Profile and Prognostic Impact of Multimorbidity in Elderly Patients with Heart Failure: Are there Differences between Men and Women?

PURPOSE OF REVIEW: Heart failure (HF) represents a pathology in constant growth, but, despite the fact that a significant proportion of its population is comprised of elderly patients, they are not adequately represented in clinical trials or registries. They constitute a heterogeneous population with their particularities and interaction of the multiple comorbidities that characterize this age group, which makes the clinical course, prognosis and outcomes of the disease different. RECENT FINDINGS: Compared to men, women with HF tend to be older, with a greater burden of non-cardiovascular comorbidities, less ischemic heart disease and preserved ventricular function in most cases. This fact translates into worse self-perceived quality of life, with lower hospitalization and mortality rates. Moreover, paradoxically, women are less likely to receive treatment recommended by clinical practice guidelines, including revascularization and device placement. As there are not enough representative studies of this population, the reasons for these results with better prognosis and relatively benign impact in the elderly female population are unknown, which is why it is necessary to continue with research in order to obtain greater evidence of the exposed gaps.

Acupuncture for the treatment of diabetic peripheral neuropathy in the elderly: a systematic review and meta-analysis.

Background: Diabetic peripheral neuropathy (DPN) is one of the most common complications of diabetes mellitus, often causing pain or numbness in the patient's limbs and even leading to amputation and death. Elderly patients with DPN usually have higher morbidity and more severe results. Acupuncture has been widely used as an effective treatment for DPN in China. However, the efficacy of acupuncture in the treatment of DPN remains unclear. In this review, we aimed to explore the impact of acupuncture in alleviating symptoms of DPN. Method and analysis: Six databases were searched from inception to October 2023. We searched Medline, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), and three Chinese databases, namely China National Knowledge Infrastructure (CNKI), SinoMed, and Wanfang. All randomized controlled trials related to the effect of acupuncture on DPN will be included. There was no restriction in language or publication year. The primary outcome is the response rate. The secondary outcomes are the Toronto clinical scoring system (TCSS), nerve conduction velocities (NCVs), and blood glucose before and after the treatment. Two researchers will be responsible for the selection of study, data extraction, and assessment of study quality independently. RevMan V5.1.0 software will be used to assess the risk of bias and generate data. Results: We searched 4518 studies, among which 9 RCTs were considered eligible. Overall, acupuncture treatment had a higher response rate than controls (relative risk (RR), -2.87 [95% confidence interval (CI), -5.27 to -0.48], p = 0.02) and significantly alleviated the symptoms of DPN patients, reduced their blood glucose levels, and improved their NCVs compared to the control group. This study will provide a high-quality synthesis of current available evidence for the clinical treatment of DPN with this therapy. Conclusion: The results suggested that acupuncture might be effective in improving symptoms of DPN in elderly patients. Owing to the overall low quality of the literature included, we need more large-sample, high-quality, and low-bias studies to prove it.

Non-diabetic elderly populations: the MHR as a protective factor against bone abnormalities.

Objectives: In China, osteoporosis has become a major health concern among elderly population, imposing significant burden on the country's social and economic systems. The monocyte to high-density lipoprotein ratio (MHR) has been currently recommended as a novel marker of inflammation and oxidative stress associated with osteoporosis in type 2 diabetes mellitus (T2DM). However, its reliability in non-diabetic elderly populations remains unclear. The present study was to evaluate the association between MHR and osteoporosis in a non-diabetic elderly population. Methods: The clinical data of 240 non-diabetic elderly subjects (115 in the osteoporosis group and 125 in the normal bone group) were retrospectively analyzed and all statistical analyses were performed by using SPSS 26.0. Results: Differences in age, neutrophils, lymphocytes, monocytes, MHR, uric acid, creatinine, triglycerides,and high-density lipoprotein cholesterol were found to be statistically significant between the two groups. A binary logistic regression model was conducted by including age, MHR, UA and Cr as variables. The results showed that age was an independent risk factor and MHR was an independent protective factor for bone abnormality in the non-diabetic elderly population. The ROC analysis showed that the area under the curve for the predictive effect of MHR, age and their combined test on osteoporosis in non-diabetic elderly populations was 0.623, 0.728 and 0.761, respectively; the correlation analysis showed that MHR was positively correlated with lumbar and hip BMD, and negatively associated with femoral neck stress ratio, femoral intertrochanteric stress ratio, and femoral stem stress ratio, showing statistically significant differences (P<0.05). Conclusions: For the non-diabetic elderly population: the MHR is a protective factor against bone abnormalities and was significantly higher in the normal bone group than in the abnormal bone group.

