Background: Time commitments, limited access, or unwillingness to join a group are some of the many reasons for low adherence to structured exercise in older adults. A promising alternative approach is integrating exercise into daily routines. Objective: This study tested whether an adapted Lifestyle-integrated Functional Exercise (aLiFE) programme is suitable for adults aged 60–70 years. Methods: The aLiFE approach was evaluated by interviews and focus-groups with participants and trainers following 4-week pre-post intervention pilot study. For data analyses, Framework Approach was used. Coding was managed using NVivo, and subsequently organised into overarching themes. Results: Twenty women and 11 men (mean age 66.4 ± 2.7 years) and 6 trainers (30.0 ± 6.2 years; 5 women) participated. Both participants and trainers were positive about the programme. Participants understood the concept of integrating balance, strength and physical activities into daily lives and valued the individual tailoring in the programme, the preventive approach, and the support of trainers. Trainers valued the flexible approach and peer support between trainers. However, both participants and trainers disliked the extensive study paperwork and reported some challenges to integrate activities into daily routines during the compressed intervention: busy and varied lifestyles, embarrassment performing activities in public, pain, difficulty of specific activities. Participants noted habitualisation of some activities within the short intervention period, even without continuous self-monitoring. Conclusions: aLiFE is a highly acceptable intervention amongst adults aged 60–70 years. Trainers are especially relevant as motivators and support providers. The effectiveness of the aLiFE approach should be tested in a randomised controlled trial.
Posted: June 19, 2019, 8:04 am
General practitioners (GPs) play a key role in the timely diagnosis of dementia and also in advance care planning (ACP). They often have known patients and their families for decades and are familiar with their values and treatment preferences; they are, therefore, in a position to initiate the ACP process even before the appearance of the first symptoms of dementia and certainly following disclosure of the diagnosis. To do so, they should recognise whether patients are receptive to an ACP consultation or whether they might reject it for personal, social or cultural reasons. Under no circumstances should the patient or their family be coerced into making these provisions. In most countries, the current framework does not provide enough time and money for GPs to carry out actual ACP consultations completely on their own. There is evidence that specially trained health professionals are able to more effectively discuss treatment goals and limits of life-prolonging measures than GPs who are well acquainted with their patients. Consequently, we suggest that it will be the GPs’ task to seize the right moment for starting an ACP process, to raise awareness of patients and their relatives about ACP, to test the patient’s decision-making capacity and, finally, to involve appropriately trained healthcare professionals in the actual ACP consultation process. Care should be taken that these professionals delivering time-intensive ACP consultations are not only able to reflect on the patient’s values but are also familiar with the course of the disease, the expected complications and the decisions that can be anticipated. The GP will ensure an active exchange with the ACP professional and should have access to the documentation drawn up in the ACP consultation process (treatment plan and advance directive including instructions for medical emergencies) as soon as possible. GPs as coordinators of healthcare provision should document appropriately all specialists involved in the care and ensure that treatment decisions are implemented in accordance with the patient’s preferences for future care or the presumed will of the patient.
Posted: June 18, 2019, 12:29 pm
Anxiety disorders are common, yet clinically underrecognized in late life, with estimated prevalence rates ranging from 1.2 to 15%. They are highly comorbid with depression, sleep disorders, and substance use disorders, may accelerate cognitive decline, and potentially catalyze morbidity and mortality risk in the elderly. Thus, a more detailed knowledge about the underlying mechanisms of late-life anxiety disorders is urgently warranted. Age-related genetic, neuroimaging, neuroendocrine, and neuropsychological markers as well as late-life specific psychosocial aspects, particularly loss and isolation, have been identified as prominent pathogenetically relevant and thus potentially targetable factors. Personalized treatments based on individual biological and biographic markers, innovative therapeutic approaches, and preventive strategies have great potential to alleviate the high individual and societal burden of late-life anxiety disorders.
Posted: June 18, 2019, 12:28 pm
In response to a variety of cancer-inducing stresses, cells may engage a stable cell cycle arrest mechanism, termed cellular senescence, to suppress the proliferation of preneoplastic cells. Despite this cell intrinsic tumor suppression, senescent cells have also been implicated as active contributors to tumorigenesis by extrinsically promoting many hallmarks of cancer, including evasion of the immune system. Here, we discuss these dual, and seemingly contradictory, roles of senescence during tumorigenesis. Furthermore, we highlight findings of how senescent cells can influence the immune system and discuss the possibility that immune cells themselves may be acquiring senescence-associated alterations. Lastly, we discuss how senescent cell avoidance or clearance may impact pathology.
