Association of Facial Wrinkles With Different Facial Forms in the Population of Maharashtra: A Prospective Observational Study.

INTRODUCTION: Wrinkles commonly manifest in various areas of the face as individuals age. This study aimed to assess the association between facial wrinkles and different facial forms. MATERIALS AND METHODS: An observational, prospective study was conducted on the facial photographs of 400 subjects aged 40-60 years, which were divided into four groups of 100 subjects each: Group 1, square facial form; Group 2, ovoid facial form; Group 3, square tapered facial form; and Group 4, tapered facial form. All groups had almost equal distributions of males and females. Six types of facial wrinkles were studied, namely, forehead, glabellar, canthal, nasolabial, wrinkles at the corner of the mouth, and perioral wrinkles. Analysis of variance (ANOVA) was used for intergroup comparison, and an independent Student's t-test was used to assess gender differences in facial wrinkles. RESULTS: Significant gender differences were observed for forehead wrinkles in Groups 1 and 3, canthal wrinkles in Groups 1 and 2, and right perioral wrinkles in Group 1 (p<0.05). There were non-significant gender differences between right and left-side facial wrinkles (p>0.05). Significant differences between the groups were observed for all facial wrinkles between the right and left sides of the face (p<0.05). There was a significant difference between the groups for the presence of glabellar, corner of the mouth, and perioral wrinkles, with the presence of higher wrinkles in ovoid and tapered facial forms compared to square and square tapered facial forms (p<0.05). CONCLUSIONS: Females had more facial wrinkles than males, predominantly in the forehead region. The least prominent wrinkles were observed in the perioral region of the face. Glabellar, corner of the mouth, and perioral wrinkles were predominantly observed in ovoid and tapered facial forms.

Expanding the ethnographic toolkit: Using medical documents to include kinless older adults living with dementia in qualitative research.

Ethnographic research with cognitively impaired older adults can be challenging, in part because cognitive impairment raises questions about the ability to provide informed consent. Relying on proxy consent is a commonly used strategy, but often excludes people with dementia who lack close kin (de Medeiros, Girling, & Berlinger, 2022). In this paper, we describe how we have analyzed existing research data from a well-established and ongoing prospective cohort study, the Adult Changes in Thought Study, along with unstructured text from the medical records of participants who had no living spouse or adult children when they developed dementia, as a way of studying the circumstances, life trajectories, caregiving resources, and care needs of this vulnerable and difficult-to-research group. In this article, we detail this methodology, exploring what can and cannot be gleaned from it, what the ethical implications may be, and how and whether this type of research can be considered ethnographic. In conclusion, we argue that collaborative interdisciplinary research using existing, longitudinal research data and text from medical records deserves to be considered as a potentially useful addition to the ethnographic toolkit. We anticipate that this is a methodology that could be applied more broadly, and paired with more traditional ethnographic methods, might be one way to make research with this population more inclusive.

Kinless Older Adults With Dementia: Qualitative Analysis of Data From the Adult Changes in Thought Study.

OBJECTIVES: To examine the circumstances and needs of older adults who were "kinless," defined as having no living spouse or children, when they developed dementia. METHODS: We conducted a secondary analysis of information from the Adult Changes in Thought study. Among 848 participants diagnosed with dementia between 1994 and 2016, we identified 64 who had no living spouse or child at dementia onset. We then conducted a qualitative analysis of administrative documents pertaining to these participants: handwritten comments recorded after each study visit, and medical history documents containing clinical chart notes from participants' medical records. RESULTS: In this community-dwelling cohort of older adults diagnosed with dementia, 8.4% were kinless at dementia onset. Participants in this sample had an average age of 87 years old, half lived alone, and one third lived with unrelated persons. Through inductive content analysis, we identified 4 themes that describe their circumstances and needs: (1) life trajectories, (2) caregiving resources, (3) care needs and gaps, and (4) turning points in caregiving arrangements. DISCUSSION: Our qualitative analysis reveals that the life trajectories that led members of the analytic cohort to be kinless at dementia onset were quite varied. This research highlights the importance of nonfamily caregivers and participants' own roles as caregivers. Our findings suggest that clinicians and health systems may need to work with other parties to directly provide dementia caregiving support rather than rely on family, and address factors such as neighborhood affordability that particularly affect older adults who have limited family support.