Mandated face mask use for health care providers, secondary to COVID-19, creates an additional communication barrier for older adults with cognitive, communication, and/or hearing challenges. Face masks can soften a speaker's voice, conceal vocal tone, and hide facial expressions that relay essential non-verbal information. An inability to understand health care information or words of support can lead to frustration, anxiety, and decreased quality of life. Therefore, the purpose of this article...
CONCLUSION: The need for identification and treatment of those with mental health issues, especially among the elderly population, and collaborative multidiscipline management teams is increasing during the current global pandemic. Specific interview strategies are needed when engaging with elderly suicidal patients. Suicide prevention in elderly patients is worthy of strong public attention.
CONCLUSIONS: This study highlights the communication and implementation of recommendations in the Ontario LTC sector, despite some concerns regarding feasibility. Importantly, LTC clinician respondents clearly indicated that better engagement with LTC leaders is needed to plan a coordinated pandemic response.
The COVID-19 pandemic placed hygiene at the centre of disease prevention. Yet, access to the levels of water supply that support good hand hygiene and institutional cleaning, our understanding of hygiene behaviours, and access to soap are deficient in low-, middle- and high-income countries. This paper reviews the role of water, sanitation and hygiene (WaSH) in disease emergence, previous outbreaks, combatting COVID-19 and in preparing for future pandemics. We consider settings where these...
OBJECTIVES: The primary objective is to demonstrate that COVID-19 convalescent plasma (CCP) prevents progression to severe pneumonia in elderly COVID-19 pneumonia patients with chronic comorbidities. Secondary objectives are to demonstrate that CCP decreases the viral load in nasopharyngeal swabs and increases the anti-SARS-CoV-2 antibody titre in recipients.
A 7-day consultant-geriatrician-led service across five surgical wards, with integrated working among surgeons and physicians, was implemented in response to the COVID-19 pandemic. Our model has shown to increase discharge rates and improve MDT wellbeing. Embedded physician working with surgeons could be key in the recovery to COVID-19.
Background Severe coronavirus disease (COVID-19) is characterized by a pro-inflammatory state with high mortality. Statins have anti-inflammatory effects and may attenuate the severity of COVID-19. Methods and Results An observational study of all consecutive adult patients with COVID-19 from March 1, 2020 to May 2, 2020 admitted to a single-center located in Bronx, New York. Patients were grouped as those that did and did not receive a statin and in-hospital mortality was compared by competing...
The coronavirus disease 2019 (COVID-19) pandemic has led to multiple service delivery changes across acute care sectors in the UK. Due to increased responsibility for care of COVID-19 patients, medical trainees across all specialties might experience difficulty in achieving certain competencies for their training curriculum due to changes in learning opportunities. While there might be a tendency to perceive these changes negatively in terms of the impact on training, we think this unprecedented...
OBJECTIVE: We aim to evaluate the immediate impacts of COVID-19 stay-at-home orders on the mental well-being of Bangladeshi adults. We recruited 1404 healthy adults following the Bangladesh government's lockdown announcement. A questionnaire comprising the Warwick Edinburgh Mental Well-being Scale was used to define mental health.
CONCLUSION: Here, we emphasized several points. First, telemedicine may be adequate for the initial screening, but further complaints would be better evaluated in person by either a medical or surgical subspecialist; here, both could have recognized the very clear unilateral foot drop. Second, the patient should have had a scheduled follow-up in-person consultation. Third, appropriate diagnostic studies should have been ordered at the time of the second telemedicine consultation to establish the...
