Sleep disturbances and risk of falls in an old Chinese population-Rugao Longevity and Ageing Study

BackgroundTo explore the relationship between sleep disturbances and falls in an elderly Chinese population.MethodsData from 1726 individuals aged 70–87 years from the Rugao Longevity and Ageing Study were used. The Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep variables. Outcomes were falls ≥1 time per year and falls ≥2 times per year.ResultsA total of 22.7% of the participants experienced ≥1 fall, and 9.8% experienced ≥2 falls per year. Poor sleep quality was associated with ≥1 fall (OR 1.08, 95% CI 1.05–1.12; OR 1.27, 95% CI 1.14–1.41) and ≥2 falls (OR 1.08, 95% CI 1.03–1.14; OR 1.28, 95% CI 1.10–1.48), with an increase per PSQI score and SD PSQI score, respectively. In addition, sleep quality, sleep latency, sleep efficiency, and sleep disturbance subcomponents were associated with an increased risk of ≥1 fall with ORs of 1.44 (95% CI, 1.21–1.72), 1.23 (95%CI,1.09–1.40), 1.12 (95%CI, 1.01–1.23) and 1.70 (95% CI,1.35–2.14), respectively, and were associated with an increased risk of ≥2 falls with ORs 1.54 (95%CI, 1.22–1.96), 1.21(95%CI, 1.02–1.44), 1.17 (95% CI 1.02–1.33), and 1.78 (95%CI, 1.31–2.44), respectively. Further, participants slept ≤5 h per night had an increased risk of ≥1 fall (OR 2.34; 95%CI, 1.59–3.46) and ≥2 falls (OR 2.19; 95%CI, 1.30–3.69).ConclusionsPoor sleep quality and several subcomponent sleep symptoms were consistently associated with increased risk of falls ≥1 time and ≥2 times in Chinese elderly. The identification of sleep disturbances may help identify high-risk Chinese elders who may benefit from fall prevention education.     

The relationship between restless sleep and symptoms of the knee: data from the Osteoarthritis Initiative

Objective

To examine the associations between restless sleep and knee symptoms among individuals with radiographically confirmed KOA.

Methods

Cross-sectional and longitudinal associations were examined using Osteoarthritis Initiative (OAI) data. Participants with radiographic KOA (n = 2517) were asked how often sleep was restless in the past week over the 4 years, and the Western Ontario and McMaster Universities Arthritis Index (WOMAC) was used to measure knee symptoms. Adjusted β coefficients (aβ) and 95% confidence intervals (CI) were derived from generalized estimating equations (GEEs) models stratified by sex.

Results

One in 7 participants reported ≥ 3 nights with restless sleep. Cross-sectional analyses indicated that restless sleep 5–7 nights was associated with worse symptoms (Women: pain: aβ 1.93, 95% CI 1.12–2.74, stiffness: aβ 0.57, 95% CI 0.19–0.94, physical function: aβ 5.68, 95% CI 3.09-8.27; Men: pain: aβ = 1.85, 95% CI 0.85–2.86; stiffness: aβ 0.63, 95% CI 0.15–1.12; physical function: aβ 5.89, 95% CI 2.68–9.09) compared with < 1 night. Longitudinal analyses confirmed that more nights with restless sleep were associated with worse pain (P trend = 0.01) and function (P trend = 0.04) in women and physical function in men (P trend = 0.04), although estimates did not meet thresholds for minimal clinically meaningful differences.

Conclusion

While the analysis of cross-sectional data supported the association between restless sleep and KOA symptoms, such relationships were not confirmed in more robust longitudinal analysis. Further research examining whether sleep quality, duration, or disorders is associated with worsening symptoms in persons with KOA is warranted.

Effect of allergic rhinitis on sleep in children and the risk factors of an indoor environment

Purpose

Allergic rhinitis (AR) is an independent risk factor for sleep disorders in children, including abnormal sleep behaviors. We investigated the occurrence of abnormal sleep behaviors in children with AR to determine indoor environmental risk factors affecting sleep.

Methods

This case-control study collected the sleep status and characteristics of the indoor environment of children aged 3–14 years with and without AR using a questionnaire. The differences between the two groups were compared using the Mann–Whitney U test, chi-square test, and Fisher’s exact test. The indoor environmental factors affecting sleep behavior were analyzed using logistic regression analysis.

