Cognitive Fitness: Harnessing the Strength of Exerkines for Aging and Metabolic Challenges.

Addressing cognitive impairment (CI) represents a significant global challenge in health and social care. Evidence suggests that aging and metabolic disorders increase the risk of CI, yet promisingly, physical exercise has been identified as a potential ameliorative factor. Specifically, there is a growing understanding that exercise-induced cognitive improvement may be mediated by molecules known as exerkines. This review delves into the potential impact of aging and metabolic disorders on CI, elucidating the mechanisms through which various exerkines may bolster cognitive function in this context. Additionally, the discussion extends to the role of exerkines in facilitating stem cell mobilization, offering a potential avenue for improving cognitive impairment.

Familial Hypercholesterolemia in the Elderly: An Analysis of Clinical Profile and Atherosclerotic Cardiovascular Disease Burden from the Hellas-FH Registry.

BACKGROUND: Familial hypercholesterolemia (FH) carries a high risk of atherosclerotic cardiovascular disease (ASCVD). As the population ages, the age-related influence on clinical characteristics and outcomes becomes increasingly pertinent. This cross-sectional analysis from the HELLAS-FH registry aims to explore potential differences in clinical characteristics, treatment, ASCVD, and goal achievement between those younger and older than 65 years with FH. RESULTS: A total of 2273 adults with heterozygous FH (51.4% males) were studied. Elderly FH patients (n = 349) had a higher prevalence of ASCVD risk factors, such as hypertension (52.1% vs. 20.9%, p < 0.05) and type 2 diabetes (16.9% vs. 6.0%, p < 0.05), compared to younger patients (n = 1924). They also had a higher prevalence of established ASCVD (38.4% vs. 23.1%, p < 0.001), particularly CAD (33.0% vs. 20.2%, p < 0.001), even after adjusting for major ASCVD risk factors. Elderly patients were more frequently and intensively receiving lipid-lowering treatment than younger ones. Although post-treatment LDL-C levels were lower in elderly than younger patients (125 vs. 146 mg/dL, p < 0.05), both groups had similar attainment of the LDL-C target (3.7% vs. 3.0%). CONCLUSIONS: Elderly FH patients have a higher prevalence of ASCVD, particularly CAD. Despite more aggressive treatment, the achievement of LDL-C targets remains very poor. These results emphasize the importance of early FH diagnosis and treatment in reducing ASCVD.

Role of Enhancing Aerobic Capacity in Countering COVID-19-induced Liver Injury in Elderlies.

COVID-19 is still a world disaster; however, its vaccination is globally available. Liver and gastrointestinal disturbances occur in patients infected with COVID-19 at varying incidences. Aging decreases the functions of the liver. Thus, the elderly have a weaker response to the COVID-19 virus. The COVID-19 virus affects the liver directly through direct and indirect mechanisms. It directly affects the renin-angiotensin system or indirectly causes sepsis, uncontrolled immune reactions, drug-related hepatic injury, and cytokine storm. Also, COVID-19 vaccines and anti-drugs have adverse effects on the liver too. Thus, this review explores the effect of enhancing aerobic capacity as a nonpharmacological intervention on decreasing COVID- 19-induced liver injury. Enhancing aerobic capacity decreases COVID-19-induced liver injury through the following: 1) downregulating systemic and tissue ACE/ANG II/AT1R axis, upregulating ACE2/ANG 1-7/Mas axis, and moving the renin-angiotensin system to the direction of the ACE2/ANG (1-7)/Mas axis, 2) Improving mitochondrial function and oxygenation to body and lung tissues, causing a decrease in harmful oxidative reactions, 3) Increasing the processing of accumulated free radicals and inhibiting the acute respiratory distress syndrome, 4) Acting as an antioxidant to protect the liver from oxidative stress, 5) Increasing the effect of antiviral drugs and COVID-19 vaccines, which improves the function of immune biomarkers, decreases the viral load, and increases the body's defense against the virus, 6) Decreasing coagulation abnormalities and thrombosis. In conclusion, enhancing aerobic capacity may be an efficient nonpharmacological intervention to decrease COVID-19-induced liver injury in elderlies and regenerate the liver to its normal status after being infected by the COVID-19 virus. It also helps to strengthen the body's immunity for better effects of both COVID-19 vaccination and drugs.

Eye Recognition by YOLO for Inner Canthus Temperature Detection in the Elderly Using a Transfer Learning Approach.

Early detection of physical frailty and infectious diseases in seniors is important to avoid any fatal drawback and promptly provide them with the necessary healthcare. One of the major symptoms of viral infections is elevated body temperature. In this work, preparation and implementation of multi-age thermal faces dataset is done to train different "You Only Look Once" (YOLO) object detection models (YOLOv5,6 and 7) for eye detection. Eye detection allows scanning for the most accurate temperature in the face, which is the inner canthus temperature. An approach using an elderly thermal dataset is performed in order to produce an eye detection model specifically for elderly people. An application of transfer learning is applied from a multi-age YOLOv7 model to an elderly YOLOv7 model. The comparison of speed, accuracy, and size between the trained models shows that the YOLOv7 model performed the best (Mean average precision at Intersection over Union of 0.5 (mAP@.5) = 0.996 and Frames per Seconds (FPS) = 150). The bounding box of eyes is scanned for the highest temperature, resulting in a normalized error distance of 0.03. This work presents a fast and reliable temperature detection model generated using non-contact infrared camera and a deep learning approach.

