Association between chronic conditions, multimorbidity, and dependence levels in Chinese community-dwelling older adults with functional dependence: a cross-sectional study in south-central China.

Background: The rising prevalence of multimorbidity and functional dependence in community-dwelling older adults contribute to the demand for home care services. Evidence on how chronic conditions, especially multimorbidity, affect dependence levels among older adults with functional dependence in a socio-cultural context is much needed to inform policy, workforce, aged care service development to meet the care needs of this population. Objectives: This study aimed to determine the association between chronic conditions, multimorbidity and dependence levels among Chinese community-dwelling older adults with functional dependence. Methods: A cross-sectional study was conducted with 1,235 community-dwelling older adults with functional dependence in Hunan province, China, from June to October 2018. Data on socio-demographic factors, cognitive function, vision and hearing conditions, activities of daily living (ADLs), and health conditions were collected, and binary logistic regression analyses were used to determine the association between chronic conditions, multimorbidity and dependence levels, with adjustments for relevant covariates. Results: Among the participants, 62.9% had multimorbidity. Parkinson's disease, stroke, COPD, hypertension, mood and psychotic disorders (Anx/Sch/Dep) were significantly associated with high levels of functional dependence. After adjusting for demographic variables, cognitive function, vision, and hearing conditions, we observed a significant relationship between multimorbidity and higher functional dependence, but this association became insignificant when including certain chronic diseases closely associated with high-level dependence. Study revealed that Parkinson's disease and stroke notably increase dependency risk across seven ADL domains, demonstrating their extensive impact on daily functioning. Conclusion: The prevalence of multimorbidity among Chinese community-dwelling older adults with functional dependence is very high. The association of multimorbidity with functional dependence is mediated by specific chronic conditions. These findings highlight the necessity of adopting an integrated care model that combines medical and social care, with a particular emphasis on managing multimorbidity and critical chronic conditions that lead to severe functional dependence to preventing and diminish the onset of disabilities.

Employing the International Classifications of Functioning, Disability, and Health to identify relevant categories for disability evaluation in older adults from the research perspective: a systematic review.

INTRODUCTION: The objective of this study was to identify relevant aspects for disability evaluation used in scientific literature for older adults. EVIDENCE ACQUISITION: We employed a systematic review methodology as outlined by the ICF Research Branch. The methodology consists of four steps: 1) identifying studies that focus on disability evaluation among older adults; 2) identifying disability measures used in these studies; 3) linking the concepts contained in these measures to ICF categories; 4) conducting frequency analysis. EVIDENCE SYNTHESIS: A total of 1942 concepts contained in disability measures from 137 studies were extracted. About 97.7% of the concepts could be linked, and 1862 concepts were linked to 52 second-level ICF categories. Of these, 44 categories found in at least 5% of the studies (range 5.1-85.4%) were selected to develop an outcome set that represents the relevant categories, including five categories in the Body Functions component and 39 categories from the Activities and Participation component. CONCLUSIONS: The relevant categories identified in our study reflect the essential areas that measure disability for older adults, providing a scientific basis for developing an ICF Core Set for disability evaluation, in combination with further empirical study and expert survey. Information from the outcome set is also valuable for providing a standardized minimal set for disability measurement, which can be used for data comparison across different studies and the development of an ICF-based disability measurement tool.

Effects of vibration therapy on muscle mass, muscle strength and physical function in older adults with sarcopenia: a systematic review and meta-analysis.

BACKGROUND: Sarcopenia, a progressive loss of muscle mass and function with advancing age, is a prevalent condition among older adults. As most older people are too frail to do intensive exercise and vibration therapy has low risk and ease of participation, it may be more readily accepted by elderly individuals. However, it remains unclear whether vibration therapy would be effective among older adults with sarcopenia. This systematic review and meta-analysis examined the effect of vibration therapy including local vibration therapy and whole-body vibration therapy, for enhancing muscle mass, muscle strength and physical function in older people with sarcopenia. METHODS: A systematic literature search was conducted in March 2019 in the following 5 electronic databases: PubMed, CINAHL, Embase, PEDro, and the Cochrane Central Register of Controlled Trials, with no restriction of language or the year of publication. Randomized controlled trials and quasi-experimental studies examining effects of vibration therapy on muscle mass, muscle strength or physical function in older adults with sarcopenia were included in this systematic review. Two reviewers independently assessed the methodological quality of the selected studies. RESULTS: Of the 1972 identified studies, seven publications from six studies involving 223 participants were included in this systematic review. Five of them conducted whole-body vibration therapy, while two conducted local vibration therapy. A meta-analysis of randomized controlled studies indicated that muscle strength significantly increased after whole-body vibration therapy (SMD 0.69, 95% CI 0.28 to 1.11, I2 = 0%, P = 0.001) and local vibration therapy (SMD 3.78, 95% CI 2.29 to 5.28, P < 0.001). Physical performance measured by the sit-to-stand test and the timed-up-and-go test were significantly improved after the intervention (SMD -0.79, 95% CI - 1.21 to - 0.37, I2 = 0%, P < 0.001) and SMD -0.83, 95% CI - 1.56 to - 0.11, I2 = 64%, P = 0.02, respectively). CONCLUSION: Vibration therapy could be a prospective strategy for improving muscle strength and physical performance in older adults with sarcopenia. However, due to the limited number of the included studies, caution is needed when interpreting these results. More well-designed, large sample size studies should be conducted to further explore and validate the benefits of vibration therapy for this population.