Results

Children with AR (n=427) had a higher probability of snoring (8.7 % vs. 2.9 %; P < 0.001), mouth breathing (14.1 % vs. 5.2 %; P < 0.001), restless sleep (6.6 % vs. 4.1 %; P = 0.047), sleep talking (3.3 % vs. 1.1 %; P = 0.003), and hyperhidrosis (16.4 % vs. 8.5 %; P < 0.001) than those without AR (n=1046). Emulsion wall paint (odds ratio (OR) = 2.779; 95 % confidence interval (CI), 1.332–5.796; P = 0.006) and tobacco exposure in early infancy (OR = 2.065; 95 % CI 1.079–3.950; P = 0.029) were associated with hyperhidrosis.

Conclusion

Children with AR are more likely to have abnormal sleep behaviors than those without, including snoring, mouth breathing, restless sleep, sleep talking, and hyperhidrosis. Emulsion paint wall and tobacco smoke exposure in early infancy had a twofold higher risk of hyperhidrosis during sleep.

     

Sexual Function and Aging in Racially and Ethnically Diverse Women

OBJECTIVES: To examine factors influencing sexual activity and functioning in racially and ethnically diverse middle-aged and older women.
DESIGN: Cross-sectional cohort study.
SETTING: Integrated healthcare delivery system.
PARTICIPANTS: One thousand nine hundred seventy-seven women aged 45 to 80.
MEASUREMENTS: Self-administered questionnaires assessed sexual desire, activity, satisfaction, and problems.
RESULTS: Of the 1,977 participants (876 white, 388 African American, 347 Latina, and 351 Asian women), 43% reported at least moderate sexual desire, and 60% had been sexually active in the previous 3 months. Half of sexually active participants (n=969) described their overall sexual satisfaction as moderate to high. Among sexually inactive women, the most common reason for inactivity was lack of interest in sex (39%), followed by lack of a partner (36%), physical problem of partner (23%), and lack of interest by partner (11%); only 9% were inactive because of personal physical problems. In multivariable analysis, African-American women were more likely than white women to report at least moderate desire (odds ratio (OR)=1.65, 95% confidence interval (CI)=1.25–2.17) but less likely to report weekly sexual activity (OR=0.68, 95% CI=0.48–0.96); sexually active Latina women were more likely than white women to report at least moderate sexual satisfaction (OR=1.75, 95% CI=1.20–2.55).
CONCLUSION: A substantial proportion of community-dwelling women remain interested and engaged in sexual activity into older age. Lack of a partner capable of or interested in sex may contribute more to sexual inactivity than personal health problems in this population. Racial and ethnic differences in self-reported sexual desire, activity, and satisfaction may influence discussions about sexual difficulties in middle-aged and older women.     

Physiological and psychosocial factors in spiritual needs attainment for community-dwelling older adults

BackgroundSpiritual well-being enhances older persons’ health status. Factors that optimize their spiritual well-being are not well-established.ObjectiveTo describe spiritual needs attainment and identify factors associated with such attainment among community-dwelling older persons.DesignCross-sectional.SettingSixty-five U.S. continuing care retirement communities or independent housing facilities.Subjects4077 persons entering the facilities between January 1, 2007 and November 30, 2016.MethodsStandardized Community Health Assessment and Wellness Survey instruments were used to determine the proportion of subjects reporting their spiritual needs were met. Multivariate logistic regression identified characteristics independently associated with this outcome.ResultsAmong the 4077 subjects (mean age 81.6 ± 7.5; male, 28.8%; and White race, 70.7%), 93.4% stated their spiritual needs were met. Factors independently associated with a greater likelihood of spiritual needs attainment were: satisfaction with life (adjusted odds ratio (AOR) 2.81, 95% confidence interval (CI) 2.00, 3.96; p < 0.001), feeling valued (AOR 2.51, 95% CI 1.61, 3.92; p < 0.001), strong and supportive family relationship (AOR 1.99, 95% CI 1.20, 3.29; p = 0.008), sufficient sleep (AOR 1.59, 95% CI 1.15, 2.19; p = 0.005), no pain (AOR 1.35, 95% CI 1.01, 1.82; p = 0.046), and having someone to talk to about death among those interested in doing so (AOR 0.39, 95% CI 0.29, 0.54; p < 0.001).ConclusionsThe majority of community-dwelling older persons reported their spiritual needs were met. Adequate sleep, pain relief, and having a person with whom to discuss death are potentially modifiable factors that may promote spiritual needs attainment in this population, which in turn, may improve their health outcomes.     

