Literature review: prevention of aspiration in the elderly overseas.

Objective: This review seeks to identify trends and issues in preventing aspiration for the elderly overseas in the hopes of gathering information regarding how a similar level of care may be provided in Japan. Materials and Methods: The authors used the CHINAL Ultimate database to review academic publications from December 2012 to December 2022. Four terms, one from each of four sets of keywords, were combined as search criteria: (1) "dysphagia", "aspiration", "choking", "airway obstruction asphyxia", "swallowing function", or "pneumonia", (2) "aged" or "elderly people", (3) "nursing" or "nursing care", and (4) prevention. Papers that did not directly relate to the purpose of this review were excluded. Results: The authors identified fourteen publications regarding preventative care for aspiration in the elderly. According to the reports, preventative care mainly consisted of ensuring proper oral care, screening to assess swallowing function, and taking steps at meals to prevent aspiration. Conclusion: Our research showed that the primary ways of preventing aspiration in the elderly overseas included (1) screening for oral conditions and swallowing function to prevent pneumonia and (2) providing proper oral care coupled with support during meals.

Measuring the quality of self-care of elderly patients with dementia in a developing country.

In developing countries like Uganda, people with dementia are cared for by non-medically trained family members with minimal support from the formal healthcare system. The quality of care in this setting is largely unknown but significantly affects the well-being of those with dementia. A tool designed to measure the quality of informal care for old frail adults with or without dementia was translated into Luganda. A committee of experts reviewed and finalized the translation, which was pilot-tested and then used to measure the quality of dementia self-care. We consecutively enrolled 105 caregivers of elderly people with dementia; the median age was 35 years (Interquartile Range 26-47 years), and 67% were females, taking care of a grandparent (44%) or a parent (34%). We used confirmatory factor analysis to assess for structural validity and computed correlation coefficients and Cronbach's alpha to assess for discriminant validity and internal reliability, respectively. The three-factor model applied to the 20 items, adequately fit the data (Comparative Fit Index = 0.88, Tucker-Lewis Index = 0.87, Root Mean Square Error of Approximation = 0.08; 90% Confidence Interval (0.06-0.09), Standardized Root Mean Square Residual = 0.089). There was good discriminant validity, and correlation coefficients between dimensions/scales and the Dementia Knowledge Assessment Scale scores were low. There was good internal reliability with all items Cronbach's alpha ranging from 0.69 to 0.89. Our findings demonstrated that this culturally adapted, shorter measurement tool is valid and reliable. The tool can be used by researchers, health workers, and agencies to assess the quality of self-care for elderly people with dementia in Uganda.

Clinical Audit in the Elderly by Assessing Hydration and Renal Functions Before and After Contrast CT Scans at District Headquarters Hospital, Dera Ismail Khan, Pakistan.

Introduction Contrast-induced nephropathy (CIN) is a serious risk involved in computed tomography (CT) scans, particularly for older people. The main idea of this clinical audit was to assess current practices regarding renal function tests (RFTs) and hydration status before and after contrast CT scans in older patients at District Headquarters Hospital (DHQ), Dera Ismail Khan, Pakistan, and to implement recommendations for improvement. CIN is a form of acute kidney injury that occurs after the administration of contrast dye used in imaging procedures and is characterized by a sudden deterioration in renal functions. Methods This clinical audit checked adherence to renal protection protocols in elderly patients undergoing contrast CT scans. Conducted over three cycles from July 5 to August 15, 2022, this clinical audit included 30 patients aged 75 and above. Each cycle had 10 patients, divided equally between males and females, and further categorized into age groups of 75-85 years and 86-95 years. Data collection involved reviewing patient files, medication charts, and CT scan reports. Compliance with RFT documentation and hydration before and after the CT scan was assessed against the standards set by Basildon and Thurrock University Hospitals NHS Foundation Trust. Data were analyzed using Microsoft Excel 2023 (Microsoft® Corp., Redmond, WA), and graphs were created using Microsoft Word 2023 (Microsoft® Corp., Redmond, WA). Results The mean age ± standard deviation (SD) for males was 81.8 ± 5.01 in the first cycle, 83.4 ± 6.46 in the second cycle, and 82.4 ± 4.72 in the third cycle. For females, the mean age ± SD was 83.2 ± 5.80 in the first cycle, 85.2 ± 6.41 in the second cycle, and 83.0 ± 6.12 in the third cycle. The first audit cycle revealed that, while all patients (100%) had their RFTs documented before the CT scan, only 20% were adequately hydrated pre-scan, and none (0%) had RFTs performed post scan. Post-scan hydration was also low at 20%. These findings highlighted gaps in adherence to renal protection protocols. The second cycle showed improvements, with pre-scan hydration adherence increasing to 80%, post-scan RFTs to 60%, and post-scan hydration to 70%. By the third cycle, full compliance (100%) was achieved across all standards, including pre- and post-scan renal functions test and hydration. Conclusion The clinical audit at District Headquarters Hospital, Dera Ismail Khan, addressed gaps in renal protection protocols for elderly patients undergoing contrast CT scans. The audit improved adherence over three cycles through targeted interventions, including staff training, implementation of checklists, patient education, modifying the reporting format, and providing instructions in the local language. It also highlighted the importance of continuous education and regular monitoring. The clinical audit would be expanded to another hospital within the medical teaching institute, Dera Ismail Khan. This measure will maintain and enhance patient care, prevent CIN, and improve the renal health of elderly patients.

