Stress hormones,sleep deprivation and cognition in older adults

Cognition can be deteriorated in older persons because of several potential mechanisms including the hormonal changes occurring with age. Stress events cause modification in hormonal balance with acute and chronic changes such as increase in cortisol and thyroid hormones, and simultaneous alterations in dehydroepiandrosterone sulphate, testosterone and insulin like growth factor-1 levels. The ability to cope with stress and regain previous healthy status, also called resiliency, is particularly impaired in older persons Thus, stressful conditions and hormonal dysregulation might concur to the onset of cognitive impairment in this population.     

The asthma knowledge and perceptions of older Australian adults: Implications for social marketing campaigns

Objective

The purpose of this research is to gain an understanding of the asthma perceptions of older adults and identify gaps in their asthma knowledge.

Methods

In regional New South Wales, Australia, a stratified, random sample of 4066 adults, aged 55 years and over, both with and without an asthma diagnosis, completed a survey based on the Health Belief Model about asthma knowledge and perceptions.

Results

Almost half of the sample had experienced symptoms of breathlessness in the past four weeks. Breathlessness was a predictor of lower health ratings and poorer mood. Older adults reported low susceptibility to developing asthma. The sample demonstrated poor knowledge of key asthma symptoms including shortness of breath, tightness in the chest and a cough at night.

Conclusion

There is a general lack of asthma awareness in this age group. This could result in not seeking medical help, and thus a reduced quality of life.

Practical Implications

Older adults should be made aware of key symptoms and the prevalence of asthma in the older adult population, and be empowered to take control of their respiratory health. Audience segmentation for an intervention should be based on recent experience of breathlessness and asthma diagnosis.     

The association of health literacy with illness and medication beliefs among older adults with asthma

Objective

Suboptimal health literacy (HL) and asthma beliefs are associated with poor asthma self-management and outcomes. We tested the hypothesis that low HL is associated with inaccurate beliefs.

Methods

Asthmatics ≥60 were recruited from hospital and community practices in New York, NY and Chicago, IL (n = 420). HL was measured with the Short Test of Functional Health Literacy in Adults; validated instruments derived from the self regulation model were used to assess beliefs. The association of beliefs with HL was evaluated with multivariate models.

Results

Thirty-six percent of patients had low HL; 54% believed they only have asthma when symptoms are present, 29% believed they will not always have asthma and 20% believed that their doctor can cure asthma. HL was associated with beliefs of not having asthma all the time and that asthma can be cured (OR: 1.84, 95% CI: 1.2–2.82; OR: 2.22, 95% CI: 1.29–3.82, respectively). Patients with low HL were also more likely to be concerned about medication use (β = 0.92, p = .05), despite recognizing their necessity (β = −1.36, p = .01).

Conclusions

Older asthmatics with low HL endorse erroneous asthma beliefs.

Practice implications

Health communications for improving self-management behaviors in asthma should employ both health literacy-appropriate strategies and messages to counter illness-related misconceptions.     

Self-reported sleep quality and dysfunctional sleep-related beliefs in young and older adults: changes in times of COVID-19 lockdown

ObjectiveThis study examined changes due to COVID-19 lockdown in young and older adults’ self-reported sleep quality and dysfunctional sleep-related beliefs.MethodsAdults involved in studies prior to the pandemic were contacted during the COVID-19 lockdown. Seventeen young adults (age range: 18–35 years) and 21 older adults (age range: 65–90 years) agreed to participate. Participants were interviewed by phone (between 27th April and 4^th May, 2020) to complete the Pittsburgh Sleep Quality Index (PSQI) and the Dysfunctional Beliefs About Sleep (DBAS) questionnaire they had been administered before the pandemic.ResultsIn terms of mean changes, the results showed null effect sizes for changes in self-reported sleep quality for both age groups. In young adults, a medium effect size emerged for changes in sleep latency, which increased during lockdown. No changes in any of the self-reported sleep quality dimensions emerged in older adults. In both age groups, the effect sizes for changes in dysfunctional sleep-related beliefs were negligible. In older adults, however, changes in self-reported sleep quality were largely associated with changes in dysfunctional sleep-related beliefs.ConclusionsOur results suggest that self-reported sleep quality and dysfunctional sleep-related beliefs were not affected by the COVID-19 lockdown in young or older adults. They also suggest that it might be useful to consider changes in dysfunctional sleep-related beliefs to better capture the impact of stressful events (such as a period of quarantine) on sleep quality, especially where older adults are concerned.     

