Time Benders: A Model of Subjective Aging in Aging Adults

This article develops a new model for understanding the aging experience. Drawing upon aging literature from the chronological, biological, mental, and social aging perspectives, the model offered is an integrated perspective that provides better understanding of the relationship between chronological age and an individual's perceived age. The article provides evidence of ways that consumers are trying to “time bend” and change today's perceived reality of aging. The article concludes with a discussion of implications for the health care industry and provides examples of how some businesses seem to already be looking at aging and health related issues through this lens.     

社会支持与主观幸福感关系研究

  目的  探讨躯体健康和心理健康在老年人社会支持与主观幸福感之间的中介效应,为有效利用社会支持改善老年人主观幸福感,实现积极、健康老龄化提供科学依据。  方法  于2016年4 — 6月采用配额方便抽样方法在辽宁省沈阳、大连、锦州、盘锦、抚顺、本溪、铁岭7个城市社区抽取978名在该地区居住满1年的≥60岁老年人进行问卷调查,并应用结构方程模型采用系数乘积法中的偏差校正的百分位Bootstrap方法,通过增加辅助变量进行完整的中介效应检验。  结果  老年人躯体健康和心理健康平均分分别为（2.96 ± 0.18）和（3.65 ± 0.84）分,社会支持平均分为（3.31 ± 0.84）分,主观幸福感平均分为（3.84 ± 1.00）分;社会支持对老年人主观幸福感有直接正向影响（c′ = 0.574,P < 0.05）;躯体健康和心理健康的特定路径中介效应（a₁b₁、a₂b₂）、总中介效应（a₁b₁ + a₂b₂）、对比中介效应（a₁b₁ – a₂b₂）置信区间分别为（0.003～0.020）、（0.121～0.353）、（0.132～0.365）、（– 0.532～– 0.129）（均P < 0.05）,其中介效应占总效应的比例（P_M）为30%,且心理健康较躯体健康的中介效应更强（a₁b₁ – a₂b₂ = – 0.347）。  结论  老年人社会支持状况对主观幸福感有直接影响,且部分是通过躯体健康和心理健康的中介效应实现。     

Gender and use of health care among older adults in Egypt and Tunisia

In Western industrialized countries, women report using health services more often than do men. We explore the applicability of existing theory to explain gender differences in use of health care among older adults in Egypt and Tunisia, where females have received less health care than males in early life. Findings show that women report visiting providers and using medications more often than do men; however, adjusted odds of visiting doctors are comparable for women and men in Tunisia and lower for women than men in Egypt. Odds of using health care are higher for women than men among those reporting no morbidity or functional impairment, but these relative odds diminish or reverse among those reporting multiple morbidities or severe impairments. The contributions of subjective and objective illness, quality of social support, and availability of services on gender differences in care in later life should be assessed in these and other settings where girls’ excess mortality persists.     

Physical activity of adults aged 50 years and older in Switzerland

Summary. Objective: This study explores the prevalence of guideline-compliant physical activity (PA) behavior based on socio-demographic, health-related and environmental variables.Methods: Cross-sectional data of the Swiss Health Survey 2002 were used in a Swiss population segment aged 50+. Four categories of PA were created with respect to Swiss and US guidelines: “moderate sports/exercise”, “vigorous sports/exercise”, “habitual PA”, and “optimal PA” (i. e. combined variable used when both “vigorous sports/exercise” and “habitual PA” apply). Sedentary lifestyle was a fifth category.Results: In the total sample considered for analysis (N = 8405) the prevalence of guideline-compliant PA was: 9.1% moderate sports/exercise; 18.2% vigorous sports/exercise; 45% habitual PA; 8.7% optimal PA. Almost 50% of the age groups 65–79 and 80+ were involved in habitual PA. Higher socio-economic status was associated with involvement in moderate sports/exercise, vigorous sports/exercise, or optimal PA. In contrast, lower socioeconomic status was associated with habitual PA. While living in an urban or rural environment had no differentiating effect on sports/exercise, living in rural areas was associated with a sedentary lifestyle and little involvement in habitual PA and/or optimal PA. Self-reported good health and/or health orientation were associated with vigorous sports/exercise, habitual PA and optimal PA, regardless of whether the person had chronic health problems or not.Conclusion: Habitual PA seems to have the greatest potential for increasing overall guideline-compliant activity levels. A behavioral/ cognitive and political/environmental approach to improving PA is suggested.