Timed Up and Go and Five Times Sit to Stand Test among community ambulant, overweight, obese Saudi elderly population.

OBJECTIVE: To investigate the effect of Timed Up and Go category on the Five Times Sit to Stand Test, and to determine the role of recreational status on Timed Up and Go rating. METHODS: The descriptive, cross-sectional study was conducted between October 2018 and April 2019 at the College of Medical Rehabilitation Sciences, Taibah University, Madina, Saudi Arabia, and comprised community-ambulant retired overweight or obese subjects of either gender aged 60-69 years. Timed Up and Go, Five Times Sit to Stand Test and Single-Leg Stance Test were used to measure basic mobility, transitional skills and static balance respectively. Data was analysed using SPSS 23. RESULTS: Of the 150 subjects, 108(72%) were males and 42(28%) were females. The overall mean age was 63.1}2.5 years and the mean body mass index was 29.6}3.8 kg/m2. There were 46(31.5%) subjects who were freely mobile, 60(41.1%) who were mostly independent and 40(27.4%) who had variable mobility. Also, 36(24%) subjects were recreationally active, while 114(76%) were recreationally inactive. The freely mobile subjects managed to finish the Five Times Sit to Stand Test in less time than the other groups (p<0.05). The recreationally active subjects took significantly less time to finish the Timed Up and Go test compared to the inactive. Besides, the males had longer Single-Leg Stance Test timing than females (p<0.05). CONCLUSIONS: The elderly belonging to different Timed Up and Go mobility categories demonstrated variable Five Times Sit to Stand abilities, with the recreational mobility status significantly affecting the category.

New trends in treatment of muscle fatigue throughout rehabilitation of elderlies with motor neuron diseases.

Muscle fatigue is a problem in rehabilitation, particularly in elderlies and patients with motor neuron diseases. There are high contradictions in the effectiveness of the used methods to decrease muscle fatigue during rehabilitation. They mainly concentrate on increasing rest periods, decreasing training load, or using an ascending intensity of manner of exercise. The training should focus on the newly discovered sensory system of muscle fatigue because of the important role of the sensory system in driving the motor system. Thus, this editorial provides insight on using proprioceptive training to enhance the sensory system of muscle fatigue.

Optimal P2Y12 inhibition in older adults with acute coronary syndromes: a network meta-analysis of randomized controlled trials.

AIMS: Dual antiplatelet therapy (DAPT) with a P2Y12 inhibitor on top of aspirin is the cornerstone of therapy after acute coronary syndromes (ACS). Nonetheless, the safest and most efficacious P2Y12 for older patients who are both at high ischaemic and bleeding risk remains uncertain. We aimed to examine the effect of available P2Y12 inhibitors on ischaemic and bleeding endpoints in older adults with ACS. METHODS AND RESULTS: Randomized clinical trials that reported separately the results of adults older >70 years for at least the primary endpoint [composite of death, myocardial infarction (MI), and stroke]. Seven studies (14 485 patients-years) were included. Network meta-analysis showed that prasugrel was associated with similar occurrence of the primary endpoint and of a secondary ischaemic endpoint (composite of MI and stroke) and was most likely the best treatment [Surface Under the Cumulative Ranking curve Analysis (SUCRA) 54.5 and 59.8, respectively]. With regards to major bleedings, clopidogrel showed the highest likelihood of event reduction (SUCRA 70.1%), while ticagrelor of stent thrombosis (SUCRA 55.6%). Our meta-regression with a fixed proportion of patients managed invasively of 100% confirmed these trends with increasing SUCRA. CONCLUSION: Among older subjects with ACS, DAPT should be balanced upon ischaemic and bleeding risks as prasugrel is associated with the highest probability of reduction of ischaemic events and clopidogrel of bleedings. Ticagrelor had highest SUCRA for stent thrombosis reduction but seems suboptimal in older adults.