Exploring observed and instructed mHealth use in the middle-aged and elderly people (MAEP): A social learning perspective.

Objective: Based on social learning theory, this study aimed to explore the intention of middle-aged and elderly people (MAEP) to engage with mobile health (mHealth) and the underlying effects of usability and utility. The goal was to garner insights that could enhance the advancement of mHealth and improve the scope of benefits of mHealth use among MAEP in the future. Methods: We employed a survey-based approach to delve into the mHealth use intentions among MAEP individuals aged 45 and above. A total of 371 valid survey responses were collected and analyzed using SmartPLS 3.0 for statistical examination and model verification. Results: Our hypotheses tests revealed that vicarious utility fully mediated the relationship between observed use and direct use intention and both indirect use intentions. Instructed usability and instructed utility were found to fully and partially mediate the relationship between instructed use and indirect use intention, respectively. Conclusions: This study demonstrates that the observed and instructed use behaviors of MAEP can promote their eventual intention to adopt mHealth through processes of observational and reinforcement learning. These findings underscore the importance of understanding the underlying effects of MAEP's intention to use mHealth is critical to increasing their adoption of mHealth, and thereby potentially improving their health outcomes.

A Study of Factors Contributing to the Nutritional Status of Elderly People Receiving Home Care.

(1) Background: Nutrition is a critical aspect of health and well-being in the elderly population, as physiological changes associated with aging can impact nutrient utilization and dietary needs. The aim of this study was the assessment of nutritional screening and associated factors among community-dwelling elderly people. (2) Methods: This study is the first phase of an intervention trial of people aged 65 years and over who received primary health services and resided in the municipality of Archanes Asterousia in Crete, Greece. Nutritional risk was assessed using the Mini Nutritional Assessment. Diet-related factors were analyzed, including health status (oral hygiene, depression, cognitive decline, impaired functioning, quality of life), social factors (educational attainment, marital status, type of work before 60 years), and lifestyle factors (smoking, drinking, diet). (3) Results: A total of 730 elderly people were evaluated (males, 31.5%), with an average age (±SD) of 76.83 (±6.68) years. MNA was found to have a statistically significant connection with assessment of oral hygiene, mental state, Charlson comorbidity, functional independence (assessed with the Barthel scale), and quality of life. The exception was geriatric depression (GDS), with which no statistically significant association was found (p > 0.05). Nutritional risk analysis revealed 379 participants (51.9%) to be adequately nourished, 205 (28.1%) to be at risk of malnutrition, and 146 (20.0%) to be malnourished. (4) Conclusions: These results clearly demonstrated the key factors that contribute to the nutritional screening of elderly people and need to be addressed by health authorities and social services.

A post-marketing study to evaluate the safety and immunogenicity of a quadrivalent influenza split-virion vaccine in elderly people aged 60 years and older.