Background: Swallowing disorders are a serious health concern among older adults. Previous studies reported that sarcopenia may affect swallowing disorders; however, whether sarcopenia is related to the capacity to swallow (measured according to swallowing speed) in community-dwelling older adults is unclear. Objectives: The aim of this study was to investigate the relationship between sarcopenia and swallowing capacity in community-dwelling older women. Methods: This cross-sectional observational study was conducted among community-dwelling older women in Japan. The inclusion criteria were as follows: women aged ≥65 years, with the ability to walk independently, and without dysphagia. The exclusion criterion was a history of stroke or Parkinson’s disease that directly caused dysphagia. The participants were divided into a sarcopenia and a healthy group based on the criteria of the Asian Working Group for Sarcopenia 2019. We measured swallowing speed (mL/s) as the swallowing capacity by conducting a 100-mL water-swallowing test. To assess the relationship between sarcopenia and swallowing capacity, we performed a multiple regression analysis. Results: Two-hundred and sixty participants were enrolled in the study. Their mean age was 82.3 ± 6.9 years, and 61 (23.5%) of them displayed sarcopenia. The mean swallowing speed was 11.5 ± 4.9 mL/s, and 17 women (6.5%) exhibited choking or a wet-hoarse voice. Multiple regression analysis revealed that sarcopenia was related to the swallowing capacity after adjusting for age, the Mini-Mental State Examination, and the number of comorbidities (β = –0.20, 95% CI –3.78 to –0.86, p = 0.002). Conclusions: We found that sarcopenia was related to the swallowing capacity in older women in this study. Future research should clarify whether a similar relationship exists in older men as well as the effect of sarcopenia on the swallowing capacity in older adults over a period of time.
Posted: October 19, 2020, 12:23 pm
Introduction: Age-related functional decline elevates the risk of car accidents. Whether specific cognitive impairments and physical frailty increase the risk of car accidents is still unclarified. Objective: This study examines the association between car accidents, frailty, and cognitive function, owing to an increase in car accidents related to older adults. Methods: Data were collected from 12,013 older adults (45.4% women, mean age: 71.7 years [min: 60, max: 96]) enrolled in the National Center for Geriatrics and Gerontology (NCGG) – Study of Geriatric Syndromes. A 2-year self-reported history of car accidents was assessed. The Japanese cardiovascular health study index was used as the criterion and included the following components of frailty: shrinking, weakness, exhaustion, low activity, and slowness. “Frailty” was assigned a value of 1 or more based on these components. Cognitive function was assessed using the NCGG Functional Assessment Tool, and cognitive impairment was assessed using a standardized value. Results: Of the participants, 1,117 (9.3%) had a car accident history. The proportions of the frailty components’ applicability were observed in the car accidents group compared to the non-car accidents group: shrinking (p = 0.006), exhaustion (p = 0.031), low activity (p = 0.034), and slowness (p = 0.030), but not weakness (p = 0.452). The proportion of cognitive impairment in executive function was also higher in the car accidents group (p = 0.011). A logistic regression analysis showed that both frailty (OR 1.26, 95% CI 1.11–1.43; p #x3c; 0.001) and cognitive impairment (OR 1.26, 95% CI 1.11–1.43, p #x3c; 0.001) are associated with car accidents. Discussion: This study’s findings contribute to enhancing the utility of risk assessments for older drivers. Further study is required to clarify the risk of car accidents.
Posted: October 19, 2020, 8:00 am
Introduction: Being elderly is a well-known risk factor for candidemia, but few data are available on the prognostic impact of candidemia in the very old (VO) subjects, as defined as people aged ≥75 years. Objective: The aim of this study was to assess risk factors for nosocomial candidemia in two groups of candidemia patients, consisting of VO patients (≥75 years) and adult and old (AO) patients (18–74 years). In addition, risk factors for death (30-day mortality) were analysed separately in the two groups. Methods: We included all consecutive candidemia episodes from January 2011 to December 2013 occurring in six referral hospitals in north-eastern Italy. Results: A total of 683 nosocomial candidemia episodes occurred. Of those, 293 (42.9%) episodes were in VO and 390 (57.1%) in AO patients. Hospitalization in medical wards, chronic renal failure, urinary catheter, and peripheral parenteral nutrition (PPN) were more common in VO than in AO patients. In the former patient group, adequate antifungal therapy (73.2%) and central venous catheter (CVC) removal (67.6%) occurred less frequently than in AO patients (82.5 and 80%, p #x3c; 0.002 and p #x3c; 0.004, respectively). Thirty-day mortality was higher in VO compared to AO patients (47.8 vs. 23.6%, p #x3c; 0.0001). In AO patients, independent risk factors for death were age (OR 1.04, 95% CI 1.00–1.09, p = 0.038), recent history of chemotherapy (OR 22.01, 95% CI 3.12–155.20, p = 0.002), and severity of sepsis (OR 40.68, 95% CI 7.42–223.10, p #x3c; 0.001); CVC removal was associated with higher probability of survival (OR 0.10, 95% CI 0.03–0.33, p #x3c; 0.001). In VO patients, independent risk factors for death were PPN (OR 3.5, 95% CI 1.17–10.47, p = 0.025) and hospitalization in medical wards (OR 2.58, 95% CI 1.02–6.53, p = 0.046), while CVC removal was associated with improved survival (OR 0.40, 95% CI 0.16–1.00, p = 0.050). Conclusion: Thirty-day mortality was high among VO patients and was associated with inadequate management of candidemia, especially in medical wards.