Posted: June 18, 2019, 9:57 am
Age-related hearing loss is a progressive, bilateral, and symmetrical sensorineural hearing loss due to degeneration of inner ear structures and it is considered a multifactorial complex disorder. Changes in tissue performance act from the cellular level to the molecular level. Histological visible damage in different structures of the inner ear signifies that the high frequency region is more sensitive and earlier affected. For many years it has been known that, with advancing age, there is an increasing loss of outer and inner hair cells and peripheral and central neurons. Furthermore, it comes to an atrophy of the stria vascularis. In recent years, investigations of the inner ear have shown that a loss of cochlear nerve synapses also plays an important role in age-related hearing loss. Degeneration of cochlear nerve synapses at the inner hair cell leads to a worsening of complex auditory tasks, such as understanding speech in difficult listening environments with minimal effects on pure-tone thresholds. This phenomenon has been called “hidden hearing loss.” Recent research has shown that senescence of the immune system plays an important role in age-related degeneration of the inner ear, termed inflammaging. A mild form of chronic systemic inflammatory response is thought to activate cochlear macrophages.
Posted: May 22, 2019, 1:30 pm
Connected and automated vehicles (CAV) are expected to improve the mobility of older people by compensating for the effects of a decreasing age-related fitness to drive. However, the technology is still under development and it is unclear how automated transport services will be implemented and which effects will be achievable. This paper aims to assess the potential of connected and automated transport to improve the mobility of older people. The discussion focuses on potentially disrupting highly automated services; in addition, general effects on the transport system and quality of life influenced by the increased mobility of older people are considered. Based on findings from mobility behavior research and studies exploring the mobility barriers of older people, the current mobility gaps are systematically analyzed on external barriers (availability of transport and related information) and 3 different internal barrier levels: access (physical limitations), ability (skills and know-how), and acceptance (experiences and symbolic meaning associated with a service). Subsequently, the potential of CAV to bridge these gaps is assessed. The results show that CAV can mitigate several of the barriers experienced by older people, especially barriers related to motor, sensory, and cognitive limitations. For other gaps, such as socioeconomic, usability, or acceptance issues, the potential benefits strongly depend on the way CAV are implemented and how the transformation takes place. Additionally, improvement of the mobility of older people by car can also have negative effects on their health and well-being, as physical activities like walking and social relations like receiving support from others may decline. In general, the introduction of CAV shows significant potential to improve the mobility of elderly travelers. However, the role automated services will take over in the future transport system can also bear some risks, especially if automated cars are used excessively. A comprehensive design of future transport systems is required to define the role of automated services in order to target the current supply gaps and improve the quality of life of transport-disadvantaged groups while avoiding unduly traffic growth.
Posted: May 22, 2019, 11:29 am
Background: The Lifestyle-integrated Functional Exercise (LiFE) program is an intervention integrating balance and strength activities into daily life, effective at reducing falls in at-risk people ≥70 years. There is potential for LiFE to be adapted to young seniors in order to prevent age-related functional decline. Objective: We aimed to (1) develop an intervention by adapting Lifestyle-integrated Functional Exercise (aLiFE) to be more challenging and suitable for preventing functional decline in young seniors in their 60s and (2) perform an initial feasibility evaluation of the program. Pre-post changes in balance, mobility, and physical activity (PA) were also explored. Methods: Based on a conceptual framework, a multidisciplinary expert group developed an initial aLiFE version, including activities for improving strength, neuromotor performances, and PA. Proof-of-concept was evaluated in a 4-week pre-post intervention study measuring (1) feasibility including adherence, frequency of practice, adverse events, acceptability (i.e., perceived helpfulness, adaptability, level of difficulty of single activities), and safety, and (2) changes in balance/mobility (Community Balance and Mobility Scale) and PA (1 week activity monitoring). The program was refined based on the study results. Results: To test the initial aLiFE version, 31 young seniors were enrolled and 30 completed the study (mean age 66.4 ± 2.7 years, 60% women). Of a maximum possible 16 activities, participants implemented on average 12.1 ± 1.8 activities during the intervention, corresponding to mean adherence of 76%. Implemented activities were practiced 3.6–6.1 days/week and 1.8–7.8 times/day, depending on the activity type. One noninjurious fall occurred during practice, although the participant continued the intervention. The majority found the activities helpful, adaptable to individual lifestyle, appropriately difficult, and safe. CMBS score increased with medium effect size (d = 0.72, p = 0.001). Increase in daily walking time (d = 0.36) and decrease in sedentary time (d = –0.10) were nonsignificant. Refinements included further increasing the task challenge of some strength activities and defining the most preferred activities in the trainer’s manual to facilitate uptake of the program. Conclusion: aLiFE has the potential to engage young seniors in regular lifestyle-integrated activities. Effectiveness needs to be evaluated in a randomized controlled trial.
