Psychogeriatric Diagnoses in Old People's Homes and Negative Health Behavior.

BACKGROUND: The study was designed as a gerontologic-public health analysis of the relationship between the leading and accompanying psychogeriatric diagnoses and negative health behaviors recorded in the old people's home users, with the aim to evaluate and redefine gerontologic-public health priorities and geroprophylactic measures, with special reference to persons suffering from Alzheimer's disease and other dementias. SUBJECT AND METHODS: Gerontologic-public health indicators obtained by monitoring health care needs of the elderly in specific institutional primary health care at 10 old people's homes (N=1185) in Croatia in 2013 were analyzed using the professional methodology developed at Department of Health Gerontology, Andrija Stampar Teaching Institute of Public Health (Registry List 1 that refers to monitoring specific primary health care needs of elderly at old people's homes). RESULTS: Study results revealed that essential arterial hypertension was the principal (leading) principal diagnosis in the old people's home users as of 2013, accounting for 13% of all leading diagnoses recorded in the elderly in institutional health care. In the study population, psychogeriatric diagnoses were recorded among the first five accompanying and leading diagnoses. Refusal of occupational therapy was the most common unfavorable health behavior recorded in the old people's home users, accounting for 22%, followed by poor personal and environmental hygiene (19%), physical inactivity (18%), mental inactivity (15%), obesity (13%) and smoking (5%) of 861 unfavorable behaviour characteristics recorded in study subjects. Study results showed the leading diagnoses in the old people's home users (such as circulatory system diseases, hip fracture, non-insulin dependent diabetes mellitus) to be associated with negative health behaviors that can be considered as risk factors for the development or progression of the disease, in psychogeriatric patients in particular. CONCLUSIONS: The results obtained by gerontological-public health indicator analysis indicate that programs of geroprophylaxis, gerontologic and psychogeriatric measures should be implemented in old people's homes as a priority, with day centers for Alzheimer's disease patients. It is necessary to identify and evaluate risk factors for the occurrence of preventable diseases, change the negative health behaviors in the elderly, and apply the nutritional-gerontologic dietary standards at old people's homes including follow up of dietary intake of nutrients such as vitamins and mineral, with special reference to psychogeriatric patients.

Angiotensin-converting enzyme deletion allele is beneficial for the longevity of Europeans.

The human angiotensin converting enzyme (ACE) gene is one of the most investigated candidate genes for cardiovascular diseases (CVD), but the understanding of its role among the elderly is vague. Therefore, this study focuses at: (a) testing the association of ACE polymorphism with CVD risk factors among the elderly, and (b) detecting the possible unequal distribution of ACE genotypes between senescent and younger segments of the European populations. The association of ACE I/D polymorphism with CVD health status [hypertension (HT), obesity, dislypidemia] in 301 very old subjects (88.2 ± 5 years; F/M = 221/80) was tested by means of logistic regression analysis. The meta-analysis of D allele frequency in general vs. elderly (80+ years) groups was conducted using all publicly available data for European populations comprising both age cohorts. Multiple multinomial logistic regression revealed that within this elderly sample, age (younger olds, 80-90 years), female sex (OR = 3.13, 95% CI = 1.59-6.19), and elevated triglycerides (OR = 2.53, 95% CI = 1.29-4.95) were positively associated with HT, while ACE polymorphism was not. It was also established that the DD genotype was twice as high in 80+ cohort compared to general population of Croatia (p < 0.00001). This trend was confirmed by the meta-analysis that showed higher D allele frequencies in olds from nine of ten considered European populations (OR = 1.19, 95% CI = 1.08-1.31). The data in elderly cohort do not confirm previously reported role of ACE DD genotype to the development of HT. Moreover, meta-analysis indicated that ACE D allele has some selective advantage that contributes to longevity in majority of European populations.

Functional ability of the elderly in institutional and non-institutional care in Croatia.

Gerontology-public health indicators of functional ability of the elderly in institutional and non-institutional health care in Croatia were determined by use of expert methodology developed at Department of Gerontology, Dr. Andrija Stampar Institute of Public Health in Zagreb, with the aim to upgrade the Program of Health Care Measures and Procedures in Health Care of the Elderly. Comparison of functional ability between the users of selected Old People's Homes (institutional care; N = 5030) and Gerontology Centers (non-institutional care; N = 2112) yielded highest between-group difference in the proportion of "fully movable" and "fully independent" categories in favor of the latter, thus steering the program of health care for the elderly accordingly. In addition, study results showed greater difference in the proportion of categories describing mental status of institutional and non-institutional care users as compared with the categories describing their physical status, suggesting that mental status plays a more important role than physical status in the geriatric user's stay in non-institutional care versus institutional care. This issue requires additional studies. The results obtained by this indicator analysis pointed to the preventive and geroprophylactic measures to ensure efficient health care for the elderly and to develop the program of mental health promotion and preservation. According to 2007 estimate, there were 759,318 (16.9%) persons aged > or = 65 in Croatia. Data collected at gerontology database kept at Department of Gerontology, Dr. Andrija Stampar Institute of Public Health (September 2008) showed 2% of the elderly (N = 14807) to be accommodated at Old People's Homes, which is below the European average of 4%.