A systematic review of the impacts of intergenerational engagement on older adults’ cognitive,social, and health outcomes

BackgroundIntergenerational engagement could benefit health and wellbeing within an ageing population. This systematic review evaluated the impacts of intergenerational engagement on cognitive, social, and health outcomes in healthy older adults and older adults with mild cognitive impairment.Research design and methodsComprehensive literature searches were undertaken, with records filtered according to pre-registered criteria. Study quality was formally assessed, and a narrative synthesis of the findings produced.ResultsForty-four studies were reviewed. Regarding quantitative evidence, 4 out of 8 studies found significant intergenerational engagement effects on cognitive outcomes, 15 of 24 on social outcomes, and 21 of 31 on health-related outcomes. Qualitative evidence was also important for understanding perceived impacts and experiences of intergenerational programmes. Only 11 studies fully met criteria for high quality research, of which the majority focused on social outcomes.Discussion and implicationsThere are a range of potential benefits of intergenerational engagement, most notably regarding anxiety, generativity, cross-age attitudes, and physical activity. However, heterogeneity in programme context, sample design, dosage, and duration indicate that more research is required to enable wider implementation and generalisability. Scientific rigour in both quantitative and qualitative research should also be employed as far as possible, to provide the highest quality evidence.     

Manual reduction with traditional small splints for distal radius fracture in older patients

Objective: To investigate the effect of manual reduction with traditional small splints fixation for distal radius fractures in older patients in the emergency department.Methods: Older patients (aged at least 60 years) with distal radius fractures were enrolled in this study. The patients were randomly divided into the treatment group and the control group. The treatment group was treated with manual reduction and small splints fixation. The control group was treated with manual reduction and resin plaster fixation. Before treatment, after reduction, and 3 months after treatment, the palmar tilt angle, ulnar deviation angle, and radial length were recorded. Before treatment and 3 months after treatment, the Cooney wrist joint scores were recorded. The time of fracture healing and related adverse events during the treatment were recorded. Results: Before treatment and after reduction, there were no statistically significant differences between the two groups in palmar tilt angle, ulnar deviation angle, or radial length (P>0.05). Three months after treatment, the palmar tilt angle, ulnar deviation angle, and radial length of the treatment group were better than those of the control group (P<0.05). The Cooney wrist scores of the treatment group was significantly higher than that of the control group three months after the treatment (P<0.05). The time of fracture healing of the treatment group was shorter than that of the control group, but the difference was no statistically significant (P>0.05). Conclusions: Compared with resin plaster fixation, traditional small splints fixation for distal radius fractures in older patients have the advantages of less loss of fracture reduction and faster functional recovery. Besides, the method is simple and low cost thus, it needs to be promoted.     

面动脉-颏下动脉岛状瓣修复65例腭癌术后BrownⅡ类缺损的疗效评价

目的：比较使用面动脉-颏下动脉岛状瓣（facial-submental artery island flap,FSAIF）同期修复年轻或老年腭癌患者肿瘤术后BrownⅡ类缺损的疗效。方法：65例腭部鳞状细胞癌患者,肿瘤术后缺损采用FSAIF修复。患者按年龄分为2组—年轻组（≤60岁）35例,老年组（> 60岁）30例。2组患者心脑血管等其他疾病的比例分别为37.1%（13/35）和156.7%（47/30）。临床分期包括Ⅰ、Ⅱ和Ⅲ期,年轻组分别为8.6%、85.7%和5.7%,老年组分别为6.7%、86.7%和6.7%。采用SPSS 20.0软件包对数据进行χ²检验、独立样本t检验和Mann-Whitney U检验,分析组间数据差异。结果：65例Brown Ⅱ类上颌骨缺损中,Ⅱa类4例,Ⅱb 49例,Ⅱc 5例和Ⅱd 7例。皮瓣成活率为96.9%（63/65）。老年组伴发疾病的几率显著高于年轻组（P<0.05）。2组间在性别、TNM分期、上颌骨缺损类型、皮瓣大小、皮瓣总存活率、局部或全身并发症发生率、生存状态方面无显著差异（P>0.05）。结论：面动脉-颏下动脉岛状瓣修复老年腭癌患者肿瘤术后BrownⅡ类缺损,是一种安全可靠的方法。     