Analysis of the barrier-free levels of village clinics of a city in the aging era / 中华医院管理杂志

Objective:To evaluate the barrier-free level of village clinics of a city in the aging era, for references in improving the barrier-free medical environment for the elderlies.Methods:The village dectors of 156 village clinics in 12 counties of a city were selected as the objects of a questionnaire survey from Dec.2020 to Jan.2021, with 6 evaluation indexes established, each set with 1-10 points. This questionnaires was used to survey the barrier-free construction levels of village clinics. The data were statistically analyzed by rank sum ratio and quadrant graph model.Results:The barrier-free buildings of such clinics scored 32.86 points in average. Among the six indexes, the barrier-free access and doors(7.21 points) scored the highest, and the barrier-free parking space(4.71points) and toilets(3.28 points) scored the lowest. All the counties of the city fell into four categories, including 2 counties with high degree of aging-high level of accessibility, 4 counties with low degree of aging-high level of accessibility, 4 counties with low degree of aging-low level of accessibility, and 2 counties with high degree of aging-low level of accessibility, according to the quadrant graph model built based on the aging degrees and the barrier-free levels of village clinics.Conclusions:The barrier-free level of the village clinics in a city needs to be further improved, and the barrier-free transformation of parking space and toilets should also be strengthened in the future. The government should take different measures in view of conditions of each county to improve the accessibility of village clinics and facilitate the health care-seeking of elderlies.

Puntos de encuentro entre Teorías de Swanson y Roy en el cuidado continuo del adulto mayor con cáncer prostático / Meeting Points between Swanson's and Roy´s Theories in Continuous Care for the Elderly with Prostate Cancer

Introducción: La gestión del cuidado de enfermería, en las personas mayores es un desafío actual para la profesión. Lo que implica planificar y coordinar cuidados seguros y de calidad. Donde se atribuye la necesidad de integrar el enfoque de las teorías y su práctica en el cuidado sistémico y dinámico a la persona en su realidad total. Objetivo: Analizar los puntos de encuentro entre las teorías de Swanson y Roy en el cuidado continuo del adulto mayor con cáncer de próstata. Métodos: Revisión bibliográfica sistemática, durante 2019, de artículos publicados desde 2009 hasta 2019 en las bases de datos SciELO y Google académico. La pregunta guía se elaboró a través del acrónimo PICo. La estrategia de búsqueda se realizó mediante aceptación de los descriptores en Ciencias de la Salud (DeCS) "Teorías de enfermería", "Modelo de adaptación de Callista Roy", "Teoría de Kristen Swanson", "Cuidados continuos", "Adulto mayor", "Neoplasia de la próstata" y "Enfermedades crónicas" con el operador booleano AND, se utilizó el diagrama de flujo (PRISMA). El análisis de contenido permitió interpretar los referentes teóricos y la organización del conocimiento de las 13 bibliografías seleccionadas. Conclusiones: Resulta limitada la producción científica encontrada en relación al alcance de las teorías de Swanson y Roy en la atención al paciente con cáncer. Ambas teorías tienen implícitas, en la fundamentación de sus componentes, un acercamiento biopsicosocial al modo de cuidar en la práctica clínica y la cultura del cuidado continuo en el adulto mayor con cáncer de próstata, desde la perspectiva de enfermería(AU)

Introduction: Nursing care management in the elderly is a current challenge for the profession. This implies planning and coordinating safe and quality care, processes requiring to integrate theoretical approach and their praxis into systemic and dynamic care to the person in a total reality. Objective: To analyze the meeting points between the theories of Swanson and Roy in the continuous care of the elderly with prostate cancer. Methods: Systematic bibliographic review, carried out during 2019, of articles published from 2009 to 2019 in the SciELO and Google Scholar databases. The guiding question was developed through the acronym PICO. The search strategy was carried out by accepting the following descriptors in Health Sciences (DeCS): teorías de enfermería [nursing theories], modelo de adaptación de Callista Roy [Callista Roy's adaptation model], teoría de Kristen Swanson [Kristen Swanson's theory], cuidados continuos [continuous cares], adulto mayor [elderly], neoplasia de la próstata [prostate neoplasm] and enfermedades crónicas [chronic diseases] with the Boolean operator AND. The flow diagram (PRISMA) was used. Content analysis allowed to interpret the theoretical references and to organize knowledge of the thirteen selected bibliographies. Conclusions: There is limited scientific production found about the scope of Swanson's and Roy´s theories regarding the care of patients with cancer. Both theories include implicitly, in the foundation of their components, a biopsychosocial approach to the way of caring, in clinical praxis, as well as the culture of continuous care for the elderly with prostate cancer, from the nursing perspective(AU)

Bleeding risk prediction in elderly patients managed invasively for acute coronary syndromes: External validation of the PRECISE-DAPT and PARIS scores.

BACKGROUND: We sought to assess and compare the prediction power of the PRECISE-DAPT and PARIS risk scores with regards to bleeding events in elderly patients suffering from acute coronary syndromes (ACS) and undergoing invasive management. METHODS: Our external validation cohort included 1883 patients older >74 years admitted for ACS and treated with PCI from 3 prospective, multicenter trials. RESULTS: After a median follow-up of 365 days, patients in the high-risk categories according to the PRECISE-DAPT score experienced a higher rate of BARC 3-5 bleedings (p = 0.002) while this was not observed for those in the high-risk category according to the PARIS risk score (p = 0.3). Both scores had a moderate discriminative power (c-statistics 0.70 and 0.64, respectively) and calibration was accurate for both risk scores (all χ2 > 0.05), but PARIS risk score was associated to a greater overestimation of the risk (p = 0.02). Decision curve analysis was in favor of the PRECISE-DAPT score up to a risk threshold of 2%. CONCLUSIONS: In the setting of older adults managed invasively for ACS both the PARIS and the PRECISE-DAPT scores were moderately accurate in predicting bleeding risk. However, the use of the PRECISE-DAPT is associated with better performance.