BACKGROUND: Influenza remains a global public health concern. Understanding the vaccination-induced response in an aging population, which is susceptible and at high risk, is essential for disease prevention and control. Here, we report findings on the safety and immunogenicity of a quadrivalent influenza split-virion vaccine (15 µg/subtype/0.5 ml/dose) (hereinafter referred to as the "quadrivalent influenza vaccine") in a population aged ≥ 60 years. METHODS: This open-label, pragmatic post-marketing trial enrolled 1399 older adults to receive one dose of an approved commercially available quadrivalent influenza vaccine manufactured by Hualan Biological Bacterin Inc. (hereinafter referred to as "Hualan Bio"). Participants with contraindications for the vaccine were excluded, while poor health condition was acceptable. All vaccinated subjects experienced adverse events collection within 30 days and serious adverse events within 180 days post-vaccination. 25% subjects, selected randomly, underwent venous blood sampling pre-vaccination and 30 days after post-vaccination, for detecting antibody titers against each subtype of influenza virus by hemagglutination inhibition assay. The incidences of adverse events and antibody titers against each subtype of influenza virus were statistically analyzed using SAS 9.4. RESULTS: No grade 3 adverse reactions occurred within 30 days post-vaccination. The incidences of overall adverse reactions, local adverse reactions and systemic adverse reactions were 3.79%, 2.86% and 1.00%, respectively. No serious adverse reactions occurred within 180 days post-vaccination. There were 350 subjects who completed venous blood sampling pre-vaccination, among whom 348 subjects completed venous blood sampling at 30 days post-vaccination for immunogenicity assessment. With respect to hemagglutination inhibition antibodies against influenza viruses H1N1, H3N2, BV and BY subtypes, at 30 days post-vaccination, the seroconversion rates were 87.64%, 75.57%, 73.28% and 78.74%, respectively; the seropositive rates were 93.97%, 98.56%, 79.31% and 95.40%, respectively; and the geometric mean increase (GMI) in post-immunization/pre-immunization antibodies was 24.80, 7.26, 10.39 and 7.39, respectively. CONCLUSION: One 15 µg/subtype dose of the vaccine had a good safety profile and elicited favorable immunogenicity among subjects aged ≥ 60 years. The results of this study indicate that Hualan Bio quadrivalent influenza vaccine strike balance between safety and immunogenicity, supporting unnecessity to increase dosage or inoculation frequency for further enhancing immunogenicity. TRIAL REGISTRATION: Registered on ClinicalTrials.gov. REGISTRATION NUMBER: NCT06334510. Registered on 28/03/2024 (retrospectively registered).

The Functional Efficiency of Older Patients after Lumbar Spine Surgery, the Impact of Pain, and the Passage of Time: Tips for Care Providers.

Chronic back pain in adults is often a cause of absenteeism from work, limitations in social interactions, and difficulties in performing daily activities. This study aimed to check whether the functioning of everyday activities in elderly patients after neurosurgery improved over time compared to their condition before the procedure and whether there is a connection between fitness, self-esteem, and pain intensity. This was a cross-sectional study carried out using an anonymous survey. This study included patients over 60 years of age from the neurosurgical ward. The following scales were used to assess cognitive functioning, depression, functional status: basic and instrumental activities of daily living (IADL), back pain disability (QBPDS), pain intensity, and self-esteem. The level of independence in terms of IADL and QBPDS increased, and the intensity of pain decreased. Surgery reduced pain intensity from 8 ± 0.8 to 6.1 ± 1.4 points. The level of self-esteem (RSES) remained at a low level. The passage of time after neurosurgical treatment has a beneficial effect on reducing pain intensity and increasing independence in life activities. Daily physical activity and rehabilitation are important factors supporting the return to independence.

Association between Mild Overweight and Survival: A Study of an Exceptionally Long-Lived Population in the Sardinian Blue Zone.