Impact of intimate partner violence on clinic attendance,viral suppression and CD4 cell count of women living with HIV in an urban clinic setting

The substance abuse, violence and HIV/AIDS (SAVA) syndemic represents a complex set of social determinants of health that impacts the lives of women. Specifically, there is growing evidence that intimate partner violence (IPV) places women at risk for both HIV acquisition and poorer HIV-related outcomes. This study assessed prevalence of IPV in an HIV clinic setting, as well as the associations between IPV, symptoms of depression and PTSD on three HIV-related outcomes—CD4 count, viral load, and missed clinic visits. In total, 239 adult women attending an HIV-specialty clinic were included. Fifty-one percent (95% CI: 45%–58%) reported past year psychological, physical, or sexual intimate partner abuse. In unadjusted models, IPV was associated with having a CD4 count <200 (OR: 3.284, 95% CI: 1.251–8.619, p?=?0.016) and having a detectable viral load (OR: 1.842, 95% CI: 1.006–3.371, p?=?0.048). IPV was not associated with missing >33% of past year all type clinic visits (OR: 1.535, 95% CI: 0.920–2.560, p?=?0.101) or HIV specialty clinic visits (OR: 1.251, 95% CI: 0.732–2.140). In multivariable regression, controlling for substance use, mental health symptoms and demographic covariates, IPV remained associated with CD4 count <200 (OR: 3.536, 95% CI: 1.114–11.224, p?=?0.032), but not viral suppression. The association between IPV and lower CD4 counts, but not adherence markers such as viral suppression and missed visits, indicates a need to examine potential physiologic impacts of trauma that may alter the immune functioning of women living with HIV. Incorporating trauma-informed approaches into current HIV care settings is one opportunity that begins to address IPV in this patient population.     

Structural and Microstructural Brain Changes Predict Impairment in Daily Functioning

BackgroundBrain changes on magnetic resonance imaging (MRI) reflect accumulating pathology and have clinically disabling consequences, such as dementia. However, little is known on the relation of these MRI markers with daily functioning in nondemented individuals. We investigated whether structural and microstructural brain changes are associated with impairment in activities of daily living in a community-dwelling population.MethodsBetween 2005 and 2009, 2025 stroke-free nondemented participants (aged 59.9 years) from the population-based Rotterdam Study underwent brain MRI, yielding global MRI markers, focal MRI markers, and microstructural MRI markers. We used the Stanford Health Assessment Questionnaire to assess basic activities of daily living, and the Instrumental Activities of Daily Living Scale to assess instrumental activities of daily living. Follow-up on activities of daily living was obtained between 2008 and 2013 (mean follow-up 5.7 years). We used linear regression to analyze continuous scores of daily living and logistic regression for incident impairment.ResultsEighty-two participants became impaired in basic and 33 in instrumental activities of daily living. Smaller brain and hippocampal volume and higher diffusivity were associated with larger change in activities of daily living. Smaller brain volume (odds ratio [OR] 4.05 per SD; 95% confidence interval [CI], 1.81–9.02), larger white matter lesion volume (OR 1.33/SD; 95% CI 1.02–1.72) and higher mean (OR 1.55/SD; 95% CI, 1.11–2.15), axial (OR 1.49/SD; 95% CI, 1.08–2.07), and radial diffusivity (OR 1.51/SD; 95% CI, 1.09-2.10) were associated with higher risk of impairment in basic activities of daily living.ConclusionsIn community-dwelling individuals, brain changes are associated with deterioration and incident impairment in daily functioning.     

