Looking in the Rearview Mirror and to the Road Ahead on Dementia & Living Well

The number of Americans living with Alzheimer's and all other dementias continues to increase. Most of them will need long-term and community-based services as the disease progresses. While medical research is making advances, there is more work to be done to ensure that every person receives care that is person-centered and allows them to live with dignity and respect.

So, You Want to Build a Program?

This article will help dementia care service organizations develop and evaluate intervention programs in the absence of evidence-based solutions, which is key, given: the limited access family caregivers have to evidence-based intervention programs;and the need for organizations to use limited resources to develop and test new programs to serve families living with dementia. It draws upon two case studies of interventions developed at an academic-service center: KINDER and Ayudando a Quien Ayuda;evaluates lessons learned in assessing the two programs to refine them by applying the Exploration, Preparation, Implementation, Sustainment (EPIS) framework, and recommends ways organizations can refine interventions prior to efficacy-testing.

The effect of covid-19 vaccines on pneumothorax in geriatric patients hospItalized in intensive care unit due to covid-19

In our study, we examined the effect of COVID-19 vaccination on the incidence of pneumothorax in intensive care patients over age 65. COVID-19 intensive care patients that presented to our department between April 2020 and May 2021 during the COVID-19 pandemic were evaluated retrospectively. Patients were divided into two main groups, i.e., before and after the vaccination period. Patients were evaluated retrospectively for the following parameters: Gender, age, side of pneumothorax, mortality, discharge, comorbidity, and additional pleural complications. The total number of patients was 87, i.e., 66 patients before vaccination and 21 patients after vaccination. When patients in the pre- and post-vaccination period were compared, there was a significant difference in the incidence of pneumothorax between the two groups (p<0.05). Pneumothorax was less common after vaccination. When patients with pneumothorax and tube thoracostomy were evaluated according to pre- and post-vaccination mortality, mortality was significantly higher (89%) in the pre-vaccination period (p<0.05). We consider that COVID-19 vaccines used in patients aged over 65 reduced the incidence of pleural complications, especially pneumothorax. We think that mortality due to pneumothorax in patients over 65 years of age was lower during the vaccination period. In addition, we think that bilateral pneumothorax was more common in the non-vaccinated period. As a result, we think that life-threatening pneumothorax and similar complications could be reduced by increasing the number of vaccines made in the COVID-19 pandemic and spreading it around the world.Copyright © 2022, Dr. Mladen Stojanovic University Hospital. All rights reserved.

Importance of meaningful engagement: how and why older adults volunteer in uncertain times

PurposeMany older adults engage in volunteer activities, drawing meaning and purpose through such efforts. Social distancing restrictions, put in place during Covid-19 surges to reduce the risk of transmission, disrupted older adult volunteers' lives and volunteer experiences. Social distancing measures provide a unique opportunity to explore what happened when the choices around pausing or stopping volunteering were not entirely within the control of older adults. This paper aims to explore the experiences of older adult volunteers as they navigated uncertainties and made difficult decisions around balancing their safety and their desire to continue volunteering.Design/methodology/approachThe authors conducted interviews with 26 community-dwelling older adults, age 50+, who had engaged in volunteer activities for at least 1 h a week prior to the start of the pandemic. The interviews were conducted on the phone or via Zoom. The authors used thematic analysis to help us analyze the data and identify patterns from participants' experiences.FindingsDespite the risk presented by Covid-19, most participants volunteered during the pandemic. They continued some or all of their previous activities with safety-related adjustments, with some seeking new or different opportunities. Participants' discussions highlight the challenges of volunteering during the pandemic and the importance of engagement to their resiliency and subjective well-being.Originality/valueThis paper provides original contributions to understanding how and why older adults volunteered during the Covid-19 pandemic. The social distancing measures provide a novel opportunity to enrich our understanding of the meaningfulness and value of volunteerism to older adults' lives and subjective well-being.

Acceptability of Telemedicine in a Geriatric Outpatient Practice During the COVID-19 Pandemic.