Background/Objectives: Overweight and obesity are generally considered risk factors for premature mortality. However, scientific evidence suggests that among older populations, mild conditions of overweight might be associated with reduced comorbidity and longer survival. This study investigates the potential association between anthropometric parameters and survival among a cohort of nonagenarians in Sardinia, Italy. Methods: This study included 200 subjects (50% females) aged 89 and older, enrolled in 2018 in the Sardinian Blue Zone-a population known for longevity-and followed for up to six years. Anthropometric variables such as body height, weight, age, sex, comorbidity, disability, and food group intake were collected using validated questionnaires and analyzed through multivariable analysis. Results: Out of 200 participants at baseline, 28 (14%) were still alive after six years of follow-up (females 10%, males 18%). Mean survival was 3.36 years (range 0.1-6.9 years) for males and 3.03 years (range 0.2-6.6 years) for females. Participants with a Body Mass Index (BMI) in the range of 25.0-27.0 kg/m2 among males and 25.0-27.2 kg/m2 among females had longer survival compared to those who were underweight (p = 0.002) or obese (p < 0.0001). The Cox proportional hazards regression model, adjusted for age, sex, and comorbidity, revealed a statistically significant association between the BMI and survival, demonstrating an inverted-U relationship. This indicates that mild overweight was associated with a survival advantage compared to both normal weight and obesity. Conclusions: Our study indicates that mild, but not severe, overweight in nonagenarians is associated with extended lifespan. Therefore, primary care physicians and geriatricians should exercise caution before recommending calorie-restricted diets for mildly overweight elderly patients.

Uncontrolled blood pressure among the established hypertensive elderly people in Jashore, Bangladesh: A cross-sectional type of observational study.

Objectives: Hypertension is one of the major modifiable risk factors for cardiovascular mortality and morbidity throughout the world. Increased life expectancy leads to increase prevalence of non-communicable diseases among the elderly people including Bangladesh. However, different studies reported high prevalence of uncontrolled hypertension ranging from 52.6% to 67.9% among the elderly people in different countries. With this view, we aimed to assess the frequency of uncontrolled blood pressure (BP) among the elderly hypertensive people and its associated risk factors and treatment pattern in Bangladesh. Methodology: This cross-sectional type of observational study recruited 246 eligible hypertensive elderly patients attending in 250 Bedded General Hospital, Jashore, Bangladesh dated from 1st July to 31st December 2022. A structured questionnaire was developed and data on associated risk factors, treatment pattern and current blood pressure (BP) measurement were collected by face-to-face interview for the purposive sampling technique. Results: The mean age of our study patients was 72 ± 7 years with a male and female ratio nearly 1:1. Of the total hypertensive patients aged over 65 years or more, 56.5% remained with uncontrolled hypertension even on their prescribed antihypertensive medications. The mean systolic (SBP) and diastolic (DBP) blood pressure were significantly high (P < 0.001) as 167 ± 22 mm Hg and 95 ± 11 mm Hg, respectively, among the uncontrolled hypertensive patients. However, we noticed the mean SBP and DBP among the total hypertensive patients were also significantly high (P < 0.001) as 148 ± 27 mm Hg and 87 ± 13 mm Hg, respectively. In this study, we reported that the mean number of last prescribed antihypertensive medications used by the total patients was 2 ± 1 (P =0.224) which was similar among the controlled and uncontrolled hypertensive patient groups. Among the elderly hypertensive patients, the most commonly prescribed antihypertensive medications were Amlodipine 39.8% (P =0.006), Olmesartan 29.3% (P = 0.186), Losartan 24.4% (P = 0.127), Bisoprolol 15.0% (P = 0.266) and Atenolol 14.6% (P = 0.224). Conclusion: We noticed high frequency of uncontrolled blood pressure among the elderly hypertensive patients, despite of using multiple antihypertensive medications in Jashore, Bangladesh.

[Securing the management of medicines at risk in a geriatric hospital: A comprehensive approach]. / La prise en charge des médicaments à risque dans un hôpital gériatrique.

High-risk drugs, which are potentially a source of serious adverse reactions, are a major concern in healthcare establishments, particularly for geriatric patients, who often have multiple medications and co-morbid conditions. With a view to continuously improving the quality and safety of care, we have embarked on a proactive approach aimed at identifying, securing and improving the management of medicines at risk in geriatric wards.

Money and mental health: The impact of intergenerational transfers on elderly people in China.