Posted: October 16, 2020, 8:15 am
Introduction: Previous studies have demonstrated the relationship between cognitive frailty and falls among older adults. Activity engagement (AE) is known to be related to falls in older adults but the subject has been limited to empirical study. This study aimed to explore the mediating role of AE between cognitive frailty and falls among older adults in rural Shandong, China. Methods: A total of 3,242 rural seniors (age ≥60 years; 63.6% women) were included in this cross-sectional study. Regression and bootstrap analyses were performed to explore the mediating role of AE between cognitive frailty and falls. Results: The prevalence of falls was 13.1% and the prevalence of cognitive frailty was 6.6% among the participants. AE mediated the association between cognitive frailty and falls (95% CI 0.077–0.223). However, the direct effect was no longer significant after being adjusted for AE (95% CI –0.037 to 0.684; p = 0.078). Conclusion: Cognitive frailty was found to be associated with falls among rural older adults, and AE mediated this association. More attention should be paid to promote AE among Chinese rural older adults with cognitive frailty.
Posted: October 12, 2020, 12:53 pm
Introduction: Falls are currently the top safety problem in long-term care facilities (LTCFs) in China. Due to the increasing number of residents living in LTCFs, more evidence is needed to give a foundation for fall prevention. Objective: This study aimed to explore the epidemiological characteristics of falls in LTCFs in central Shanghai. Methods: The study was conducted in 21 LTCFs in a central district in Shanghai, with a capacity of 3,065 residents. A two-stage sampling method was applied in participant recruitment. Falls were recorded by LTCF staff over a 12-month period. Details of falls were obtained by face-to-face interviews. The χ2 test was used in data analyses. Results: The incidence of falls was 13.5%; 64.0% falls resulted in injuries, with 32.0% involving fractures. Women had a significantly higher incidence of injurious falls than men (χ2 = 4.066, p = 0.044). Residents aged 80–89 years or in level 1 care had the highest incidence of falls with severe consequences. The incidence of falls was significantly higher at small- or medium-sized LTCFs, public LTCFs, and LTCFs with higher environmental risk levels compared to their counterparts. Most falls occurred when walking on a flat floor (28.9%) and rising up or sitting down (24.0%); 40.9% occurred during the night. Of those injured, 54.8% were treated in hospitals, and only 53.7% completely recovered. Conclusions: Though the average incidence of falls in LTCFs in Shanghai was relatively low, great variation was observed between LTCFs, and severe consequences occurred frequently. Fall prevention programmes should be evidence-based with applicable devices and individualized care services and supports. The roles of personal and institutional factors on falls warrant further study.