Survey on the demand for long-term care services by elderlies with different activity of daily living / 中华医院管理杂志

Objective:To explore the aging care willingness and requirements for long-term care services among elderlies with different activity of living(ADL).Methods:7 070 elderlies aged 60 years and above were subject to a questionnaire survey using stratified multistage random cluster sampling in three municipalities of Shandong province from August through September, 2017. Data information was obtained by a customized questionnaire and ADL scale. Rank sum test and multivariate logistic regression were used for statistical analysis.Results:According to the ADL scoring, the participants were divided into 3 groups: normal, decreased function, and dysfunction, with 5 467(77.3%), 1 283(18.2%), and 320(4.5%)people respectively. Elderlies with different ADL had different aging care willingness, and the difference was statistically significant( Z=8.704, P<0.05). The factors influencing long-term care services need varied with the degree of ADL. The willingness was a common factor for long-term care services needs of the three elderly groups. The age and living arrangements were factors among the normal ADL group. The living arrangements and chronic diseases were those among the decreased function group, and the education and self-rated economic status were those among the dysfunction group. Conclusions:The demand for long-term care service were diversified with the degree of ADL. Targeted interventions should be taken to meet the needs of elderlies of different ADL.

Efficacy and Safety of Elobixibat in Elderly Patients with Chronic Constipation: A Single-center, Observational Study.

OBJECTIVES: A retrospective, observational study was conducted to examine the efficacy and safety of elobixibat, a novel therapeutic agent for chronic constipation, in Japanese elderly patients aged ≥ 65 years with chronic constipation. METHODS: The study was conducted at Kunimoto Hospital. Patients who visited the hospital from April 2018 to March 2019 due to symptoms of chronic constipation and who took elobixibat were enrolled. The outcome measures were changes in the Constipation Scoring System (CSS) score and the Bristol stool form scale (BSFS) before and after elobixibat administration. RESULTS: The study included 150 patients. The total CSS score significantly improved from 11.7±4.5 at baseline to 9.3±5.2 two weeks after drug administration. The improvement was confirmed in six out of eight CSS items. The BSFS at baseline of 2.5±1.8 was improved to 3.4±1.7 two weeks after treatment, nearly close to the normal stool consistency of 4. Adverse reactions were observed in 18 of 150 patients (12.0%) with 21 events, most commonly diarrhea in nine patients (6.0%) and abdominal pain in eight patients (5.3%). CONCLUSIONS: Elobixibat improved not only the frequency of bowel movements but also alleviated various symptoms of constipation, such as difficulty with evacuation and sensations of incomplete evacuation in elderly patients with chronic constipation. All adverse drug reactions were mild in severity with no safety concerns.

Efectividad de una intervención educativa en nivel de conocimientos de cuidadores no formales de adultos mayores / Effectiveness of an Educational Intervention about the Level of Knowledge of Informal Caregivers of Elderlies

Introducción: La transición demográfica y el envejecimiento poblacional son fenómenos que traen consigo el aumento del número de los adultos mayores dependientes de cuidado, acompañados de cuidadores no formales con desconocimiento sobre los cuidados geriátricos básicos en la comunidad. Objetivo: Demostrar la efectividad de una intervención educativa en el nivel de conocimientos de cuidadores no formales de adultos mayores. Métodos: Estudio cuasi experimental de intervención educativa en el Policlínico "José Martí Pérez", Santiago de Cuba, en el periodo de julio a diciembre de 2018. El universo estuvo constituido por 25 cuidadores no formales. Desarrollado en tres etapas (evaluación del nivel de conocimiento de los cuidados geriátricos antes y después de la intervención, se clasificaron los conocimientos en adecuados e inadecuados; intervención y evaluación). Se realizó análisis descriptivo de la información que incluyó frecuencias absolutas y porcentajes para variables cualitativas; medias, medianas y desviaciones estándar con intervalos de confianza (95 por ciento para variables cuantitativas). Para estudiar la efectividad de la intervención se compararon los resultados mediante la Prueba de McNemar. Resultados: El 100 por ciento fueron cuidadoras, amas de casa, predominó el grupo etario entre 46-55 años de edad (48 por ciento). conocimientos sobre cuidados geriátricos, antes de la intervención, fueron inadecuados en el 76 por ciento y después de la intervención en el 28 por ciento, con un nivel de confiabilidad del 95 por ciento, con la aplicación de la prueba de probabilidad de McNemar (p < 0.05). Conclusiones: La intervención educativa fue efectiva para mejorar el nivel de conocimientos de los cuidadores no formales sobre cuidados geriátricos básicos en el adulto mayor en estado de necesidad(AU)