Using three waves of the China Health and Retirement Longitudinal Study, this paper examines whether financial transfers from adult children to elderly parents affect the latter's mental health. Both OLS and instrumental variable (IV) estimates show that financial transfers significantly attenuate depressive symptoms of elderly individuals, with a much larger size of the IV estimates. We also examine the income and cultural channels through which intergenerational transfers work and further discuss the explanatory powers of these two channels through a decomposition analysis. The results suggest the cultural channel accounts for a larger proportion of the financial transfer effect. This means that the unique beneficial impact of intergenerational financial transfers on the mental health of older adults cannot be fully substituted in the foreseeable future.

Thriving of Older People Assessment Scale (TOPAS): Transcultural adaptation, psychometric evaluation, and refinement in a Spanish sample.

The objective of this study was to culturally adapt the Thriving of Older People Assessment Scale (TOPAS) instrument and evaluate its psychometric properties. The study was carried out in two phases: cross-cultural adaptation and psychometric validation and refinement through a cross-sectional study conducted between 2018 and 2020 with 314 participants. The refinement resulted in an abbreviated version of TOPAS, maintaining the original 5 factors with 16 items. Cronbach alpha was 0.91. Composite reliability (0.72-0.89) and average variance extracted (0.57-0.81), supporting discriminant validity. Maximum shared variance for the factors (0.22-0.50) and average shared variance (0.16-0.31), demonstrating discriminant validity. The abbreviated version of TOPAS showed evidence of being a valid and reliable instrument for measuring the adaptability of elderly residents in institutions. Implementing this instrument in Spanish nursing homes allows for a continuous evaluation of residents' well-being in relation to their environment, a construct not previously assessed with available scales.

Potentially avoidable hospitalizations and associated factors among older people in French Guiana using the French National Health Data System.

Knowing the prevalence of potentially avoidable hospitalizations (PAHs) and the factors associated with them is essential if preventive action is to be taken. Studies on PAHs mainly concern adults, and very few have been carried out in South America. To the best of our knowledge, there has been no study on PAHs in French Guiana, particularly among older adults. This case-control study aimed to estimate the prevalence of PAHs in the Guianese population aged over 65 and to analyze their associated factors. We used the 2017-2019 data from the French National Health Service database (Système National des Données de Santé). The patients were age- and sex-matched 1 : 3 with controls without any PAH in 2019. Factors associated with PAHs were investigated through two conditional logistic regression models [one including the Charlson comorbidity index (CCI) and one including each comorbidity of the CCI], with calculation of the adjusted odds ratio (aOR) and 95% confidence interval (CI). The PAH incidence was 17.4 per 1000 inhabitants. PAHs represented 6.6% of all hospitalizations (45.6% related to congestive heart failure or hypertension). A higher CCI was associated with PAHs [aOR 2.2 (95% CI: 1.6, 3.0) and aOR 4.8 (95% CI: 2.4, 9.9) for 1-2 and ≥3 comorbidities, respectively, versus 0], as was immigrant health insurance status [aOR 2.3 (95% CI: 1.3, 4.2)]. Connective tissue disease, chronic pulmonary disease, congestive heart failure, diabetes, and peripheral vascular disease were comorbidities associated with an increased risk of PAHs. While the prevention of PAHs among immigrants is probably beyond the reach of the Guianese authorities, primary care and a public health policy geared toward prevention should be put in place for the French Guianese population suffering from cardiovascular disease in order to reduce PAHs.

Prior Engagement in Physical Activity Correlates with Enhanced Quality of Life Perceptions among Older Adults during COVID-19 Lockdown.