Posted: October 6, 2020, 9:10 am
Background: Functional and physiological adaptations induced by resistance training have been extensively studied in older adults. However, microRNA (miRNA) as the novel regulator in protective effects remains poorly understood. Objective: The purpose of an exploratory study was to analyze the response of a panel of circulating miRNAs to adaptations mediated by resistance training. Methods: Ten healthy older adults (age: 67.6 ± 2.2 years, 7 women and 3 men) without previous experience in resistance training were recruited. Blood samples were collected at baseline and after a 12-week resistance training. Next-generation sequencing was used to determine circulating miRNA responses to chronic resistance training. Results: After the 12-week training, physical functions including grip strength, lower body strength and endurance, and walking capacity were improved in the older adults, while the serum levels of leptin (from 18.1 ± 20.0 to 14.9 ± 17.6 ng/mL, p = 0.029) and tumor necrosis factor alpha (TNFα; from 4.4 ± 0.6 to 4.0 ± 0.6 pg/mL, p #x3c; 0.001) were significantly decreased. In addition, adipogenesis-related miRNAs (miR-103a-3p, -103b, -143-5p, -146b-3p, -146b-5p, -17-5p, -181a-2-3p, -181b-5p, -199a-5p, -204-3p, and -378c), anti-adipogenesis-related miRNAs (miR-155-3p, -448, and -363-3p), myogenesis-related miRNAs (miR-125b-1-3p, -128-3p, -133a-3p, 155-3p, -181a-2-3p, -181b-5p, -199a-5p, -223-3p, and -499a-5p), and inflammation-related miRNAs (miR-146b-3p, -146b-5p, -155-3p, -181a-2-3p, and -181b-5p) were changed significantly in the older adults after training (fold change #x3e;2, p #x3c; 0.05). The log2 fold change of miRNA-125-1-3p was inversely correlated with delta walking time (R = –0.685, p = 0.029) and change in insulin-like growth factor 1 (R = –0.644, p = 0.044). Conclusions: Our results can help explain the link between specific circulating miRNAs and beneficial effects of resistance training on functional and physiological adaptations in older adults.
Posted: October 6, 2020, 8:50 am
Introduction: Previous studies have shown an association between a high health numeracy and good cognitive functioning. Objective: To investigate the moderation effect of education on this relationship and which brain structures support health numeracy. Methods: We examined 70 healthy older persons (66% females; mean ± SD: age, 75.73 ± 4.52 years; education, 12.21 ± 2.94 years). The participants underwent a T1-weighted 3-T MRI and a neuropsychological assessment including a health numeracy task. Statistical parametric mapping was applied to identify focal changes in cortical thickness throughout the entire brain and to correlate image parameters with behavioral measures. Results: Executive functions and mental calculation emerged as predictors of health numeracy (B = 0.22, p #x3c; 0.05, and B = 0.38, p #x3c; 0.01). An interaction was found between education and executive functions (B = –0.16, p = 0.01) and between education and mental calculation (B = –0.11, p #x3c; 0.05). Executive functions and mental calculation had an impact on health numeracy in participants with a low to intermediate education (≤12 years) but not in those with a higher education (#x3e;12 years). Health numeracy scores were associated with cortical thickness in the right dorsomedial prefrontal cortex and the right superior temporal gyrus (p = 0.01). Conclusions: Older people with a higher education perform better in health numeracy tasks than those with a lower education. They have access to previously acquired knowledge about ratio concepts and do not need to rely on executive functions and computational skills. This is highly relevant when decisions about health care have to be made.
Posted: September 25, 2020, 8:20 am
The number of elderly is growing rapidly, including those that struggle with cognitive decline and, consequently, activities of daily living. Developing interventions that slow down cognitive decline would greatly benefit the autonomy of these elderly, as well as their caretakers. Virtual reality (VR) is an immersive and interactive human-computer interface with real-time simulation that is suggested to be a promising tool to improve cognitive functioning. This literature review discusses the features of immersive VR, including its opportunities and limitations, that are of special relevance for improving cognition in elderly. First, the high flexibility of VR allows for personalized and safe training of potentially harmful situations and isolated aspects of tasks. Second, VR’s dynamic and real-time feedback on performance provides a labor-extensive tool for caretakers in elderly care. Third, the acquisition of high resolution data enables the exposure of subtle changes over time, relevant for detecting the nature and extent of cognitive changes in elderly, including those with dementia. Fourth, immersive VR has been related to cybersickness. Finally, VR is immersive and enables the perception and expression of emotions, motor behaviors, and multiple senses. Aged subjects are found to have sparing of emotional learning and show increased reliance on multisensory integration for learning. Moreover, they experience high levels of flow, motivation, and presence in VR setups. Despite the clear potential of immersive VR, the studies available are small scale and have not been replicated. The digital illiteracy of elderly and healthcare personnel form an additional barrier for implementation. Hence, while replication of outcomes and standardization of VR interventions is required before it can be used in standard care, VR may provide a particularly effective tool for training cognition in elderly.