Introduction: Demographic transition and population aging are phenomenons that provoke the increase in the number of care-dependent elderlies, accompanied by informal caregivers with no knowledge about basic geriatric care in the community. Objective: To demonstrate the effectiveness of an educational intervention about the level of knowledge of informal caregivers of elderlies. Methods: Quasi-experimental study of educational intervention carried out at José Martí Pérez Polyclinic, in Santiago de Cuba, in the period from July to December 2018. The study population consisted of 25 informal caregivers. Developed in three stages (assessment of the level of knowledge of geriatric care before and after the intervention, knowledge was classified as adequate and inadequate; intervention and evaluation). Descriptive analysis of the information was performed, which included absolute frequencies and percentages for qualitative variables; means, medians and standard deviations with confidence intervals (95 percent for quantitative variables). To study the effectiveness of the intervention, the results were compared using McNemar's test. Results: 100 percent were caregivers, housewives, with a predominance of the age group between 46-55 years of age (48.00 percent). Knowledge about geriatric care, before the intervention, was inadequate in 76.00 percent and, after the intervention, in 28.00 percent, with a 95 percent reliability level, with the application of McNemar's probability test (p < 0.05). Conclusions: The educational intervention was effective in improving the level of knowledge of informal caregivers about basic geriatric care in the elderly in need(AU)

Una concepción de cuidador familiar de anciano / A Conceptualization about Family Caregiver of the Elderly

Introducción: El envejecimiento, fenómeno social y de salud que afecta la contemporaneidad, hace que investigadores se enfoquen en este grupo poblacional, las necesidades y respuestas humanas crecientes que los caracterizan, así como a los seres humanos que dedican tiempo al cuidado de los ancianos. Sin embargo, no se identifican referentes ni una definición actualizada que se configure desde la enfermería, por lo que es necesario analizar los enfoques en el contexto internacional y nacional relacionado con este sujeto. Objetivo: Sistematizar el término cuidador familiar de anciano para lograr su contextualización en el ámbito de la enfermería. Métodos: Se realizó una revisión sistemática para un análisis crítico reflexivo de contenido de documentos publicados durante 10 años, desde 2005 al 2015, con una clara metodología y referencial teórico seleccionado, durante el mes de julio del 2019. Se utilizaron las palabras clave identificadas en DeCS y operadores booleanos: "cuidadores" AND "anciano" OR "adulto mayor" AND "enfermería". La búsqueda fue realizada en la base de datos SciELO, redalyc y medigraphic. Se utilizó el diagrama de flujo (PRISMA) para contribuir a la formulación de la estrategia de búsqueda. Conclusiones: La sistematización permitió la definición operacional de cuidador familiar de anciano desde una perspectiva de la enfermería, esta se concibe como: Persona adulta allegada o con vínculo de parentesco, que asiste o ayuda y toma decisiones sobre los cuidados crecientes de un miembro de la familia de 60 años o más, cuyo estado de salud e inadaptación a los cambios del entorno, demanda de la satisfacción de necesidades(AU)

Introduction: Aging, a social and health phenomenon that affects contemporaneity, makes researchers focus on this population group, the growing human needs and responses that characterize them, as well as the human beings who spend time caring for the elderly. However, no references or any updated definition are identified as supported from the field of nursing, so it is necessary to analyze the approaches in the international and national context related to this subject. Objective: To systematize the term family caregiver of the elderly to achieve its contextualization in the field of nursing. Methods: A systematic review was carried out for a critical reflexive content analysis of documents published for 10 years, from 2005 to 2015, with a clear methodology and selected theoretical reference, during the month of July 2019. The following keywords identified in DeCS and Boolean operators were used: "cuidadores" AND "anciano" OR "adulto mayor" AND "enfermería" [in English, "caregivers" AND "elderly" OR "elderly" AND "nursing"]. The search was carried out in the database SciELO, redalyc and medigraphic. The flow chart (PRISMA) was used to contribute to the formulation of the search strategy. Conclusions: The systematization allowed the operational definition of family caregivers of the elderly from a nursing perspective, this is conceived as: An adult person close to or related by kinship, who assists or helps and makes decisions about the growing care of a member of the family aged 60 years or more, whose state of health and lack of adaptation to changes in the environment demand for the fulfillment of needs(AU)

An investigation of the relationship between ageing in place and successful ageing in elderly individuals.