Prevalence and social correlates of sexual intercourse among schoolgoing adolescents in Namibia

Adolescent sexuality is an important public health issue, as it affects risk to contract HIV and other sexually transmitted infections. The assessment of prevalence of sexual intercourse among adolescents is of public health significance, as it may guide policies and programmes aimed at reducing the transmission of sexually transmitted infections among this age group. This cross-sectional study using standardised methodology was conducted to assess the prevalence and correlates of sexual intercourse among Namibian schoolgoing adolescents in 2004. Overall the prevalence of sexual intercourse was 33.2% (44.0% males and 24.8% females). Variables positively associated with the outcome in multivariate analysis were male gender (OR=2.39; 95% CI (1.81, 3.17)), cigarette smoking (OR=1.67; 95% CI (1.07, 2.63)), alcohol drinking (OR=1.63; 95% CI (1.18, 2.26)), and drug use (OR=9.82; 95% CI (6.28, 15.36). Parental supervision was negatively associated with sexual intercourse in the last 12 months (OR=0.73; 95% CI (0.56, 0.94)). Efforts to control unhealthy lifestyles (smoking, alcohol and illicit drug use) may impact on adolescents' sexual activity.     

The relationship between sexual activity and urinary incontinence in older women

OBJECTIVES: To determine whether continence status is associated with sexual activity in older women. DESIGN: Cross-sectional postal survey. SETTING: Random selection from a list of respondents to a Canada Post survey. PARTICIPANTS: Community-dwelling women aged 55 to 95. MEASUREMENTS: The International Consultation on Incontinence Questionnaire Short Form measured the presence, severity, and type of incontinence. Sexual activity and marital status were assessed using single close-ended questions. The Medical Outcomes Study 12-item Short-Form Health Survey was used to query physical and mental health status. RESULTS: Data from 2,361 women (mean age 71) were available for analysis. Thirty-nine percent reported urinary incontinence (UI), and 27% were sexually active. UI was associated with sexual activity in crude logistic analyses (odds ratio (OR)=0.82, 95% confidence interval (CI)=0.68-0.98) but not in multivariate models adjusted for physical and mental health. Marital status and age were the strongest predictors of sexual activity (OR 8.94, 95% CI=6.89-11.60 for married women; OR=3.09, 95% CI=2.57-3.73 for age 相似文献   

Risk factors for fall in elderly with diabetes mellitus type 2

AimsDiabetes mellitus type 2 (DMT2) is a major chronic condition that also common in older people, and associated with an increased risk of falling. This study aimed to determine the risk factor of fall in elderly with DMT2.MethodsIn this cross-sectional study, 220 elderly diabetic patients who had referred to diabetes center in Kerman were chosen via convenience sampling method. To collect data, Semi-structured Fall Risk questionnaire and the Pittsburgh Sleep Quality Index (PSQI) were used.FindingsThe mean age was estimated to be 69.82 (SD: 9.9) years. Among the participants, 38.5% suffered falls in the past one year. Good sleep quality (OR = 0.45, 95% CI = 0.1–0.85) and appropriate environment (OR = 0.6, 95% CI = 0.1–0.77) were significantly associated with a lesser odd of having recurrent falls. Gait problem (OR = 1.8, 95% CI = 1.1–4.9), balance difficulties (OR = 2.1, 95% CI = 1.24–7.12), hypotension (OR = 1.7, 95% CI = 1.2–5.6), and medication above three medicine (OR = 1.55, 95% CI = 1.12–6.34) were significantly associated with a greater odd of having recurrent falls.ConclusionIt would therefore appear that older diabetic patients would be a suitable target group for a strategy aimed at preventing falls. Early recognition of the multiple causes of falls in the older diabetic patient and prompt referral of this group of patients to a specialist falls clinic is recommend.     

Domestic violence in a genitourinary medicine setting--an anonymous prevalence study in women

Domestic violence (DV) affects around one in four women in the UK. This study aimed to determine the prevalence of DV and the associations with sociodemographic and sexual behaviour variables in female attendees of an inner-city genitourinary (GU) medicine clinic. In this cross-sectional survey, 177 of 380 women (46.6%) disclosed a history of abuse and 17.4% reported DV in the preceding 12 months. Women with a history of a sexually transmitted infection (STI) were more likely to have experienced DV at some point in their lives (odds ratio [OR]=2.39; 95% confidence interval [CI]: 1.58-3.63). Logistic regression analysis revealed that being black compared with white, (OR=1.7; 95% CI: 2.4-12.5) current cohabitation with a partner (OR=2.24; 95% CI: 1.06-4.75), increasing number of sexual partners in the last year (OR=1.24; 95% CI: 1.01-1.5) and consumption of illicit drugs (OR=2.05; 95% CI: 1.02-4.11) were significantly associated with DV in the last 12 months but age, current occupation, history of STIs, age of coitarche and condom use were not. DV was common in this GU medicine clinic population and associated with STIs. We recommend that health practitioners undergo training to increase awareness of the links between partner violence and sexual health problems.     