Characteristics of the top 100 cited electroencephalography articles on aging: a bibliometric analysis.

Electroencephalography (EEG) is a widely used tool in neuroscience. To explore the features of the top 100 cited articles related to EEG and aging over the past decade, we conducted a bibliometric analysis using Web of Science Core Collection (WoSCC) data as of January 21, 2024. The selected top 100 cited papers were analyzed using VOSviewer and Excel. We examined the distribution of publication years, authors, institutions, countries/regions, and journals. Hotspots were identified through keyword analysis. The analyzed articles were published between 2014 and 2021, with the majority being published before 2020 (n=91). Citation counts in WoSCC ranged from 24 to 250, with a median of 40 and a mean of 53. A total of 818 authors from 283 institutions in 35 countries/territories contributed to these top papers. The United States of America (USA) (n=37), Germany (n=14), and Canada (n=11) ranked in the top three in terms of total publications or citations. The predominant journals were in the fields of Neuroscience (n=58), Geriatrics & Gerontology (n=22), Clinical Neurology (n=13), and Anesthesiology (n=9), which published most of the high-quality articles. Key themes included EEG, aging, Alzheimer's disease, mild cognitive impairment, functional connectivity, and alpha oscillations. Emerging topics included sleep, machine learning, delirium, postoperative cognitive function, virtual reality, monitoring, resting state, coherence, and transcranial direct current stimulation. In conclusion, this study provides a comprehensive overview of the trends in scientific literature on EEG in aging over the past decade. Authors and institutions from North America, Europe, and East Asia led in contributions. Journals focusing on neuroscience, geriatrics, and anesthesiology published the majority of articles. Degenerative neurological diseases and cognitive impairment were prominent topics, suggesting future studies should explore EEG's diagnostic utility for these disorders.

Bone metabolism factors in predicting the risk of osteoporosis fracture in the elderly.

OBJECTIVE: Osteoporosis (OS) is a systemic bone disease characterized by low bone mass and bone microstructure damage. This study. METHODS: According to the T value, 88 elderly fracture patients were grouped as the control group (without OS, 43 cases) and observation group (with T value <-2.5, which could be diagnosed as OS, 45 cases). The content of boney containing protein (BGP), total type 1 collagen amino terminal extender peptide (TPINP), ß-Crosslaps (ß-CTX), parathyroid hormone (PTH) and insulin-like growth factors-1 (IGF-1) was compared. Multivariate logistic regression was adopted to analyze the correlation between biochemical indexes and the occurrence of senile OS fracture and the related risk factors. The diagnostic value in the elderly was analyzed by receiver operating characteristic (ROC) curve. RESULTS: The levels of BGP, TPINP, ß-CTX, PTH and IGF-1 were elevated, and the level of IGF-1 was decreased in the observation group compared with the control group (P < 0.05). The elevated content of BGP, TPINP, ß-CTX and PTH, and the decreased expression of IGF-1 were influencing factors for OS fractures in the elderly (P < 0.05). The sensitivity and specificity to predict the occurrence of OS fractures in the elderly were 91.70% and 90.50%, respectively. The AUC of combined detection was 0.976 (95% CI: 0.952-1.000), which was memorably higher than single indicator detection (P < 0.05). Among 45 patients, 32 cases had good prognosis and 13 had poor prognosis. In comparison with the good prognosis group, the content of BGP, TPINP, ß-CTX and PTH were sensibly higher, the level of IGF-1 was prominently lower, and the proportion of fracture history was much higher in poor prognosis group (P < 0.05). Fracture history, BGP, TPINP, ß-CTX, PTH and IGF-1 were independent risk factors for poor prognosis of elderly OS fractures (P < 0.05). CONCLUSION: Bone metabolism factors were associated with poor prognosis of OS in the elderly. The combined detection had higher diagnostic value in calculating the risk of OS fracture in the elderly than single indicator detection.