BACKGROUND: With the increase in longevity in the world, successful ageing has become an important issue. This study aims to investigate the relationship between ageing in place and successful ageing in elderlies. METHODS: This study, which utilised a descriptive and relational-screening model, was conducted with the participation of 370 individuals aged 65 and over who were registered in Family Health Centres in a city centre located in the eastern part of Turkey. RESULTS: The participating elderlies' Successful Ageing Scale mean score was 54.16 ± 11.32, and the Ageing in Place Scale mean score was 54.24 ± 12.88. While there was a positive, statistically significant relationship between the Successful Ageing Scale total score, the Ageing in Place Scale total score, and living in the same environment, there was a negative, significant relationship between age and the Successful Ageing Scale total score. CONCLUSION: Elderlies' successful ageing processes are affected positively by the increase in the duration of living in the same environment and satisfaction level about the place they lived in. Successful ageing is negatively affected by the increase in age. It is recommended that elderly people's living environments should not be changed and their social support networks should be strengthened as much as possible so they can have a successful ageing process.

Vivências e desafios ao cuidar de familiar idoso com acidente vascular cerebral / Experiencias y retos al cuidar de un familiar anciano con accidente cerebrovascular / Experiences and Challenges When Caring for an Elderly Family Member with Cerebrovascular Accident

Introdução: O Acidente Vascular Cerebral é uma das principais causas de mortes e incapacidades entre idosos. Os cuidados após Acidente Vascular Cerebral, comumente, são assumidos pela família, que possui pouco conhecimento acerca da doença e capacidades para desempenhar o cuidado no domicílio. Objetivo: Conhecer as vivências e desafios enfrentados por cuidadores familiares de pessoas idosas dependentes de cuidados após Acidente Vascular Cerebral, sobre as atividades de cuidado realizadas no domicílio. Métodos: Estudo qualitativo por meio da técnica de grupo focal, realizado com cinco cuidadores familiares de idosos com Acidente Vascular Cerebral, em acompanhamento na Linha de Cuidado do Acidente Vascular Cerebral de um hospital da região sul do Brasil. Realizaram-se três encontros em abril de 2018. Utilizou-se a Análise Temática para interpretação dos resultados. O estudo foi aprovado por Comitê de Ética em Pesquisa sob nº 18007. Resultados: Emergiram quatro categorias: Tornar-se cuidador de um familiar após Acidente Vascular Cerebral; Dificuldades vivenciadas; Despreparo para lidar com o familiar dependente; e Estratégias de enfrentamento. Conclusões: As vivências e desafios relatados fornecem evidências para estruturar e qualificar programas de atenção a cuidadores partindo das necessidades dos mesmos(AU)

Introducción: El accidente vascular cerebral es una de las principales causas de muerte e incapacidad entre ancianos. Los cuidados después del accidente vascular cerebral, comúnmente, son asumidos por la familia, que tiene poco conocimiento acerca de la enfermedad y capacidades para desempeñar el cuidado en el domicilio. Objetivo: Conocer las vivencias y desafíos en las actividades de cuidado realizadas en el domicilio enfrentados por los cuidadores familiares de personas ancianas dependientes de cuidados tras accidente vascular cerebral. Métodos: Estudio cualitativo por medio de la técnica de grupo focal, realizado con cinco cuidadores familiares de ancianos con accidente vascular cerebral, en seguimiento en la Línea de Cuidado do Accidente Vascular Cerebral de un hospital de la región sur de Brasil. Se realizaron tres encuentros en abril de 2018. Se utilizó el análisis temático para la interpretación de los resultados. el estudio fue aprobado por el comité de ética en investigación con el número 18007. Resultados: Emergieron cuatro categorías: hacerse cuidador de un familiar después de accidente vascular cerebral; dificultades vivenciadas; no preparación para tratar con el familiar dependiente y estrategias de enfrentamiento. Conclusiones: Las vivencias y desafíos relatados proporcionan evidencias para estructurar y calificar programas de atención a cuidadores partiendo de las necesidades de los mismos(AU)

Introduction: Cerebrovascular accident is one of the main causes of death and disability among the elderly. The cares following cerebrovascular accident are commonly undertaken by the family, with little knowledge about the disease and few capacities to provide care at home. Objective: To know the experiences and challenges in the care-related activities performed at home and undertaken by the family caregivers of elderly people dependent on care after cerebrovascular accident. Methods: Qualitative study carried out using the focus group technique and with five family caregivers of elderly people with cerebrovascular accident under follow-up by the Cerebral Vascular Accident Care Line of a hospital in the southern region of Brazil. Three meetings were held in April 2018. Thematic analysis was used for the interpretation of the results. The study was approved by the Research Ethics Committee under number 18007. Results: Four categories emerged: becoming a caregiver for a family member after cerebrovascular accident, difficulties experienced, no preparation for managing the dependent family member, and coping strategies. Conclusions: The experiences and challenges reported provide evidence for structuring and qualifying care programs for caregivers based on their needs(AU)

Testing The Effectiveness Of Integrated Elderly Care Model On Quality Of Care And Health Outcomes Among Hospitalized Elderlies In West Bank