Determinants of symptom burden related to bowel preparation for colonoscopy

BackgroundSymptoms developing during bowel preparation are major concerns among subjects who refuse the procedure.AimsWe aimed to explore the determinants of symptoms occurring during preparation among patients undergoing elective colonoscopy.MethodsThis is a prospective multicenter study conducted in 10 Italian hospitals. A multidimensional approach collecting socio-demographic, clinical, psychological and occupational information before colonoscopy through validated instruments was used. Outcome was a four-category cumulative score based on symptoms occurring during preparation, according to the Mayo Clinic Bowel Prep Tolerability Questionnaire, weighted by intensity. Missing values were addressed through multiple imputation. Odds ratios (OR) and 95% confidence intervals (CI) were estimated through multivariate logistic regression models.Results1137 subjects were enrolled. Severe symptoms were associated with female sex (OR=3.64, 95%CI 1.94-6.83), heavier working hours (OR=1.13, 95% CI=1.01-1.25), previous gastrointestinal symptoms (OR=7.81, 95% CI 2.36-25.8 for high score), somatic symptoms (OR=2.19, 95% CI=1.06-4.49 for multiple symptoms), day-before regimen (OR=2.71, 95%CI 1.28-5.73). On the other hand, age ≥60 years (OR=0.10, 95% CI 0.02-0.44) and good mood (p=0.042) were protective factors. A high-risk profile was identified, including women with low mood and somatic symptoms (OR=15.5, 95%CI 4.56-52.7).ConclusionsWe identified previously unreported determinants of symptoms burdening bowel preparation and identified a particularly vulnerable phenotype. Symptoms during preparation especially impact heavier working activity.     

Moderate or severe low back pain is associated with body mass index amongst community-dwelling older Australians

ObjectiveLow back pain is prevalent in older populations and modifiable risk factors may include being overweight or obese. This study aimed to describe the prevalence and impact of moderate or severe low back pain in community-dwelling older adults and its association with body mass index (BMI).MethodsCross-sectional study involving 16,439 Australians aged ≥70 years. Logistic regression was used to describe associations between the presence or absence of moderate or severe low back pain experienced on most days with BMI. Analyses were conducted separately for males and females, and controlled for age and depression at baseline.ResultsOf 14,155 pain question respondents, 11 % of males (n = 710/6475) and 18 % of females (n = 1391/7680) reported moderate or severe low back pain (total 15 %, n = 2101/14,155). Of those reporting moderate or severe low back pain (n = 2101), 55 % reported taking pain-relieving medication regularly, and 29 % reported that the pain regularly interfered with sleep, 37 % with walking, and 47 % with day to day activities. When age and depression were controlled for, there was a statistically significant (p < 0.001) association between moderate or severe low back pain and being overweight (females: odds ratio OR = 1.50, 95 % confidence interval CI = 1.27−1.76) or obese (males: OR = 2.23, 95 %CI = 1.77−2.80 and females: OR = 2.91, 95 %CI = 2.48−3.42).ConclusionModerate or severe low back pain is common, has a significant impact, and is associated with either an overweight or obese BMI among community-dwelling Australians aged ≥70 years.     

Changes in sexual behaviors following diagnosis with HIV: patterns and correlates among people living with HIV (PLHIV) in China

Effective secondary prevention of HIV infections requires knowledge about changes in sexual behaviors after diagnosis among people living with HIV (PLHIV), yet there is a dearth of literature assessing gender-specific patterns and correlates of such changes among heterosexual PLHIV in China. Data used in the current study were derived from a cross-sectional survey conducted from 2012 to 2013 among 1212 heterosexual sexually active PLHIV in Guangxi, China. Most participants reduced sexual frequency (71.2%), reduced or maintained the same number of sexual partners (96.6%), and increased or maintained same frequencies of condom use (80.6%). Gender difference was found in changes in sexual frequency, but not in the number of sexual partners or condom use. For males, decrease in sexual frequency was associated with having no desire to have children (OR?=?2.03, 95% CI 1.20, 3.44), being virally suppressed (OR?=?0.27, 95% CI 0.079, 0.94), and social support (OR?=?1.44, 95% CI 1.06, 1.96). Health promoting behaviors in condom use (i.e., increased or maintained same frequencies of condom use) for males was associated with being 45 years of age or older (OR?=?0.35, 95% CI 0.21, 0.61), having an HIV-negative main partner (OR?=?1.80, 95% CI 1.11, 2.92), and physical health-related quality of life (OR?=?1.02, 95% CI 1.00, 1.04). For females, decrease in sexual frequency was associated with having no desire to have children (OR?=?1.58, 95% CI 1.01, 2.47). Health promoting behaviors in condom use for females was associated with having an HIV-negative main partner (OR?=?3.24, 95% CI 1.63, 6.45) and social support (OR?=?0.75, 95% CI 0.57, 0.99).