BACKGROUND: This longitudinal study aimed to evaluate whether prior engagement in a physical exercise program correlated with enhanced perceptions of quality-of-life components among older adults during the COVID-19 lockdown period. METHODS: The cohort comprised elderly individuals (aged ≥ 65 years) who had previously partaken in a 12-week randomized controlled trial investigating the effects of a mixed aerobic-anaerobic, moderate-intensity exercise program. Participants' health-related quality of life was assessed using the Short Form Health Survey-12 item (SF-12) at the beginning of the initial trial and, again, one year later during the COVID-19 lockdown. In the exercise group, 44 participants were included, while the control group consisted of 49 participants, with computer-based, double-blind randomization conducted in Cagliari, Italy. The differences in scores for each SF-12 item between the two groups from T0 to T1 were compared using one-way ANOVA with Bonferroni corrections. Data were analyzed using the Statistical Package for Social Sciences (SPSS) version 27. RESULTS: No statistically significant differences were observed on average by age (exercise group vs. control group 72.20 ± 4.78 vs. 72.91 ± 4.77; F = 0.513, p = 0.476). A decrease from T0 to T1 towards a better score on the SF-12 was observed in the exercise group compared to the control group in item 1 (F = 67.463, p < 0.0001); in item 5 (F = 4.319, p = 0.041); item 8 (F = 4.269, p = 0.041); item 9 (F = 10.761, p = 0.001); item 10 (F = 170.433, p < 0.001); and item 11 (F = 4.075, p = 0.046). CONCLUSIONS: The results suggest that participation in a moderate physical exercise program one year prior may have equipped older adults with better coping mechanisms to navigate the stress and isolation imposed by the COVID-19 lockdown, as reflected by their enhanced scores on quality-of-life components pertaining to mental well-being. Exercise may confer a protective effect against the adverse psychological impacts of stressful events like the pandemic, even among older adults with chronic conditions. This study underscores the potential benefits of exercise interventions for promoting quality of life and preventing mood disorders in the elderly population.

Development of semi-dried goat meat jerky using tenderizers considering the preferences of the elderly.

Elderly people avoid eating red meat and dried meat product due to its texture and stiffness; they deprive them of rich sources of nutrients. In addition, food-related diseases are exponentially increasing due to using synthetic additives in food products. Therefore, this research aimed to develop semi-dried goat meat jerky considering geriatric preferences by using natural tenderizers and nitrate. Four treatments were formulated negative control (NC [synthetic nitrite without tenderizers]), positive control (PC [Swiss chard without tenderizers]), T1 (Swiss chard with pineapple powder), and T2 (Swiss chard with pineapple and tomato powder). T1 and T2 had higher processing yield, and rehydration capacity compared with NC and PC. The fat content of T1 and T2 was lower than the control groups. Moisture was significantly higher in T1, NC, and T2 than in PC (p < 0.05). T2 showed the lowest water activity (0.87), lowest shear force (4.82 kgf), and lowest total plate count (TPC). The lowest pH and thiobarbituric acid reactive substances (TBARS) were observed in T1 and T2. T1 showed the lowest lightness and the maximum redness (p < 0.05) while PC showed the lowest yellowness. During the storage period, moisture and pH decreased, and TPC and TBARS significantly increased whereas water activity is stable regardless of the treatment. The results of the myofibrillar fragmentation index (MFI) and sodium dodecyl sulfate-polyacrylamide gel revealed that T1 and T2 more effectively converted protein to polypeptides. In addition, tenderizers positively affected thrombogenicity, atherogenicity, and hypocholesterolemic/hypercholesterolemic indices. T2 observed the highest overall sensory acceptance by reducing goaty flavor. Overall, jerky treated with tenderizers is easily chewable and digestible for the elderly due to its tenderness and essential fatty acids that would be senior-friendly food.

Association Between Frailty and Pelvic Organ Prolapse in Elderly Women: A Retrospective Study.