[Cardiovascular health, diet and salt in the elderly]. / Kardiovaskularno zdravlje, prehrana i prehrambeni unos soli kod starijih osoba.

INTRODUCTION: The measures of primary prevention of cardiovascular disease are focused on lifestyle modifications in order to reduce the incidence of hypertension. Hypertension is a preventable risk factor for the development of cardiovascular disease, which is the leading cause of mortality in the elderly in Croatia. AIM: The aim of this paper is to present the share of circulatory system diseases in total hospitalization rate of the elderly. The aim is also to propose preventive public health interventions for elderly population to modify their dietary habits considering salt intake. METHODS: Gerontology analysis of the hospitalization rate includes data on geriatric patients from the City of Zagreb and Croatia as a whole for 2007, according to disease groups and prevalence. Databases of the National Institute of Public Health and Department of Gerontology, Dr. Andrija Stampar Institute of Public Health served as the source of data. DISCUSSION: Salt reduction is considered as an efficient and widely applicable measure of lifestyle modification as a non-pharmacological intervention for hypertension in the elderly. The introduction of legal provisions on dietary standards for the elderly is proposed for implementation of appropriate and preventive diet for this population group. CONCLUSION: Comparison of the rate of hospitalization of geriatric patients according to groups of diseases in the Zagreb area and Croatia in 2007 revealed the group of circulatory system diseases to be the leading cause of geriatric hospitalizations at the national level. Steering the health care planning and large-scale implementation of the program of preventive measures for the elderly with emphasis on salt intake reduction to up to 5 grams per day could reduce the prevalence of hypertension in elderly population and consecutively lower the incidence of their consequences.

The ageing of Croatian population.

With a share of people older than 65 years of 16.64 per cent in total population, Croatia is considered a very old country regarding it's population. This percentage is one of the highest in already old Europe. Demographic projections reveal a further increase of share of people older than 65 years in future. There are many causes of this condition. This fact carries negative economic and health care implications which burden Croatia. Many administrative reforms are necessary to resolve this issue and to avoid economy problems and intergenerational conflicts.

[Osteoporotic fractures in the elderly]. / Prijelomi kostiju u ljudi odmakle dobi s osteoporozom.

The epidemiology of injuries is a significant factor in the structure of mortality and causes of hospitalization of elderly people. Epidemiologically, consequences of injury, i.e. their complications, from reduced mobility, sores, contractures, infections, all over to mortality from hypostatic pneumonia, are strongly emphasized in the elderly. In 2005, more than 17.0% of Croatian population were older than 65 years of age, and 27.0% of the population were over 60. Osteoporotic bone fractures are frequent among the elderly; 5,489 hip fracture cases were registered in Croatia during 2005, and 382 of them died from fracture complications. In total, 97.38% of the dead patients were over 65 years of age. Besides hip fractures, other typical osteoporotic fractures are fractures of vertebral bodies, distal part of the radius, humerus, pelvic bones, etc. Regardless of conservative or surgical treatment for osteoporotic fracture, it is essential to stress out that after the care of fractured bone has been provided, appropriate diagnostic examinations and pharmacological treatment of osteoporosis should also be done. Orthopedic and traumatic surgeons all over the world have to understand that conservative or surgical treatment of osteoporotic fracture of any localization is just one link in this complex chain of managing the disease - osteoporotic treatment.

[Continuous physical activity promotes healthy ageing]. / Stalna tjelesna aktivnost osigurava aktivno zdravo starenje.

The growth in the prevalence of chronic diseases of civilization is of concern. In Croatia, diseases of the circulatory system are the main cause of hospitalization amongst people aged >65 and the main cause of death for two thirds of those aged >65. Continuous physical activity in older people stands out as an important factor in the prevention of chronic diseases of civilization, particularly diseases of the circulatory system, but also for other health problems. A survey on the extent of physical activity amongst older people aged >65 carried out in Zagreb (N=449, Croatian Health Survey/2003; CROCAN Project) has shown that 42.8% were physically inactive, whilst only 19.1% were physically active on a daily basis. Physical activity, two to three times per week, which is recommended by WHO, was undertaken by 11.6% of those aged >65. These gerontologic health indicators show that the Programme of preventative measures is insufficiently applied amongst the elderly. This Programme includes primarily kinesiologic measures adapted for the elderly as developed in the study. It is important to ensure that the Programme of continuous physical activity is applied amonst the elderly to promote active healthy ageing. The type of physical activity, its intensity and frequency should be adapted to each individual's health status, their interests, physical condition and the extent of any previous experiences of physical activity.Thus, professional guidance, consultation with kinesiologists for the elderly and general practitioners as well as the collaboration with other medical specialists are necessary.

[Healthy aging and productive retirement]. / Zdravo starenje i produktivno umirovljenje.

Characteristics of aging as a normal physiological process are presented. The main indicators of increased the number of older population in the world as well as problems related to society and particularly to public health are listed. The difference between gerontology and geriatrics is described. Retirement is separately presented as a psychological process. Reported are the most frequent chronic diseases that may develop in older people including dementia, mental depression, and other psychological problems. The theories of aging related to organs and organic systems are described. The importance of geroprophylaxis, including primary, secondary and terciary prevention for older people is particularly stressed.