Factors associated with stress of conscience in caring for older people with delirium in a hospital setting: An exploratory cross-sectional study

BackgroundNurses caring for older people with delirium encounter moral challenges in hospitals which could trouble their conscience, if they perceive limitations that prevent them from fulfilling their duties. Little is known about the stress associated with troubled conscience, that is stress of conscience, beyond nursing homes.AimTo explore factors associated with stress of conscience among nurses caring for older people with delirium in a hospital setting.MethodAn exploratory cross-sectional study was conducted. A total of 223 nurses completed the questionnaire at a tertiary hospital in Australia.FindingsThe stress of conscience mean sample score, comparable to previous studies, was 63.6. Younger age, more years of nursing experience, lower levels of perceived person centeredness were associated with higher stress of conscience (p < 0.001). The regression model explained 24% of the total variation in Stress of Conscience (R² = 0.24: F = 13.874: p < 0.001).DiscussionThe levels of stress of conscience (mean score of 63.6) in this study were comparable to studies of nurses caring for older people with cognitive impairment in nursing homes. Younger age and longer working experience correlated with higher levels of stress of conscience, consistent with previous research. The novel contribution was that higher perceived levels of person centeredness could mitigate nurses stress of conscience.ConclusionHigher levels of person-centredness which positively correlated with less stress of conscience in the hospital setting, provide a foundation to explore barriers and facilitators to support quality care and staff health. Further studies would be valuable as the regression model accounted for 24% of the total variance in stress of conscience.     

中国儿童与老年健康证据转化平台的构建与应用

目的介绍并推广中国儿童与老年健康证据转化平台(Chinese Clearinghouse for Evidence Translation in Child & Aging Health,CCET)。方法分别成立儿童、老年健康顾问委员会,利用科学的评价量表评价筛选国内外相关的儿童、老年健康促进项目并由研究团队翻译转化。与兰州博阳软件工程有限公司合作,根据网站需呈现的内容与目标功能,共同规划设计网站框架与界面,初步建立站点。将转化的健康证据及其他信息资源（疾病基本情况、项目评价量表、研究报告标准等）上传使之在网站相应栏目中呈现,建立CCET网站,并通过微信和微博媒介定期传播儿童及老年健康最新进展、循证研究最新方法。结果CCET主要由儿童健康、老年健康、评价量表、报告标准、推广应用和老年抑郁症循证防治数据库6个版块组成。CCET儿童与老年健康促进项目由国内外专家采用科学的评价量表筛选和评价,转化的证据科学性强,目前已有相关研究机构和社区有意向参与CCET研究和应用转化项目。结论CCET致力于循证方法培训,建立国内健康干预项目的科学性和适用性评价系统,对国外证据转换后的后续干预项目培训,提升服务机构能力,以及综合干预课程研发。CCET信息全面、界面简单、用户友好,为促进我国儿童与老年健康提供证据支持。     

The Australian/Canadian Osteoarthritis Hand Index in a community‐dwelling population of older adults: Reliability and validity

Objective

To assess the acceptability and measurement properties of the Australian/Canadian Osteoarthritis Hand Index (AUSCAN) applied to a community‐dwelling population of older adults with hand problems.

Methods

Data were obtained from 2 related sources: 2,113 responders to a 2‐stage cross‐sectional postal survey who reported hand problems in the previous 12‐months, and 55 participants with hand problems completing a clinical assessment. The AUSCAN subscales were assessed for data quality and scaling properties. Test–retest reliability was assessed in clinical participants reporting no change in their hand condition at 1 month. Construct and criterion validity were evaluated using other data from the survey and clinical assessment. Internal consistency of the subscales was tested using Cronbach's alpha and item‐total correlations.

Results

AUSCAN subscales had high completion rates in the survey (missing data: 2.3–2.7%). Subscale scores covered the possible range but were skewed towards lower pain, stiffness, and functional problems. Test–retest reliability estimates supported the use of the pain and stiffness subscales (ρ > 0.7), with the estimate for stiffness being slightly lower (ρ = 0.64). The subscales demonstrated both construct validity (significantly higher subscale scores in participants reporting a recent general practitioner consultation for their hand problems and high correlations with hand function performance measures) and criterion validity (high correlations with generic health measures and disease‐specific measures).

Conclusion

The AUSCAN is a valid and reliable measure of hand problems in a community‐dwelling population of older adults. The AUSCAN performs well both in terms of its internal reliability and its relationship with external constructs.