Health-Related Issues of Users of Social Care Services for Elderly and Their Caregivers: A Cross-Sectional Study in a Day Care Center.

AIM: The aim of this study was to examine two hypotheses: 1) Users of Day Care Center for Elderly (DCCE) would have frail health and multiple age-related care needs, and 2) caregivers would have to deal with some levels of anxiety due to the burden of care, and similar levels of quality of life to the users. MATERIALS AND METHODS: The current cross-sectional study was carried out at a DCCE of the regional unit of Heraklion, Crete, Greece, between March-April 2022. The study sample comprised 29 DCCE social care services users and 51 caregivers. A short questionnaire sheet was created to record sociodemographic characteristics and general health-related issues. Additionally, the Anxiety Symptom Scale (Short Anxiety Screening Test (SAST)) and the Quality of Life (SF-12) were used to measure anxiety and quality of life of the participants. Comparison analysis was performed to detect differences between the two groups. RESULTS: The most common morbidities for users of DCCE were hypertension (58.6%), hypercholesterolemia (55.2%), rheumatoid arthritis (24.1%), diabetes (24.1%) and heart disease (41.4%). Users of social care services have significantly higher vaccination rates (influenza: 100%, COVID-19: 100%, herpes zoster: 44.8%, and pneumococcus: 86.2%) than their caregivers. About 75% (yes: 24% and sometimes: 51.8%) of the users and 45% of their caregivers (yes: 7.8%, and sometimes: 37.3%) felt lonely at least sometimes. All participants were found to have low mean levels of the SAST score (18.4, SD:4.9) and 18.7% were on the verge of severe symptoms. Users of social care services were found to have low average levels of quality of life (SF-12), with significantly lower physical health (28.2, SD: 6.6) compared to the Mental health subscale (39.6, SD: 9.3) (p <0.001). CONCLUSIONS: This study highlighted the main health-issues of DCCE users, and that they have low quality of life. Additionally, we found that caregivers faced a few health-issues, and had higher quality of life and lower SAST levels than the users. Therefore, social and health policy providers should consider our findings and assess the users' and caregivers' needs to provide holistic care, thus improving their quality of life.

Marine algae-derived oligosaccharide via protein crotonylation of key targeting for management of type 2 diabetes mellitus in the elderly.

Global aging is a tendency of the world, as is the increasing prevalence of diabetes, and the two are closely linked. In our early research, Enteromorpha prolifera oligosaccharide (EPO) possesses the excellent ability of anti-oxidative, anti-inflammatory, and anti-diabetic. We aim to further explore the deeper mechanism of how EPO delays aging and regulates glycometabolism. EPO effectively impacts crotonylation procession to enhance glucose metabolism and reduce cell senescence in aging diabetic rats. Crotonylation modification of XPO1 influences the expression of critical genes, including p53, CDK1, and CCNB1, which affect cell cycle regulation and aging. Additionally, EPO improves glucose metabolism by inhibiting the crotonylation modification of HSPA8-K126 and activating the AKT pathway. EPO promotes crotonylation of histones in intestinal cells, influencing the aging process by increasing the butyric acid-producing bacteria Ruminococcaceae. The observed enhancement in pyrimidine metabolism underscores EPO's potential role in regulating intestinal health, presenting a promising avenue for delaying aging. In summary, our findings affirm EPO as a naturally bioactive ingredient with significant potential for anti-aging and antidiabetic interventions.

[Layer based epidemiological quality assessment of architecture of care security and geriatric wards]. / Warstwowa ocena epidemiologiczna architektury zakladów opiekunczo-leczniczych i oddzialów geriatrycznych.