Posted: May 21, 2019, 2:15 pm
Background: With the acceleration of aging process in human society, improvements of the physical functionality and life quality in the elderly population are more meaningful than pure longevity. Buckwheat trypsin inhibitor is a low molecular weight polypeptide extracted from buckwheat, which is a beneficial food for improving the health in the elderly. Objectives: The aim of the current study was to evaluate the potential beneficial effects of recombinant buckwheat trypsin inhibitor (rBTI) on age-dependent function decline and the primary mechanism. Method: Day 10 N2 Caenorhabditis elegans and day 6 AM140 C. elegans cultured at 25°C were used as models of aging and age-related disease, respectively. Motor function was as an indicator of age-dependent function. ATP content and damage mitochondrial DNA mass were detected to assess mitochondrial damage and function by ATP Assay Kit and agarose gel electrophoresis, respectively. Soluble protein content was quantified by SDS polyacrylamide gel electrophoresis. Autophagy-related genes transcription levels, autophagy marker proteins lgg-1, and lysosomal content were analyzed to quantify autophagy levels by qRT-PCR, transgenic C. elegans, and lysosomal staining. Autophagy inhibitor chloroquine, daf-16 mutant, and RNA Interference were used to determine the roles of autophagy and DAF-16 in rBTI-mediated effects. Results: In this study, we found that rBTI could decrease the proportions of insoluble protein and impaired mitochondria, finally reduce motility deficits in both models. Further study indicated that rBTI activated the autophagy, and the inhibition of autophagy reduced rBTI-mediated beneficial effects. Genetic analyses showed the transcriptional activity of DAF-16 was increased by rBTI and was required for rBTI-mediated beneficial effects. Conclusions: These data indicated that rBTI might promote the autophagy to alleviate the age-related functional decline via DAF-16 in C. elegans and suggested a potential role of rBTI as a nutraceutical for the improvement of age-related complications.
Posted: May 21, 2019, 1:02 pm
Objectives: We investigated the clinical, electrocardiographic, and echocardiographic determinants of the cardiac status in nonagenarian patients. Methods: We consecutively examined 654 Caucasian patients (232 males and 422 females) aged ≥90 years. All patients underwent clinical examination, ECG, and transthoracic echocardiography. Results: Their average age was 92.5 ± 2.5 years. Patients were predominately female of older age (p #x3c; 0.0001 and p = 0.02, respectively). A history of cardiovascular disease was present in 78.4% of the participants. One third of the patients was hospitalized for cardiovascular causes, with females being twice as many (p #x3c; 0.0001). Females showed higher levels of serum cholesterol, triglycerides, and glycemia (p #x3c; 0.0001, p#x3c; 0.0001, and p = 0.04 respectively). Sinus rhythm was detected in 65%, and atrial fibrillation in 31% of the overall population. Heart rate, PR and corrected QT (QTc) intervals, right bundle branch block (RBBB) and RBBB associated with left anterior fascicular block (LAFB) were higher in males (p #x3c; 0.0001, p = 0.036, p = 0.009, p = 0.001, and p = 0.004, respectively). Aortic root dimension, left ventricular (LV) mass index, and indexed LV systolic-diastolic volumes were higher in males (p #x3c; 0.001, p #x3c; 0.0001, p #x3c; 0.001, and p #x3c; 0.0001, respectively). Women showed fewer LV segmental kinetic disorders (p = 0009) and higher LV ejection fraction (LVEF; p#x3c; 0.0001). Hyperuricemia was positively associated with a history of cardiovascular disease (r = 0.15), glycemia (r = 19), creatininemia (r = 0.50), uremia (r = 0.51), triglycerides (r = 0.19), PR interval (r = 0.14), and left bundle branch block (r = 0.11), and inversely associated with sinus rhythm (r = –0.14) and LVEF (r = –0.17). Diabetes was positively correlated with PR and QTc intervals (r = 0.14 and r = 0.10, respectively), and RBBB with LFAB (r = 0.10), and inversely correlated with LVEF (r = –0.10). Conclusions: We found a remarkable presence of cardiovascular risk factors, ECG, and structural alterations in hospitalized nonagenarians, which presents more commonly in males.
Posted: May 21, 2019, 9:05 am
There is great interest among gerontologists, demographers, and actuaries in the question concerning the limits to human longevity. Attempts at getting answers to this important question have stimulated many studies on late-life mortality trajectories, often with opposing conclusions. One group of researchers believes that mortality stops growing with age at extreme old ages, and that hence there is no fixed limit to the human life span. Other studies found that mortality continues to grow with age up to extreme old ages. Our study suggests a possible solution to this controversy. We found that mortality deceleration is best observed when older, less accurate life span data are analyzed, while in the case of more recent and reliable data there is a persistent mortality growth with age. We compared the performance (goodness of fit) of two competing mortality models – the Gompertz model and the Kannisto (“mortality deceleration”) model – at ages of 80–105 years using data for 1880–1899 single-year birth cohorts of US men and women. The mortality modeling approach suggests a transition from mortality deceleration to the Gompertzian mortality pattern over time for both men and women. These results are consistent with the hypothesis about disappearing mortality deceleration over time due to improvement in the accuracy of age reporting. In the case of more recent data, mortality continues to grow with age even at very old ages. This observation may lead to more conservative estimates of future human longevity records.