Future intervention efforts need to target PLHIV who need extra support in making health-improvement efforts and to facilitate gender-specific behavioral changes in sexual risk reduction after HIV diagnosis.     

The impact of multidimensional frailty on dependency in activities of daily living and the moderating effects of protective factors

BackgroundDependency in activities of daily living (ADL) might be caused by multidimensional frailty. Prevention is important as ADL dependency might threaten the ability to age in place. Therefore, this study aimed to assess whether protective factors, derived from a systematic literature review, moderate the relationship between multidimensional frailty and ADL dependency, and whether this differs across age groups.MethodsA longitudinal study with a follow–up after 24 months was conducted among 1027 community-dwelling people aged ≥65 years. Multidimensional frailty was measured with the Tilburg Frailty Indicator, and ADL dependency with the ADL subscale from the Groningen Activity Restriction Scale. Other measures included socio-demographic characteristics and seven protective factors against ADL dependency, such as physical activity and non-smoking. Logistic regression analyses with interaction terms were conducted.ResultsFrail older people had a twofold risk of developing ADL dependency after 24 months in comparison to non-frail older people (OR = 2.12, 95% CI = 1.45–3.00). The selected protective factors against ADL dependency did not significantly moderate this relationship. Nonetheless, higher levels of physical activity decreased the risk of becoming ADL dependent (OR = 0.67, 95% CI = 0.46–0.98), as well as having sufficient financial resources (OR = 0.49, 95% CI = 0.35–0.71).ConclusionMultidimensional frail older people have a higher risk of developing ADL dependency. The studied protective factors against ADL dependency did not significantly moderate this relationship.     

Impact of excessive daytime sleepiness on the safety and health of farmers in Saskatchewan

BACKGROUND:Sleep disorders may negatively impact the health and well-being of affected individuals. The resulting sleepiness and impaired cognitive functioning may also increase the risks for injury.OBJECTIVE:To examine the relationship between daytime sleepiness, defined as an Epworth Sleepiness Scale score >10, and self-reported sleep apnea, as potential determinants of farming-related injury and self-perceived physical health.METHODS:Phase 2 of the Saskatchewan Farm Injury Cohort Study (2013) involved a baseline survey that included 2849 individuals from 1216 farms. A mail-based questionnaire was administered to obtain self-reports regarding sleep, demographics, farm injuries and general physical health. Multilevel logistic regression was used to quantify relationships between excessive daytime sleepiness and health.RESULTS:The prevalence of excessive daytime sleepiness was 15.1%; the prevalence of diagnosed sleep apnea was 4.0%. Sleepiness was highest in the 60 to 79 (18.7%) and ≥80 (23.6%) years of age groups, and was higher in men (19.0%) than in women (9.3%). Injuries were reported by 8.4% of individuals, and fair or poor health was reported by 6.2%. Adjusting for confounding, individuals with excessive daytime sleepiness appeared more likely to experience a farming-related injury (OR 1.34 [95% CI 0.92 to 1.96]) and were more likely to report poorer physical health (OR 2.19 [95% CI 1.45 to 3.30]) than individuals with normal daytime sleepiness.CONCLUSION:Excessive daytime sleepiness, a potentially treatable condition, appeared to be common in farmers and to negatively affect their health. Sleep disorder diagnosis and treatment programs did not appear to be used to their full potential in this population.     