BACKGROUND: The article describes the potential use of an original model called the layered epidemiological assessment (warstwowa ocena epidemiologiczna - WOE) for assessing the potential risk of infections in facilities intended for elderly individuals. MATERIAL AND METHODS: To verify the possibility of using the WOE method for assessing epidemiological safety hazards in the built environment, available literature sources related to the legal requirements in Poland regarding the assessment of medical facility ergonomics in terms of infection transmission were analyzed. The article also referred to the guidelines of the New European Bauhaus and the Baukultur Quality System as a standardized method for assessing the quality of the built environment. The article presents the fundamental assumption of the author's WOE method, which allows for the assessment of the risk of infection transmission separately for each component of a building. The effectiveness of the method was demonstrated by using it to assess the risk of infections in a geriatric ward room as an example. RESULTS: The article demonstrates that by employing the WOE, it is possible to clearly differentiate potential infection routes within the analyzed facilities and assign them to specific building components. Furthermore, by applying the presented method, it is possible to define necessary procedures and develop action plans to minimize the risk of infection spread within the analyzed properties. CONCLUSIONS: The application of the WOE for evaluating architectural solutions in facilities intended for the elderly offers several benefits. The WOE method presented in the article can serve as an expert tool for quick and precise assessment of potential epidemiological hazards. An important advantage of the WOE method is its ability to be used separately for different types of epidemiological hazards characterized by different routes of infection transmission. Med Pr Work Health Saf. 2024;75(3).

Something to Chew on; Plate-Waste at an Ontario Veteran's Centre.

There is paucity of data assessing levels of food/beverage waste in long-term care (LTC) facilities, especially in Ontario. Observations in the Veteran's Centre (VC) at Sunnybrook Health Sciences Centre (Sunnybrook) indicated food/beverage waste may be high, potentially impacting sustainability efforts within our institution. Before proceeding with waste reduction efforts, we conducted a comprehensive 3-day waste-audit of food/beverage items provided to VC residents with the goal of understanding the extent of food/beverage waste at VC, items wasted, and any other factors that may inform future changes. Our results indicate that 28% of items served to residents were wasted. Lunch was the meal with greatest waste at 31% and waste of solid items was 12% higher than that of liquids. We observed a large variability in waste between residents and within each resident, with 15% of residents wasting >50% of items provided. This study provides a deeper insight into the magnitude of food/beverage waste in a LTC population and highlights the importance of considering individualized strategies to address waste to avoid negative impact on residents.

The role of dietary fats on cognition and sarcopenia in the elderly.

BACKGROUND AND OBJECTIVES: To elucidate the role of dietary fats on the relationship between mild cognitive impairment and sarcopenia and help identifying and preventing the decline of cognitive and muscle function in elderly individuals. METHODS AND STUDY DESIGN: The study conducted involving a group of 1812 individuals between the ages of 61 and 92. Body composition and BMR were assessed by bioelectrical impedance analysis. Cognitive function and dietary nutrition were evaluated by neuropsychological assessments and questionnaire of food intake frequency. Lipidomics analysis was performed using UHPLC-Qtrap-MS/MS. RESULTS: MCI and SA are mutual influencing factors, lower intake of MUFA, PUFA and higher intake of fat was associated with cognitive dysfunction and/or SA (p < 0.05). PUFA was important for MCI combined with SA (Compared with Q1, Q4 OR: 0.176, 95%CI: 0.058,0.533). Lipidomics analysis revealed that triacylglycerol (TAG) contain more carbon chains with saturated double bonds may be closely related to cognitive impairment and the progression of SA (p < 0.05). While, DAG with carbon chains of unsaturated double bonds is opposite. CONCLUSIONS: Insufficient intake of unsaturated fatty acids was associated with the development of cognitive decline and the progression of SA. MUFA affecting muscle health, fats and PUFA has a greater impact on MCI combined with SA. Less MUFA intake and increasing saturated double-bonded fatty acid intake might be the key factors on promoting cognitive impairment and SA in the elderly. They have the potential to serve as prospective biomarkers indicating a higher risk of cognitive decline and/or SA in the elderly population.

Health Management Service Models for the Elderly with Visual Impairment: A Scoping Review.