Posted: May 20, 2019, 2:23 pm
Table of Contents for Quality in Ageing and Older Adults. List of articles from both the latest and ahead of print issues.
Quality in Ageing and Older Adults, Ahead of Print. <br/> Purpose As part of a pilot studyassessing the feasibility of record-linking health and social care data, the purpose of this paper is to examine patterns of non-delivery of home care among older clients (>65 years) of a social home care provider in Glasgow, Scotland. The paper also assesses whether non-delivery is associated with subsequent emergency hospital admission. Design/methodology/approach After obtaining appropriate permissions, the electronic records of all home care clients were linked to a hospital inpatient database and anonymised. Data on home care plans were collated for 4,815 older non-hospitalised clients, and non-delivered visits were examined. Using case-control methodology, those who had an emergency hospital admission in the next calendar month were identified (n=586), along with age and sex-matched controls, to determine whether non-delivery was a risk factor for hospital admission. Findings There were 4,170 instances of “No Access” non-delivery among 1,411 people, and 960 instances of “Service Refusal” non-delivery among 427 people. The median number of undelivered visits was two among the one-third of clients who did not receive all their planned care. There were independent associations between being male and living alone, and non-delivery, while increasing age was associated with a decreased likelihood of non-delivery. Having any undelivered home care was associated with an increased risk of emergency hospital admission, but this could be due to uncontrolled confounding. Research limitations/implications This study demonstrates untapped potential for innovative research into the quality of social care and effects on health outcomes. Originality/value Non-delivery of planned home care, for whatever reason, is associated with emergency hospital admission; this could be a useful indicator of vulnerable clients needing increased surveillance.
Posted: June 7, 2019, 9:53 am
Quality in Ageing and Older Adults, Ahead of Print. <br/> Purpose The purpose of this paper is to examine, through a qualitative lens, how community elder abuse and the ageing process are represented in the older adults’ narratives reporting abuse perpetrated by family members. Design/methodology/approach A qualitative study of a convenience sample of 22 interviews from 24 older adults (two couples) aged 60 years or older who had experienced one or more types of abuse and had sought help about the victimisation experience. A general inductive approach of thematic content analysis was employed. Findings The four main emergent themes related to the passage of time or the perception of becoming old within the process of abuse were: abuse grown old, abuse after entering later life, vulnerability to abuse and responses to abuse. Ageing was found to be associated with an increase vulnerability to abuse and an important element in shaping how older adults experience, report and cope with victimization. The social and contextual issues of being older also influenced the decision of ending (or not) the abuse and the victims’ repertoire of responses. Originality/value Despite the little suitability of chronological age to define and delimit elder abuse, understanding the phenomenon demands the recognition of ageing (both as a process and as a product) in order to more accurately identify aetiology processes and develop interventions.
Posted: June 7, 2019, 9:48 am
Quality in Ageing and Older Adults, Ahead of Print. <br/> Purpose Establishing acceptability of complex interventions to stakeholders is vital in early scientific development. The purpose of this paper is to ascertain the acceptability of a program of equine-assisted activities (EAAP) for people with dementia by elucidating programmatic practices needed to enhance their safety and quality of life (QoL) from the perspectives of service providers. Design/methodology/approach Semi-structured interviews with five providers were analyzed using a basic qualitative approach. Findings Providers perceived the EAAP as acceptable and revealed potential mechanisms of change supporting well-being, including aspects related to the physical and social environment and person with dementia. Linkages identified among the EAAP and its physical and social context support its complexity. Providers explicated program practices that promoted safety and QoL, such as implementing staff trainings and tailoring activities to each person’s preferences and needs. These practices aligned with best dementia care approaches, underscoring that the EAAP is a promising complex intervention that merits further scientific development. Originality/value This work is novel and adds to the literature by illuminating the role of a community-based, animal-assisted program for enhancing the QoL of older adults with dementia residing in institutional care facilities.
Posted: May 14, 2019, 12:16 pm
Quality in Ageing and Older Adults, Volume 20, Issue 1, Page 34-35, April 2019. <br/>
Posted: April 5, 2019, 12:10 pm
Quality in Ageing and Older Adults, Volume 20, Issue 1, Page 1-1, April 2019. <br/>
Posted: April 5, 2019, 12:10 pm