INTRODUCTION AND HYPOTHESIS: This study evaluated the association between pelvic organ prolapse (POP), frailty, and sarcopenia to explore how POP treatment can extend healthy life expectancy in elderly women. METHODS: We conducted a retrospective study of prospectively collected data, comparing women with mild POP (stages 0-II) with those with advanced POP (stages III and IV). The inclusion criteria for this study were women who visited the clinic with at least one symptom of pelvic floor dysfunction and underwent imaging studies between April 2020 and November 2022. Initially, 119 patients met these inclusion criteria. Patients were excluded if they had a history of previous POP treatment, did not respond to the study survey, or were lost to follow-up. After applying these exclusion criteria, 82 patients were included in the final analysis, of whom 65 underwent surgery (laparoscopic sacrocolpopexy, colpocleisis, tension-free vaginal tape, and native tissue repair). Assessments included POP Quantification, Kihon Checklist, Pelvic Organ Prolapse Quality of Life (P-QOL) questionnaire, International Prostate Symptom Score (IPSS), Overactive Bladder Symptom Score (OABSS), and Incontinence Symptom Questionnaire (ICIQ-SF). Pelvic muscles were measured using MRI or CT. Immunohistochemical analysis of estrogen receptor alpha (ERα), estrogen receptor beta , and androgen receptor was performed on surgical specimens from 43 patients. RESULTS: The median age of participants was 75 years. Of the 82 patients, 48 (58.5%) were classified as frail or pre-frail, and 22 (26.8%) exhibited motor impairment. Advanced POP (stages 3 and 4) was seen in 41 patients. These patients had more motor function impairments (advanced, 16; mild, 6; p = 0.01). Patients with advanced POP had poorer P-QOL, ICIQ-SF (median: 9.5 vs 4, p = 0.006) and OABSS (7 vs 4, p = 0.008) scores, and smaller pubococcygeus muscle diameter (2.5 vs 3 cm, p = 0.017). Postoperatively, significant improvements were seen in P-QOL (all domains except personal relationships: p < 0.001), total IPSS (11 vs 4, p < 0.001), OABSS (6 vs 5, p = 0.033), and ICIQ-SF scores (6 vs 2, p < 0.001). ERα expression was associated with preoperative frailty (r = -0.37, p = 0.014). CONCLUSIONS: Advanced POP correlates with poorer QOL, worse urinary symptoms, and reduced pubococcygeus muscle diameter, consistent with sarcopenia, compared with mild POP.

Breaking the Silence on Food Risks for Elderly People Living Alone.

(1) Background: Currently, numerous qualitative research studies on food and its influence on health are being conducted. In qualitative research, data are obtained by analyzing participants' responses. However, silence during conversation has been little studied. The aim of this study was to interpret the silences in the narratives of elderly people living alone about the potential risks of not keeping a healthy diet. (2) Methods: This is a descriptive and interpretative observational study under the qualitative research paradigm following a phenomenological and ethnographic perspective. The study was developed in two phases with people over 65 years old. In the first phase, from June 2021 to January 2022, 90 interviews, 12 life history analyses, 58 food diaries and 51 free listings (cultural domain technique) were conducted. In the second phase, from March to June 2022, 3 participatory workshops and 24 pile sorts (cultural domain technique) were conducted, as well as 3 focus groups. Only data from participants over 65 years old living alone are analyzed in this paper. The ATLAS-ti (Version 22) qualitative analysis software was used for coding and data analysis. (3) Results: The results show that elderly people living alone would sometimes remain silent during the various conversations conducted within the research. This silence reflects their desire to downplay the risks to their health from not eating well due to their unwanted loneliness. The people participating in our research had chronic health problems, financial insecurity and emotional problems. (4) Conclusions: We concluded that elderly people living alone are unable to maintain a healthy diet because they downplay their risk of malnutrition. This mindset is caused by their loneliness and bolstered by a situation of learned helplessness and social injustice.

A randomized controlled trial of acupuncture and receptive music therapy for sleep disorders in the elderly-ELAMUS: study protocol.

BACKGROUND: Globally, the demographic shift towards an aging population leads to significant challenges in healthcare systems, specifically due to an increasing incidence of multimorbidity resulting in polypharmacy among the elderly. Simultaneously, sleep disorders are a common complaint for elderly people. A treatment with pharmacological therapies often leads to side effects causing a high potential for dependency. Within this context, there is a high need to explore non-pharmacological therapeutic approaches. The purpose of this study is to evaluate the effectiveness of acupuncture and music therapy, both individually and combined as a multimodal therapy, in the treatment of sleep disorders in individuals aged 70 years and older. METHODS: We conduct a confirmatory randomized controlled trial using a two-factorial study design. A total of n = 100 elderly people receive evidence-based standard care information for age-related sleep disorders. Beyond that, patients are randomly assigned into four groups of n = 25 each to receive acupuncture, receptive music therapy with a monochord, multimodal therapy with both acupuncture and music therapy, or no further therapy. The study's primary outcome measurement is the improvement in sleep quality as assessed by the Pittsburgh Sleep Quality Index (PSQI) (global score), at the end of intervention. Additionally, depression scores (Geriatric Depression Scale), health-related quality of life (Short-Form-Health Survey-12), neurovegetative activity measured via heart rate variability, and safety data are collected as secondary outcomes. Using a mixed-methods approach, a qualitative process evaluation will be conducted to complement the quantitative data. DISCUSSION: The study is ongoing and the last patient in is expected to be enrolled in April 2024. The results can provide valuable insights into the effectiveness of non-pharmacological interventions for sleep disorders among the elderly, contributing to a more personalized and holistic approach in geriatric healthcare. TRIAL REGISTRATION: German Clinical Trials Register (DRKS00031886).