Posted: September 9, 2020, 6:49 am
Background: Approximately 2% of the human core promoter short tandem repeats (STRs) reach lengths of ≥6 repeats, which may in part be a result of adaptive evolutionary processes and natural selection. A single-exon transcript of the human nescient helix loop helix 2 (NHLH2) gene is flanked by the longest CA-repeat detected in a human protein-coding gene core promoter (Ensembl transcript ID: ENST00000369506.1). NHLH2 is involved in several biological and pathological pathways, such as motivated exercise, obesity, and diabetes. Methods: The allele and genotype distribution of the NHLH2 CA-repeat were investigated by sequencing in 655 Iranian subjects, consisting of late-onset neurocognitive disorder (NCD) as a clinical entity (n = 290) and matched controls (n = 365). The evolutionary trend of the CA-repeat was also studied across vertebrates. Results: The allele range was between 9 and 25 repeats in the NCD cases, and 12 and 24 repeats in the controls. At the frequency of 0.56, the 21-repeat allele was the predominant allele in the controls. While the 21-repeat was also the predominant allele in the NCD patients, we detected significant decline of the frequency (p #x3c; 0.0001) and homozygosity (p #x3c; 0.006) of this allele in this group. Furthermore, 12 genotypes were detected across 16 patients (5.5% of the entire NCD sample) and not in the controls (disease-only genotypes; p #x3c; 0.0003), consisting of at least one extreme allele. The extreme alleles were at 9, 12, 13, 18, and 19 repeats (extreme short end), and 23, 24, and 25 repeats (extreme long end), and their frequencies ranged between 0.001 and 0.04. The frequency of the 21-repeat allele significantly dropped to 0.09 in the disease-only genotype compartment (p #x3c; 0.0001). Evolutionarily, while the maximum length of the NHLH2 CA-repeat was 11 repeats in non-primates, this CA-repeat was ≥14 repeats in primates and reached maximum length in human. Conclusion: We propose a novel locus for late-onset NCD at the NHLH2 core promoter exceptionally long CA-STR and natural selection at this locus. Furthermore, there was indication of genotypes at this locus that unambiguously linked to late-onset NCD. This is the first instance of natural selection in favor of a predominantly abundant STR allele in human and its differential distribution in late-onset NCD.
Posted: September 2, 2020, 10:49 am
Background: Cognitive impairment represents a risk factor for falls in older adults. However, cognition is a complex construct comprising several functional domains. The relationship between specific cognitive domain and falls in cognitively healthy older adults is unclear. Objectives: This study aims to investigate the relationship between falls, attention, and executive function in older adults while considering the three components of attention (alerting, orienting, and executive control) and three components of executive function (updating, inhibition, and shifting). Methods: Cognitively healthy older adults were recruited (n = 60 for fallers and n = 100 for non-fallers). The participants were assessed on the Attention Network Test (alerting, orienting, and executive control), running memory test (updating), Stroop test (inhibition), and digit switching test (shifting). Confounder-adjusted logistic models were used to examine the associations between falls and specific cognitive functions in cognitively healthy older adults. Results: The results showed that falls were associated with alerting, executive control, and updating. These associations were not attenuated when adjusting for a series of covariates such as age, gender, education, balance, general health, and emotional status. Conclusions: The results suggest that among cognitively healthy older adults, falls are related to three specific cognitive functions: alerting, executive control, and updating. Disentangling the mechanism and contribution of cognitive deficits in fall risk may provide insights for the development of prevention and rehabilitation strategies for falls in older adults.
Posted: August 25, 2020, 8:00 am