@#The rapid increase in the ageing population and health conditions are imposing a higher challenge to the health care system that requires multidisciplinary teamwork utilizing coordinated care approach. This study examined the effects of integrated care model on quality of care received by older hospitalized patients in West Bank. A quantitative interrupted time series design (pretest and posttest multiple time series, quasi-experiment design) was used. The study examined the effects of integrated care model on admitted older patients (n=32) in the West Bank measuring ten dimensions of quality of care and four health indicators. There was a significant improvement in the dimensions of quality of care: dimensions: nurses’ communications with patients, physicians’ communications with patients, staff response to patients’ needs, pain management, explanations on medications, amount of information given on discharge plan, patients' area cleanliness, patients' area quietness, rating of the hospital, and willingness to recommend the hospital. Incidence of falls and incidence of pressure ulcer improved after implementing the model, while readmission rate and average length of stay did not improve. This study contributed to the limited body of knowledge related to the effect of integrated care model on hospitalized older patients’ quality of care in Palestine/ West Bank. Integrated care has the potential to improve care outcomes among hospitalized older patients.

Intervenções não farmacológicas de manejo na agitação de idosos com demência em ambiente doméstico / Intervenciones no farmacológicas de manejo de la agitación en ancianos con demencia en ambiente doméstico / Nonpharmacological Interventions for Managing Agitation in Elderlies with Dementia in the Home Setting

Introdução: A agitação é um sintoma neuropsiquiátrico recorrente em idosos com demência. No ambiente doméstico, essa condição impõe aos familiares cuidadores o desafio de intervir adequada e precocemente a fim de minimizar visitas às emergências, internações ou até mesmo institucionalizações de longa permanência. Objetivo: Identificar as intervenções não farmacológicas utilizadas por familiares cuidadores no manejo da agitação em idosos com demência. Métodos: Pesquisa qualitativa realizada com 11 familiares cuidadores de idosos em Minas Gerais, Brasil. Foram realizadas entrevistas com roteiro semiestruturado e, para a análise, foi empregada a técnica de análise de conteúdo. Resultados: As intervenções mais utilizadas foram: a conversa, a escuta, a distração, o uso de brinquedos, a música/canto e a leitura da Bíblia para acessar a espiritualidade/religiosidade. Verificou-se que, diante dos desafios impostos pela demência ao cuidado e dos desgastes físico e emocional experimentados, os familiares esforçaram-se para acolher e oferecer suporte humano ao idoso, além de sentirem-se satisfeitos por terem a oportunidade de retribuir o cuidado que receberam. Conclusão: Não há uma intervenção capaz de responder a todos os comportamentos agitados. A experiência e o vínculo desenvolvido entre familiares cuidadores e idosos ajudaram a guiar a escolha individual de intervenções não farmacológicas mais eficazes, provavelmente, por facultar certa antecipação das respostas dos idosos(AU)

Introducción: La agitación es un síntoma neuropsiquiátrico recurrente en ancianos con demencia. En el cotidiano del ambiente doméstico, esta condición impone a los familiares cuidadores el desafío de encontrar estrategias adecuadas de manejo a fin de evitar las visitas a emergencias, hospitalizaciones o incluso la institucionalización a largo plazo. Objetivo: Identificar las estrategias no farmacológicas utilizadas por los familiares cuidadores en el manejo de la agitación en ancianos con demencia. Métodos: Investigación cualitativa realizada con 11 familiares cuidadores de ancianos en Minas Gerais, Brasil. La recolección de datos fue realizada a través de entrevistas con guión semiestructurado. Para la interpretación de los datos se utilizó la técnica de análisis de contenido. Resultados: Se identificaron como estrategias más utilizadas para el manejo de la agitación: la conversación, la escucha, la distracción, el uso de juguetes, la música/canto y la lectura de la Biblia para acceder a la espiritualidad/religiosidad. Se verificó que, frente a los desafíos impuestos por la demencia al cuidado y el desgaste físico y emocional experimentado, los familiares cuidadores se esforzaron para acoger y brindar apoyo humano al familiar anciano, además de sentirse satisfechos por tener la oportunidad de retribuir el cuidado que recibieron. Conclusiones: No hay una intervención capaz de responder efectivamente a todos los comportamientos agitados. Sin embargo, la experiencia y el vínculo desarrollado entre familiares cuidadores y ancianos guiaron la elección individual de las intervenciones no farmacológicas más efectivas, probablemente al proporcionar cierta anticipación de las respuestas de los ancianos(AU)

Introduction: Agitation is a neuropsychiatric symptom recurrent in elderly people with dementia. In the daily life of the home setting, this condition imposes on the family caregivers the challenge of finding appropriate management strategies for avoiding visits to the emergency room, hospitalizations, or even long-term institutionalization. Objective: To identify the nonpharmacological strategies used by family caregivers in the management of agitation in elderly people with dementia. Methods: Qualitative research carried out with 11 family caregivers of elderly people in Minas Gerais, Brazil. The data collection was carried out through interviews with semi-structured repertory of quotations. The content analysis technique was used to interpret the data. Results: The most commonly used strategies for agitation management were identified. These were conversation, listening, distraction, use of toys, music/singing, and reading the Bible for accessing spirituality or religiosity. It was verified that, in the face of the challenges imposed by dementia onto the care and the physical and emotional outwearing experienced, family caregivers strived to welcome and provide human support to the elderly relative, in addition to feeling satisfied to have the opportunity to give back the care received Conclusions: There is no intervention capable of responding effectively to all agitation-related behaviors. However, the experience and the relationship developed between family caregivers and the elderly guided the individual choice for the most effective nonpharmacological interventions, probably by providing some anticipation to the elderly's responses(AU)