Background: The incidence of visual impairment(VI) in older people is gradually increasing. This review aimed to summarise the evidence on existing health management models and strategies for older adults with VI to improve health-related and vision-related quality of life (QoL) in older people. Methods: Based on the framework of the scoping review methodology of Arksey and O'Malley (2005), a comprehensive literature search of relevant literature published between January 2010 and June 2022 in PubMed, CINAHL, EMBASE, Web of Science, Cochrane Library, CNKI, VIP, Wanfang database, Sinomed and the grey literature. Results: Finally, 31 articles were included. The health management model had a multidisciplinary team low vision rehabilitation model, medical consortium two-way management model, low vision community comprehensive rehabilitation model, medical consortium-family contract service model, screening-referral-follow-up model, and three-level low vision care model. The health management strategy covers nine aspects, the combination of multi-element strategies is feasible, and network information technology has also shown positive results. Conclusion: In the future, under the Internet and hierarchical management model, we should provide demand-based personalized support to rationalize and scientifically achieve hierarchical management and improve resource utilization efficiency and eye health outcomes.

Chewing ability and its associated factors among community-dwelling older adults in Chengdu, China: A cross-sectional study.

AIM: To investigate the current status of chewing ability and analyze the risk factors among Chinese community-dwelling older adults. METHODS: In this cross-sectional study, color-changeable gum and a color difference meter were used to assess chewing ability in the population. The statistical analysis employed multivariate logistic regression models to identify and quantify the factors influencing chewing ability. RESULTS: A total of 373 community-dwelling adults aged 65 and older in Chengdu, in the west of China, were included in this study; 64 individuals (17.2%) exhibited signs of poor chewing ability. Female (odds ratio [OR]: 0.124, 95% CI: 0.057-0.268, p < .001), education level with college degree and above (OR: 0.114, 95% CI: 0.030-0.434, p = .001), number of teeth less than 20 (OR: 5.401, 95% CI: 2.509-11.626, p < .001), and decreased oral diadochokinesis (OR: 4.445, 95% CI: 1.775-11.132, p = .001) were significant factors in chewing ability in this study, after adjustment for potential variables. CONCLUSIONS: The prevalence of decreased chewing ability among Chinese community-dwelling older adults was 17.2% and decreased chewing ability was associated with men, lower education level, less than 20 teeth and decreased oral diadochokinesis.

The Diagnosis and Treatment of Acute Cholecystitis: A Comprehensive Narrative Review for a Practical Approach.

Acute cholecystitis (AC), generally associated with the presence of gallstones, is a relatively frequent disease that can lead to serious complications. For these reasons, AC warrants prompt clinical diagnosis and management. There is general agreement in terms of considering early laparoscopic cholecystectomy (ELC) to be the best treatment for AC. The optimal timeframe to perform ELC is within 72 h from diagnosis, with a possible extension of up to 7-10 days from symptom onset. In the first hours or days after hospital admission, before an ELC procedure, the patient's medical management comprises fasting, intravenous fluid infusion, antimicrobial therapy, and possible administration of analgesics. Additionally, concomitant conditions such as choledocholithiasis, cholangitis, biliary pancreatitis, or systemic complications must be recognized and adequately treated. The importance of ELC is related to the frequent recurrence of symptoms and complications of gallstone disease in the interval period between the onset of AC and surgical intervention. In patients who are not eligible for ELC, it is suggested to delay surgery at least 6 weeks after the clinical presentation. Critically ill patients, who are unfit for surgery, may require rescue treatments, such as percutaneous or endoscopic gallbladder drainage (GBD). A particular treatment approach should be applied to special populations such as pregnant women, cirrhotic, and elderly patients. In this review, we provide a practical diagnostic and therapeutic approach to AC, even in specific clinical situations, based on evidence from the literature.

Program of All-Inclusive Care for the Elderly: an untapped setting for research to advance pain care in older persons.

The Program of All-Inclusive Care for the Elderly (PACE) is a community-based care model in the United States that provides comprehensive health and social services to frail, nursing home-eligible adults aged 55 years and older. PACE organizations aim to support adequate pain control in their participants, yet few evidence-based pain interventions have been adopted or integrated into this setting. This article provides a roadmap for researchers who are interested in collaborating with PACE organizations to embed and evaluate evidence-based pain tools and interventions. We situate our discussion within the Consolidated Framework for Implementation Research (CFIR), a meta-theoretical framework that considers multi-level influences to implementation and evaluation of evidence-based programs. Within each CFIR domain, we identify key factors informed by our own work that merit consideration by research teams and PACE collaborators. Inner setting components pertain to the organizational culture of each PACE organization, the type and quality of electronic health record data, and availability of staff to assist with data abstraction. Outer setting components include external policies and regulations by the National PACE Association and audits conducted by the Centers for Medicare and Medicaid Services, which have implications for research participant recruitment and enrollment. Individual-level characteristics of PACE organization leaders include their receptivity toward new innovations and perceived ability to implement them. Forming and sustaining research-PACE partnerships to deliver evidence-based pain interventions pain will require attention to multi-level factors that may influence future uptake and provides a way to improve the health and well-being of patients served by these programs.