Factors influencing attitudes toward advance directives in Korean older adults

AimWe aimed to determine the factors influencing attitudes toward advance directives in Korean older adults with consideration of an Asian cultural background.MethodsWe recruited community-dwelling older adults aged 60 years or older at a regional senior welfare center in Korea. Demographic factors and mental and physical health status were examined using questionnaires and a physical examination. The questionnaire also assessed perceived necessity of advance directives and related experiences.ResultsMost participants (79.32%) agreed that advance directives were necessary. Older adults with high education levels (odds ratio [OR] 2.31, 95% confidence interval [CI] 0.84–6.34), low economic status (OR 2.09, 95% C.I. 0.60–7.27), and poor cognitive function (adjusted odds ratio [aOR] 2.10, 95% CI 0.89–4.97) had a greater odds of agreeing that advance directives are necessary. All participants with self-care problems (9/9) and most participants with at risk status of physical functioning (13/14) reported agreement. Death-related experiences were also associated. Notably, individuals who had discussions on end-of-life care with family members showed a greater odds of agreeing that advance directives are necessary (aOR 2.12, 95% CI 0.88–5.11).ConclusionsThe factors associated with increased agreement that advance directives are necessary were high education level, low economic status, poor cognitive function, problems in self-care, poor physical functioning, death-related experiences. Especially, discussions of end-of-life care with family members increased the agreement. Thus, discussion on end-of-life care should be encouraged and the factors influencing older adults’ attitudes toward advance directives should be considered in developing policies for such discussion.     

Impact of gender on sexual problems and perceptions among urban Malay elderly in Malaysia

BackgroundPhysical and pathological changes associated with advancing age affect sexual behaviours of the elderly. The aim of this study was to explore the impact of gender on sexual problems and perceptions among the urban Malay elderly.MethodsA cross-sectional study was conducted among 160 Malaysian elderly participants aged 60 years and older who live in Kuala Lumpur. Twelve neighbourhood associations were randomly selected using multi-stage cluster sampling. Data was collected using standardized and validated questionnaire by face-to-face interview technique with which was conducted by trained interviewers.ResultsMean age of the participants was 65.33 (5.87) year old with majority were still married. Female (55.7%) reported more sexual problems as evidenced by the higher proportion of those with lacked interest in having sex (72.5%), find sex is unpleasant (34.8%) and unable to come to orgasm (55.1%). Gender was found to have significant impact on every model obtained in the analysis for both sexual problems and perceptions. Female elderly were 10.6 times more likely to have sexual problem compared to male elderly (OR = 10.64, P < 0.001, 95% CI 3.61, 31.35) and 033 less likely to have good sexual perception (OR = 0.33, P = 0.027, 95% CI 0.12, 0.88).ConclusionGender is a crucial factor towards sexual problem and perceptions among older persons. Older women were reported to have more sexual problems and poor sexual perceptions, reflecting the needs for sexual awareness and education to improve the perceptions and sexuality in later life.     

Predictive validity of the Brazilian version of the Tilburg Frailty Indicator for adverse health outcomes in older adults

PurposeThis study aimed to determine the predictive value of the Brazilian Tilburg Frailty Indicator (TFI) for adverse health outcomes (falls, hospitalization, disability and death), in a follow-up period of twelve months.MethodsThis longitudinal study was carried out with a sample of people using primary health care services in Rio de Janeiro, Brazil. At baseline the sample consisted of 963 people aged 60 years and older. A subset of all respondents participated again one year later (n = 640, 66.6% response rate). We used the TFI, the Katz’s scale for assessing ADL disability and the Lawton Scale for assessing IADL disability. Falls, hospitalization and death were also assessed using a questionnaire.ResultsThe prevalence of frailty was 44.2% and the mean score of the TFI was 4.4 (SD = 3.0). There was a higher risk of loss in functional capacity in ADL (OR = 3.03, CI95% 1.45–6.29) and in IADL (OR = 1.51, CI95% 1.05–2.17), falls (OR = 2.08, CI95% 1.21–3.58), hospitalization (OR = 1.83, CI95% 1.10–3.06), and death (HR = 2.73, CI95% 1.04–7.19) for frail when compared to non-frail elderly, in the bivariate analyses. Controlling for the sociodemographic variables, the frailty domains together improved the prediction of hospitalization, falls and loss in functional capacity in ADL, but not loss in functional capacity in IADL.ConclusionThe TFI is a good predictor of adverse health outcomes among elderly users of primary care services in Brazil and appears an adequate and easy to administer tool for monitoring their health conditions.