El envejecimiento desde la perspectiva del modelo conductual de Dorothy E. Johnson / Aging from the Behavioral Model Approach of Dorothy E. Johnson

RESUMEN Introducción: El envejecimiento poblacional es un aspecto a tener en cuenta a partir de las particularidades de la sociedad actual. Los servicios de salud deben prepararse para un aumento de pacientes ancianos, y el análisis multidisciplinar del fenómeno deviene en una necesidad de la enfermería como ciencia. Esta categoría es abordada por diferentes autores, por lo que se hace necesario un análisis valorativo de sus enfoques en el contexto internacional y nacional. Objetivo: Analizar el envejecimiento desde la perspectiva del modelo conductual de Dorothy E. Johnson, al considerar sus relaciones en las condiciones actuales de salud de una población vulnerable como el paciente anciano. Métodos: Se realizó una revisión bibliográfica sistemática para desarrollar un análisis crítico reflexivo del contenido de documentos, donde se consideraron artículos originales y de revisión. Las palabras clave utilizadas fueron "envejecimiento", "modelo conductual", "ancianos", "Teorías de Enfermería", identificadas a través de DECs o de MeSH. Los criterios de inclusión para la selección de los artículos fueron: Artículos en español disponibles en los portales de datos seleccionados que presentaban adherencia a la temática, publicados entre los años 2003 y 2016 que presentaran claramente el referencial teórico seleccionado. Conclusiones: La indagación sobre el envejecimiento y los sistemas conductuales permitió contextualizar este fenómeno desde la perspectiva de una teoría foránea. Muchos autores la abordan; no obstante, los problemas naturales que desafían la salud del paciente anciano en el contexto cubano condicionan la necesidad de promover la actualización del conocimiento en correspondencia con la situación internacional(AU)

ABSTRACT Introduction: Population aging is an aspect to take into account based on the particularities of today's society. Health services must prepare for an increase in elderly patients, and the multidisciplinary analysis of the phenomenon becomes a necessity for nursing as a science. This category is addressed by different authors, so it is necessary to evaluate their approaches in the international and national context. Objective: To analyze aging from the perspective of the behavioral model of Dorothy E. Johnson, considering its relationships in the current health conditions of a vulnerable population as the elderly patient. Methods: A systematic bibliographic review was carried out to develop a reflexive critical analysis of the content of documents, for which original and review articles were considered. The keywords used were envejecimiento [aging], modelo conductual [behavioral model], ancianos [elderlies], teorías de enfermería [nursing theories], identified in DECs or MeSH. The inclusion criteria for the selection of the articles were: articles in Spanish available in the web portals of selected data, presenting adherence to the topic, published between 2003 and 2016, and clearly treating the theoretical referential selected. Conclusions: The research on aging and behavioral systems allowed us to contextualize this phenomenon from the perspective of a foreign theory. Many authors approach it; nevertheless, the natural problems that challenge the health of the elderly patient in the Cuban context condition the need to promote the updating of knowledge in correspondence with the international situation(AU)

A comparison of complete blood count reference intervals in healthy elderly vs. younger Korean adults: a large population study.

Background The use of laboratory reference intervals based on younger populations is of questionable validity in older populations. We established reference intervals for 16 complete blood count (CBC) parameters in healthy elderly Koreans aged ≥60 years and compared them to those of individuals aged 20-59 years. Methods Among 64,532 individuals (39,609 men and 24,923 women) aged ≥20 years who underwent medical checkups, 8151 healthy subjects (12.6%, 5270 men and 2881 women, including 675 and 511, respectively, who were ≥60 years of age) were enrolled based on stringent criteria including laboratory, imaging and endoscopy results; previous medical history; and medication history. CBC parameters were measured using an Advia2120i instrument. Results Overall, healthy individuals aged ≥60 years did not require separate reference intervals from those aged <60 years except for red cell distribution width (RDW) and mean corpuscular hemoglobin (MCH) in women. However, subjects aged ≥60 years still required sex-specific reference intervals for red blood cell count, hemoglobin, hematocrit, MCH, monocytes and eosinophils. Separate reference intervals were required for MCH, eosinophils and basophils for certain age subgroups of men aged ≥60 years, and for MCH and RDW in certain age subgroups of women aged ≥60 years, compared to counterparts <60 years of age. Conclusions Healthy elderly Koreans can use the same reference intervals as younger populations. Thus, abnormal CBC results may not necessarily be attributable to physiologic changes but possible underlying diseases that should be investigated.