Background: Telemedicine utilization has increased dramatically during the COVID pandemic. Few studies have evaluated the use and acceptability of telemedicine in older populations. This study examined the use and acceptability of telemedicine with older adults in an urban, geriatric practice. Methods: An anonymous survey was sent to patients seen at an urban, geriatric practice using MyChart in EPIC in March 2021. This population of patients is 55 years and older, 50% Black, 40% white, 3% Latino, 3% Asian, and 4% other. This panel is comprised of 71% Medicare, 23% non-Medicare/non-Medicaid, and 6% Medicaid. The total panel of patients includes ∼1,400 patients. The percent of patients on MyChart at the time of the survey was 78%. Thus, about 1,092 patients received the survey. Results: Of the 1,092 patients who received the survey, 247 (22.6%) responded. Around 80.37% of respondents rated their overall experience with telemedicine as good or excellent. Theme areas emerged around the advantages and disadvantages of telemedicine. A majority (70.28%) of respondents rated themselves as Somewhat Confident to Very Confident in use of telemedicine without family/friend assistance. A majority (74.16%) of respondents stated they plan to use telemedicine again. Conclusions: This survey demonstrated the feasibility and acceptability of telemedicine in an urban, geriatric population. A limit to this study is that the survey was administered on-line, so that participants may be biased regarding use of online technology. However, this study showed that the vast majority of older adults were confident in using telemedicine as an alternative to in-person visits during the COVID pandemic and plan on using it again.

Perceptions about Aging and Ageism from 14 Cross-sectional Cohorts of Undergraduate Dental Students.

BACKGROUND: Although positive and negative views of aging and older adults exist, how undergraduate dental students imagine their lives to be as they grow older remains to be fully explored. This study aimed at determining the self-perceived views of being 65, 75, or 85 y of age, as expressed by undergraduate dental students at the University of British Columbia (UBC), Vancouver, Canada. METHODS: A 14-y cross-sectional study design was utilized involving third-year undergraduate dental students at UBC's Faculty of Dentistry. Brief individual essays (150 words) encompassing students' self-perceived views were gathered as part of a dental geriatric course from 2009 to 2022; however, essays were not mandatory. Saldaña's inductive coding and thematic analysis of textual data were used. Themes and categories of information were identified and matched with their excerpts while aiming for data saturation. RESULTS: Over the 14-y period, 657 students were enrolled in UBC's undergraduate dental geriatric course, and 561 essays were collected. Inductive coding and thematic analysis identified 5 main themes and 11 categories. While themes included "oral health, general health, and the mind" and "me, myself, and familial relationships," the categories focused on "(un)able bodies" and "general health." Positive views about the aging process were shared, while less optimistic ideas-and even ageism-were apparent when students saw themselves as not employable or living in isolation. Positive and negative views were not bound by the students' academic year but might have been influenced by the COVID-19 pandemic. CONCLUSION: Although the number of older adults already surpasses the number of children in many countries, ageism appears to have permeated through students' views of 3 older ages. More positive yet realistic views of growing older were also shared. Follow-up studies are needed to explore the impact of dental education on decreasing ageism. KNOWLEDGE TRANSFER STATEMENT: As the proportion of older adults in the global population steadily grows, it is important to educate heath care providers about normal and pathologic aging to avoid ageism-stereotypes, prejudices, and discrimination against older adults. This cross-sectional study involved 14 cohorts of undergraduate dental students exploring their self-perceived views of growing older. Although positive and negative views of aging were shared, dental education must focus on decreasing ageism.

Diagnosis of delirium: a practical approach.

Delirium is an acute disorder of fluctuating attention and awareness with cardinal features that allow it to be positively distinguished from other causes of an acute confusional state. These features include fluctuations, prominent inattentiveness with other cognitive deficits, a change in awareness and visual hallucinations. We describe a framework for diagnosing delirium, noting the need to consider certain caveats and differential diagnoses. Delirium is a clinical diagnosis where a thorough history and clinical examination are much more helpful diagnostically than any single test or combination of tests.

Trends in COVID-19-Related Medication Use in US Nursing Homes, 2018-2022.

OBJECTIVES: Little is known about how COVID-19 treatment patterns have evolved over time in nursing homes (NHs) despite the devastating effects of COVID-19 in this setting. The aim was to describe changes in COVID-19-related medication use over time among NH residents in the United States. DESIGN: Retrospective cohort study. SETTING AND PARTICIPANTS: This study used electronic health records (EHR) from 11 different US NH corporations between January 1, 2018, and March 31, 2022. METHODS: The use of medications approved for COVID-19-related conditions or known to be used off-label for COVID-19 during the study period is identified. We described trends in the use of each drug and combined use per 1000 NH residents over calendar time [quarters (Q)]. RESULTS: A total of 59,022 unique residents with the use of an eligible medication were identified. Hydroxychloroquine use sharply increased from 9.8 in 2020Q1 to 30.2 orders per 1000 individuals in 2020Q2. Dexamethasone use increased sharply from 14.8 in 2020Q2 to a peak of 121.9 orders per 1000 individuals in 2020Q4. Azithromycin use increased from 44.1 in 2019Q3 to a peak of 99.9 orders per 1000 individuals in 2020Q4, with a drop in 2020Q3 of 51.3 per 1000 individuals in 2020Q3. Concurrent use of azithromycin and hydroxychloroquine increased sharply from 0.3 in 2020Q1 to 10.6 orders per 1000 residents in 2020Q2 and then drastically decreased to 0.6 per 1000 residents in 2020Q3. Concurrent use of dexamethasone and azithromycin rose considerably from 0.7 in 2020Q2 to 28.2 orders per 1000 residents in 2020Q4. CONCLUSIONS AND IMPLICATIONS: As in other settings, COVID-19-related medication use in NHs appears to have changed in response to the shifting evidence base and availability of medications during the pandemic. Providers should continue to diligently modify their prescribing as new evidence accrues.