Use of antibiotics in long-term care facilities for the elderly in Germany - point prevalence as a possible first step for data-based antibiotic stewardship.

Introduction: In Germany, hospitals, rehabilitation facilities and outpatient surgery facilities are required by law to perform antibiotic-consumption surveillance. Established IT programs are available for recording the defined daily doses. These do not exist for long-term care facilities (LTCFs). Antibiotic stewardship is also recommended for LTCFs. In view of the lack of IT solutions for consumption surveillance, this study investigated whether point prevalence studies could be a suitable basis for a data-based antibiotic stewardship program in LTCFs. Method: In May 2023, 18 elderly-care facilities in Berlin, Germany, participated in a point prevalence survey on antibiotic consumption according to the established HALT (healthcare-associated infections in long-term care facilities) method. The number of residents present and their risk factors (including the use of catheters and antibiotic therapy) were recorded. The results were compared with comparable data from previous surveys in LTCFs in Berlin, Germany as well as with the HALT data for Europe as a whole and for Germany. Results: On the day of the survey, 2040 residents were present, 7.7% of whom bore a urinary catheter and 0.5% a vascular catheter. 0.2% of the residents had a port access, 0.4% a dialysis catheter and one resident (0.05%) a tracheostoma. Twenty-seven (1.3%) residents were receiving an antibiotic on the day of the survey. Of these, 29.6% had a urinary tract catheter. 63.0% of the antibiotics were given for a urinary tract infection, 14.8% for a respiratory tract infection and 11.1% for a wound/soft tissue infection. The overall prevalence of antibiotics was in the range of previous surveys from Germany (1.2-2.4%) and significantly lower than in the Europe-wide HALT survey overall (4.3-4.5%). Discussion: The survey showed low use of antibiotics in the LTCFs in comparison with Europe-wide surveys. The time required was less than 2 hours for a 100-bed facility. Until appropriate IT programs to determine the defined daily doses are also available for LTCFs, such easy-to-perform and standardized point-prevalence surveys - if repeated several times a year - can be a suitable method for recording the use of antibiotics in nursing homes for the elderly.

Analysis of use of different rFSHs during IVF/ICSI-assisted conception in elderly population and effect of double trigger on clinical outcomes.

OBJECTIVE: To compare the number of oocytes retrieved and clinical outcomes of ovulation induction in an older population treated with in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) (IVF/ICSI) using different rFSH options and the effectiveness of antagonist treatment to induce ovulation using gonadotropin-releasing hormone agonists (GnRH-a) in combination with an human chorionic gonadotropin (HCG) trigger. METHODS: A total of 132 fresh cycles were selected for this study, which were treated with IVF/ICSI in our hospital from March 2022 to December 2022. Observations were made according to different subgroups and the effects of different triggering methods on the number of oocytes obtained, embryo quality, and clinical outcomes. RESULTS: The initial gonadotropin (Gn) dose, the number of oocytes, and the number of MII oocytes were higher in group A than in group B (p < .05), and the clinical pregnancy rate was 29.41% in group A. Group B had a clinical pregnancy rate of 27.5%. The double-trigger group was superior to the HCG-trigger group in terms of the number of 2PN, the number of viable embryos, and the number of high-quality embryos (p < .05). The use of a double-trigger regimen (OR = 0.667, 95%CI (0.375, 1.706), p = .024) was a protective factor for the clinical pregnancy rate, whereas AFC (OR = 0.925, 95%CI (0.867, 0.986), p = .017) was an independent factor for the clinical pregnancy rate. CONCLUSIONS: The use of a dual-trigger regimen of GnRH-a in combination with HCG using an appropriate antagonist improves pregnancy outcomes in fresh embryo transfer cycles in older patients.

