and pneumonia after controlling for potential confounders. Compared with patients not receiving anticholinergic drugs, the adjusted odds ratio of patients receiving anticholinergic drugs was 1.33 (95% confidence interval: 1.18 to 1.49). Anticholinergic medication is common among elderly patients in Taiwan. Elderly patients receiving anticholinergic drugs may increase their risk of incident pneumonia. The safety of anticholinergic drugs in the elderly should be of concern in Taiwan. Full article

(This article belongs to the Special Issue Health Care for Older Adults)

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12 pages, 692 KiB

Open AccessArticle

Thermotherapy Plus Neck Stabilization Exercise for Chronic Nonspecific Neck Pain in Elderly: A Single-Blinded Randomized Controlled Trial

by Ho-Jin Shin, Sung-Hyeon Kim, Suk-Chan Hahm and Hwi-Young Cho

Int. J. Environ. Res. Public Health 2020, 17(15), 5572; https://doi.org/10.3390/ijerph17155572 - 1 Aug 2020

Cited by 22 | Viewed by 8230

Abstract

Neck pain is a serious problem for public health. This study aimed to compare the effects of thermotherapy plus neck stabilization exercise versus neck stabilization exercise alone on pain, neck disability, muscle properties, and alignment of the neck and shoulder in the elderly [...] Read more.

Neck pain is a serious problem for public health. This study aimed to compare the effects of thermotherapy plus neck stabilization exercise versus neck stabilization exercise alone on pain, neck disability, muscle properties, and alignment of the neck and shoulder in the elderly with chronic nonspecific neck pain. This study is a single-blinded randomized controlled trial. Thirty-five individuals with chronic nonspecific neck pain were randomly allocated to intervention (n = 18) or control (n = 17) groups. The intervention group received thermotherapy with a salt-pack for 30 min and performed a neck stabilization exercise for 40 min twice a day for 5 days (10 sessions). The control group performed a neck stabilization exercise at the same time points. Pain intensity, pain pressure threshold (PPT), neck disability index, muscle properties, and alignment of the neck and shoulder were evaluated before and after the intervention. Significant time and group interactions were observed for pain at rest (p < 0.001) and during movement (p < 0.001), and for PPT at the upper-trapezius (p < 0.001), levator-scapula (p = 0.003), and splenius-capitis (p = 0.001). The disability caused by neck pain also significantly changed between groups over time (p = 0.005). In comparison with the control group, the intervention group showed significant improvements in muscle properties for the upper-trapezius (tone, p = 0.021; stiffness, p = 0.017), levator-scapula (stiffness, p = 0.025; elasticity, p = 0.035), and splenius-capitis (stiffness, p = 0.012), and alignment of the neck (p = 0.016) and shoulder (p < 0.001) over time. These results recommend the clinical use of salt pack thermotherapy in addition to neck stabilization exercise as a complementary intervention for chronic nonspecific neck pain control. Full article

(This article belongs to the Special Issue Health Care for Older Adults)

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Review

Jump to: Editorial, Research

22 pages, 447 KiB

Open AccessReview

Colorectal Cancer in Elderly Patients with Surgical Indication: State of the Art, Current Management, Role of Frailty and Benefits of a Geriatric Liaison

by Nicolás M. González-Senac, Jennifer Mayordomo-Cava, Angela Macías-Valle, Paula Aldama-Marín, Sara Majuelos González, María Luisa Cruz Arnés, Luis M. Jiménez-Gómez, María T. Vidán-Astiz and José Antonio Serra-Rexach

Int. J. Environ. Res. Public Health 2021, 18(11), 6072; https://doi.org/10.3390/ijerph18116072 - 4 Jun 2021

Cited by 19 | Viewed by 4224

Abstract

Six out of every 10 new colorectal cancer (CRC) diagnoses are in people over 65 years of age. Current standardized surgical approaches have proved to be tolerable on the elderly population, although post-operative complications are more frequent than in the younger CRC population. [...] Read more.