Infection à Covid-19 en gériatrie au Sénégal

Objectives: While the elderly incurred high mortality during the Covid-19 pandemic, the geriatric particularities remain little known. The objective of this work was to determine the geriatric specificities, in particular epidemiological, diagnostic and therapeutic, of this infection in Senegal. Methods: This was a retrospective, descriptive, observational study over a period of 13 months (beginning of August 2020 to end of August 2021) conducted in a population of individuals aged 65 years and older admitted to the only university geriatric department in Senegal. Patients infected with COVID-19 confirmed by a positive RT-PCR (Reverse Transcriptase Polymerase Chain Reaction) and nasal or pharyngeal swabs were included. Results: During this period, out of 215 hospitalized patients, 40 tested positive for Covid-19, a proportion of 18.6%. The mean age of the patients was 79 years (+/-7), predominantly male (65%). Most patients (45%) came from the hospital emergency department. Frailty concerned 67.5% of the patients and 25% had a chronic loss of autonomy.Clinical signs were dominated by alteration of the general state and pulmonary condensation syndrome, each affecting half of the patients, followed by fever (40%), anorexia (35%), dyspnea (32.5%) and transit disorders (25%). The geriatric syndromes were mainly loss of functional autonomy for 77.5% of the patients, malnutrition for 67.5%, confusional syndrome for 25% and depression for 25%. On the thoracic CT scan, the extent of the lesions was severe for half of the patients with extensive forms for 25% of the patients, severe for 22.5% and critical for 2.5%.All patients received antibiotic therapy based on azithromycin and 57.5% received amoxicillin-clavulanic acid while only 7.5% received hydroxychloroquine. Non-drug treatments were mainly motor rehabilitation for 80% of the patients, nutritional management for 77.5%, supportive psychotherapy for 50% and temporo-spatial reorientation protocols for confusion for 30%. Complications were dominated by acute renal failure (47.5%), ionic disorders (42.5%) and bacterial superinfections (22.5%). The mortality rate was 20%. Conclusion: This study, in addition to confirming the atypical nature of the symptomatology and the severity of the pulmonary involvement, has above all highlighted the multidimensional particularities of the geriatric management of Covid-19.

Early oral nutritional supplement improves COVID-19 outcomes among hospitalized older patients during the Omicron wave.

OBJECTIVES: The effect of and optimal timing for initiating an oral nutritional supplement(ONS) in hospitalized older patients with the Omicron variant infection remain unclear. The aim of this study was to explore the associations between the ONS and clinical outcomes. METHODS: This study used a retrospective cohort design as primary analysis and a case-control design as sensitivity analysis. We collected data from patients with confirmed coronavirus disease 2019 (COVID-19) between April 2022 and June 2022 at Shanghai Fourth People's Hospital, one of the designated medical centers for COVID-19 in Shanghai, China. Patients were identified as ONS users or non-ONS users, with the former defined as early ONS (ONS initiated within 48 h from hospital admission), and late ONS (ONS initiated after 48 h) users. RESULTS: The study included 1181 hospitalized patients ≥60 y of age. The mean age of the cohort was 78 y, and most patients were women (57.7%). Mortalities after propensity-score matching were 1.2% and 4.3% in the ONS group and non-ONS groups, respectively (P = 0.032). Subgroup analysis results showed that median (IQR) hospital length of stay and the median (IQR) length from symptom onset to viral clearance were shorter for the early ONS than for the late ONS group (9 [6-13] d versus 14 [11 -18] d; P < 0.001, and 11 [8-17] d versus 17 [13-22] d; P < 0.001, respectively). The findings from the case-control analysis supported those from the primary analysis. CONCLUSIONS: Early ONS might have significantly lowered risk for in-hospital death, as well as reduce hospital length of stay and days of viral clearance in older patients with COVID-19 during the Omicron wave.