Protective effects of acarbose against vascular endothelial dysfunction through inhibiting Nox4/NLRP3 inflammasome pathway in diabetic rats.

The cardiovascular efficacy of glucose-lowering drugs is needed due to the cardiovascular complication in type 2 diabetes mellitus (T2DM). Acarbose is an α-glucosidase inhibitor that suppresses postprandial hyperglycemia, however, the cardiovascular protection of acarbose has still remained controversial. NLRP3 inflammasome activation mediated tight junction disruption, a hallmark event of endothelial barrier dysfunction leading to endothelial hyperpermeability in diabetes. Given the anti-inflammatory property of acarbose, it was investigated that acarbose protected against vascular endothelial barrier dysfunction through inhibiting NLRP3 inflammasome in vascular endothelial cells in T2DM rats. The rat aortic endothelial cells (RAECs) were incubated with high glucose (HG, 30 mM) for 24 h in vitro. It was found that HG significantly induced the formation and activation of NLRP3 inflammasome, which was markedly blocked by acarbose treatment. Furthermore, acarbose blocked the Nox4-dependent superoxide (O2.-) generation, which regulated NLRP3 inflammasome in RAECs. Importantly, we found that acarbose remarkably enhanced the junction protein expression of ZO-1 and VE-Cadherin and consequently abolished vascular hyperpermeability, which was associated with inhibiting NLRP3 inflammasome in RAECs. In vivo, acarbose intervention relieved vascular leakage in the heart of diabetic rats injected with Evans blue dye and the vasodilatory response to acetylcholine, which was accompanied with the restoration of ZO-1, VE-Cadherin, Nox4 and NLRP3 inflammasome in the aortal endothelium of diabetic rats. Taken together, our data indicated that acarbose ameliorated endothelial barrier dysfunction by directly inhibiting NLRP3 inflammasome which was dependent on inhibiting Nox4 oxidase-dependent O2.- production. These properties might carry a potential significance for acarbose in cardiovascular protection in diabetic patients.

[Characterization of matrix effects in microanalysis of sulfide minerals by laser ablation-inductively coupled plasma-mass spectrometry based on an element pair method].

Matrix effect between reference materials and samples is one of the major factors affecting the accuracy of analytical results by laser ablation-inductively coupled plasma-mass spectrometry (LA-ICP-MS). However, there is no method or calculation formula to quantify matrix effect between standards and samples up to date. In this paper, the linear correlation coefficient r of the Ii/I(is-Ci)/Cis graphs of element pairs were used to characterize the matrix effect, which took the ratios of concentrations (ci/ c(is)) and intensities (Ii/Iis) of the analytical element and internal standard element as x-axis and gamma-axis, respectively. Matrix effects of 6 element pairs in 13 glass reference materials, 2 sulfide reference materials and 2 sulfide minerals using Fe as internal standard was studied, with the linear correlation coefficient r of Fe-Cu, Fe-Zn element pairs both less than 0. 999 and trace Fe--Mn, Fe--Co, Fe--Ga, Fe--Pb element pairs all better than 0.999. Matrix effects of 3 major element pairs in 2 sulfide ref- erence materials and 6 sulfide minerals using S as internal standard was also studied, with the linear correlation coefficient r of S--Fe, S--Cu, S--Zn all less than 0.999. The great majority of relative errors of EMPA analytical results for major elements in sulfide minerals were greater than 10%, whether analyzed using Fe as internal standard with glass reference materials as external standard, or S as internal standard with sulfide reference materials MASS-1, IMER-1 as external standard, respectively. But the most analytical results for trace elements calibrated by glass reference materials using Fe as internal standard were well agreed with sulfide standard MASS-1, with the relative errors less than 15%. The results showed that matrix effects existed in glass reference materials, sulfide reference materials and sulfide minerals, and it also proved a certain rationality and practicability for quantification of matrix effect using the linear correlation coefficient r of the Ii/Iis-Ci/Cis graphs by this element pair method. This study also indicated that trace elements in sulfide minerals could be calibrated using Fe as internal standard with non-matrix matched glass reference materials as external standard, especially for NIST610 contained nearly all the trace elements in sulfide minerals and with relative high concentrations of each element, which obtained analytical results agreed well with sulfide standard MASS-1.

[Determination of As, Sb, Bi, Cd and Sn in soils and sediments by inductively coupled plasma atomic emission spectrometry after sublimation separation as iodides].

A method was developed for the determination of As, Sb, Bi, Cd and Sn in degrees C, iodides of As, Sb, Bi, Cd and Sn were formed and sublimated from the sample matrix and then extracted by diluted HCl. The prepared solution was determined by ICP-AES. The sample treatment procedure, such as the ratio of NH4 I to sample, and sublimation and extraction conditions, was studied. The instrument determination parameters, including ICP power, Ar gas flow rate, spectral wavelengths, background subtraction, spectral interferences correction and internal standard, were selected and optimized. The established procedure is rapid and simple, the detection limits for the five elements are in the range of 0.01-0.35 microg x g(-1), and the analytical results for soil and sediment reference materials were in good agreement with the reference values.