Six out of every 10 new colorectal cancer (CRC) diagnoses are in people over 65 years of age. Current standardized surgical approaches have proved to be tolerable on the elderly population, although post-operative complications are more frequent than in the younger CRC population. Frailty is common in elderly CRC patients with surgical indication, and it appears to be also associated with an increase of post-operative complications. Fast-track pathways have been developed to assure and adequate post-operative recovery, but comprehensive geriatric assessments (CGA) are still rare among the preoperative evaluation of elderly CRC patients. This review provides a thorough study of the effects that a CGA assessment and a geriatric intervention have in the prognosis of CRC elderly patients with surgical indication. Full article

(This article belongs to the Special Issue Health Care for Older Adults)

29 pages, 843 KiB

Open AccessReview

Orthogeriatric Management: Improvements in Outcomes during Hospital Admission Due to Hip Fracture

by Francisco José Tarazona-Santabalbina, Cristina Ojeda-Thies, Jesús Figueroa Rodríguez, Concepción Cassinello-Ogea and José Ramón Caeiro

Int. J. Environ. Res. Public Health 2021, 18(6), 3049; https://doi.org/10.3390/ijerph18063049 - 16 Mar 2021

Cited by 25 | Viewed by 4834

Abstract

Hip fractures are an important socio-economic problem in western countries. Over the past 60 years orthogeriatric care has improved the management of older patients admitted to hospital after suffering hip fractures. Quality of care in orthogeriatric co-management units has increased, reducing adverse events [...] Read more.

Hip fractures are an important socio-economic problem in western countries. Over the past 60 years orthogeriatric care has improved the management of older patients admitted to hospital after suffering hip fractures. Quality of care in orthogeriatric co-management units has increased, reducing adverse events during acute admission, length of stay, both in-hospital and mid-term mortality, as well as healthcare and social costs. Nevertheless, a large number of areas of controversy regarding the clinical management of older adults admitted due to hip fracture remain to be clarified. This narrative review, centered in the last 5 years, combined the search terms “hip fracture”, “geriatric assessment”, “second hip fracture”, “surgery”, “perioperative management” and “orthogeriatric care”, in order to summarise the state of the art of some questions such as the optimum analgesic protocol, the best approach for treating anemia, the surgical options recommendable for each type of fracture and the efficiency of orthogeriatric co-management and functional recovery. Full article

(This article belongs to the Special Issue Health Care for Older Adults)

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17 pages, 640 KiB

Open AccessReview

Implementing Precision Medicine in Human Frailty through Epigenetic Biomarkers

by José Luis García-Giménez, Salvador Mena-Molla, Francisco José Tarazona-Santabalbina, Jose Viña, Mari Carmen Gomez-Cabrera and Federico V. Pallardó

Int. J. Environ. Res. Public Health 2021, 18(4), 1883; https://doi.org/10.3390/ijerph18041883 - 15 Feb 2021

Cited by 6 | Viewed by 4916

Abstract

The main epigenetic features in aging are: reduced bulk levels of core histones, altered pattern of histone post-translational modifications, changes in the pattern of DNA methylation, replacement of canonical histones with histone variants, and altered expression of non-coding RNA. The identification of epigenetic [...] Read more.

The main epigenetic features in aging are: reduced bulk levels of core histones, altered pattern of histone post-translational modifications, changes in the pattern of DNA methylation, replacement of canonical histones with histone variants, and altered expression of non-coding RNA. The identification of epigenetic mechanisms may contribute to the early detection of age-associated subclinical changes or deficits at the molecular and/or cellular level, to predict the development of frailty, or even more interestingly, to improve health trajectories in older adults. Frailty reflects a state of increased vulnerability to stressors as a result of decreased physiologic reserves, and even dysregulation of multiple physiologic systems leading to adverse health outcomes for individuals of the same chronological age. A key approach to overcome the challenges of frailty is the development of biomarkers to improve early diagnostic accuracy and to predict trajectories in older individuals. The identification of epigenetic biomarkers of frailty could provide important support for the clinical diagnosis of frailty, or more specifically, to the evaluation of its associated risks. Interventional studies aimed at delaying the onset of frailty and the functional alterations associated with it, would also undoubtedly benefit from the identification of frailty biomarkers. Specific to the article yet reasonably common within the subject discipline. Full article

(This article belongs to the Special Issue Health Care for Older Adults)

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