Concept analysis of "Insufficient health literacy" in older adults and refinement of a diagnosis proposal.

PURPOSE: This study aims to conduct a thorough analysis of the concept of insufficient health literacy (IHL) in older adults and to refine a nursing diagnosis proposal while considering the specific characteristics of this demographic. METHODS: A comprehensive concept analysis was undertaken using Walker & Avant's method as a framework. FINDINGS: A systematic search across seventeen databases yielded 29 relevant studies for inclusion. Through analysis, we identified 15 antecedents, 3 attributes, and 7 consequents associated with IHL in older adults. CONCLUSIONS: The concept analysis brought clarity to the understanding of IHL within older adults, facilitating the refinement of a diagnosis proposal. This process was instrumental in establishing a diagnostic structure that accounts for the unique needs and challenges faced by older adults. IMPLICATIONS FOR NURSING PRACTICE: The structured diagnosis derived from the concept analysis provides a solid theoretical foundation for nurses specializing in Gerontology. By tailoring care interventions to address the specific requirements of older adults, this framework enhances the quality of nursing practice and contributes to improved patient outcomes in geriatric care settings.

OBJETIVO: Este estudo tem como objetivo realizar uma análise detalhada do conceito de Letramento em saúde insuficiente na população idosa e refinar uma proposta de diagnóstico de enfermagem, levando em consideração as características específicas desse público. MÉTODOS: Foi realizada uma análise conceitual abrangente utilizando o método de Walker & Avant. RESULTADOS: Uma busca sistemática em dezessete bases de dados resultou em 29 estudos relevantes para inclusão. Através da análise, identificamos quinze antecedentes, três atributos e sete consequentes associados ao Letramento em saúde insuficiente na população idosa. CONCLUSÕES: A análise conceitual trouxe clareza à compreensão do Letramento em saúde insuficiente na população idosa, facilitando o refinamento de uma proposta de diagnóstico. Esse processo foi fundamental para estabelecer uma estrutura diagnóstica que considera as necessidades e desafios únicos enfrentados pelos idosos. IMPLICAÇÕES PARA A PRÁTICA DE ENFERMAGEM: O diagnóstico estruturado derivado da análise conceitual fornece uma base teórica sólida para enfermeiros especializados em Gerontologia. Ao adaptar intervenções de cuidados para atender aos requisitos específicos dos idosos, esse framework melhora a qualidade da prática de enfermagem e contribui para resultados de pacientes aprimorados em ambientes de cuidados geriátricos.

Aging Population Challenges and the Role of Thai Adolescents in Caring for the Elderly: A Cross-Sectional Study.

This cross-sectional study aimed to investigate the perspective and caregiving practices of Thai adolescents towards the elderly in the Northeastern region of Thailand. The study was carried out during July 1st to September 30th, 2023 among 1,551 participants in grades 4-6 from eight randomly selected schools. The analyzing using descriptive statistics. The results found that the average age was 15.30±1.66 years old, 62.4% were female, and most lived with their parents and relatives. About 36.4% of parents have experienced either widowhood or separation, 69.4% of families had a monthly income less than 15,000 THB. While 33.7% had an elderly person in the family, 1.6% lived with bedridden patients, and 40.3% required assistance in daily activities such as cooking, mobility, while 58.7% had diabetes and high blood pressure. 59.3% did not have a primary caregiver in the family, only parents or relatives usually taking on this role. Adolescent grandchildren spent the majority of their time on education. Almost one of three rarely took care of the elderly, even though their parents and teachers taught about moral responsibility. Regarding the belief in the merit that would arise from taking care of the elderly, one of five was indifferent or did not believe, while half of them believed to some extent. From self-assessment of their ability to take care of the elderly, most were in the moderate and low levels, despite receiving information from family, teachers, or various media. The predominant perspective is that caregiving is perceived as the responsibility of parents or health professionals, and the belief that the elderly is captious and irksome. Therefore, it is advisable to present policy-oriented information across education, health, and societal dimensions to support children and young people to learn about elderly individuals and instilling their responsibility within families and societies, fostering a sustainable and well-being-oriented community.