Adherence to the Mediterranean Diet Mitigates Inflammation and Hospital Stay in Frail Elderly Patients: A Moderation Analysis.

Understanding the interaction between dietary patterns and nutritional status in influencing health outcomes is crucial, especially in vulnerable populations. Our study investigates the impact of adherence to the Mediterranean diet (MD) and nutritional status on inflammatory markers (CRP) and the length of stay (LOS) in hospitalized frail elderly patients. METHODS: We conducted two-way ANOVA and multiple regression analysis to evaluate the effects of nutritional status and MD adherence on the CRP levels and LOS in a cohort of 117 frail elderly patients aged 65 years or older. Patients with cancer or acute infection were excluded. Adherence to the MD was assessed using the 14-item PREDIMED questionnaire. RESULTS: Significant interactions were found between nutritional status and MD adherence for both the CRP and LOS. The patients with low-level MD adherence and a poor nutritional status exhibited higher CRP levels and longer hospital stays compared to those with high MD adherence. Specifically, a statistically significant interaction was observed for the CRP (F (1, 113) = 7.36, p = 0.008) and LOS (F (1, 113) = 15.4, p < 0.001), indicating the protective effect of high-level MD adherence. Moderation analysis confirmed that high-level MD adherence mitigates the adverse effects of malnutrition on both the inflammatory response and LOS. CONCLUSIONS: These findings highlight the importance of promoting the MD, particularly in malnourished elderly patients, to improve health outcomes and reduce hospitalization duration. Further longitudinal studies are warranted to establish causality and explore the underlying mechanisms.

Does combining two evidence-based exercise programs in elderly people with incontinence have a triple effect on incontinence symptoms, balance and functional status?

BACKGROUND: Improving pelvic floor muscle training (PFMT), balance and functional activity is recommended in the treatment of urinary incontinence (UI) in the elderly people. The aim of this study is to examine whether PFMT combined with Otago exercises is effective on symptoms, balance and functional status in elderly people with UI compared to PFMT alone. METHODS: This study is an assessor-blinded, randomized controlled trial. Participants with UI aged 65 and over living in a nursing home were randomly assigned to the intervention (IG) and control groups (CG). The intervention group attended an exercise program that included Otago exercises combined with PFMT. The control group was included in the PFMT program with different positions. The duration of exercise for both groups was 45-60 min per session three times a week for 12 weeks. UI symptoms and severity (Pelvic Floor Distress Inventory-20, bladder diary), PFM muscle function (superficial electromyography), balance (Berg Balance Scale), functional status (Senior Fitness Test) and fear of falling (Falls Efficacy Scale) were measured at baseline and after the intervention. RESULTS: The median age of the IG (n: 22) and CG (n: 21) was 73.5 and 77 years, respectively. At baseline and after the intervention within the group, a significant improvement was observed in the PTDE-20 score (IG and CG, p: 0.00) and the 2-min step test in the IG (p: 0.02) and CG (p: 0.01). A significant decrease was found in the 2.45 m get up-and-go test, PFM work average onset, and PFM rest MVC EMG values (p: 0.01, p: 0.01, p: 0.00) in the IG. The PFM rest average value decreased (p: 0.04) in the CG. CONCLUSION: The findings of this study show that combining PFMT with Otago exercises, two evidence-based interventions, is beneficial for effectively treating incontinence symptoms, balance and functional status in elderly people. Thus, a triple effect can be achieved with a single exercise training in the same treatment session and for the same duration. CLINICAL TRIAL NUMBER: Clinical trial number: NCT06331039.