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Zusammenfassung. Körperliche Aktivität in der Schweizerischen Bevölkerung ab Alter 50Fragegestellung: Die Arbeit exploriert die Prävalenz richtlinienkonformer körperlicher Aktivität (KA) und ihre Beziehungen zu Variablen der Gesundheit und des Lebenskontextes bei Schweizer und Schweizerinnen im Alter von 50+.Methoden: Querschnittdaten der Schweizerischen Gesundheitsbefragung 2002 wurden analysiert. Gemäss Schweizer und US-amerikanischen Richtlinien wurden vier Kategorien zur KA gebildet: moderate bzw. intensive Sportaktivität; habituelle KA; “optimale” KA. Eine fünfte Kategorie bezog sich auf sitzende Lebensweise.Ergebnisse: Im Gesamtkollektiv von N = 8 405 betrug die Prävalenz der richtlinien-konformen KA: 9,1% für moderaten Sport, 12,2% für intensiven Sport, 45% für habituelle KA, 8,7% für optimale KA. Etwa 50% des Bevölkerungssegmentes der 65- bis 79- sowie der 80+-Jährigen bewegte sich ausrei- chend durch habituelle KA. Ein höherer sozioökonomischer Status stand mit moderater bzw. intensiver Sportaktivität und optimaler KA in Beziehung, ein niedrigerer Status mit habitueller KA. Leben in ländlicher und städtischer Umgebung hatte keinen differenzierenden Effekt bezüglich Prävalenz der Sportaktivität, jedoch war Leben in ländlicher Umgebung mit sitzender Lebensweise und niedriger Prävalenz habitueller bzw. optimaler KA verbunden. Unabhängig von der Existenz chronischer Gesundheitsprobleme standen die gute Gesundheit und ausgeprägte Gesundheitsorientierung mit intensiver Sportaktivität, habitueller bzw. optimaler KA in Beziehung.Schlussfolgerung: Habituelle KA scheint das grösste Potential für die Verbesserung von gesundheitsfördernder Bewegung zu haben. Strategien zur Mobilisierung dieses Potentials liegen in den Bereichen Verhalten/Kognition sowie Politik und Umgebungsstrukturen.

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Résumé. Activité physique au sein de la population suisse âgée de plus de 50 ansObjectifs: Décrire l’observance des recommandations en matière d’activité physique (AP) selon des variables se rapportant au statut socio-démographique, à l’état de santé et à l’environnement.Méthodes: Analyse transversale basée sur les données (N = 8 405) de l’Enquête Suisse sur la Santé 2002. Quatre catégories d’AP sont utilisées: “modérée”, “intensive”, “habituelle” et “optimale” (cf. les directives suisses et américaines). “Mode de vie sédentaire” définit une cinquième catégorie.Résultats: 9.1% du collectif (N = 8 405) fait partie de la catégorie “AP modérée”, 12.2% de “AP intensive”, 45% de “AP habituelle” et 8.7% de “AP optimale”. Parmi la population âgée de 65–79 ans et de 80 ans et plus, environ 50% des personnes pratiquent une AP “habituelle”. Un niveau socioéconomique élevé est associé à une d’AP “modérée”, “intensive” et “optimale”, tandis qu’un niveau socio-économique bas correspond à une “AP habituelle”. Aucune différence entre la vie en milieu citadin ou rural n’a été mise en évidence concernant la prévalence de l’activité sportive. Par contre la vie en milieu rural est associée avec un mode de vie plus sédentaire et avec une prévalence plus basse d’AP “habituelle” et “optimale”. Un bon état de santé et une orientation positive face à la santé sont en lien avec une AP “intense”, “habituelle” ou “optimale”, indépendamment de la présence de problèmes de santé chroniques.Conclusions: Il faut accroître l’observance des recommandations en matière d’activité physique. Des approches comportementales, cognitives, politiques et environnementales sont suggérées pour promouvoir l’activité physique.

     

Cluster analysis of nutritional factors associated with low muscle mass index in middle-aged and older adults

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An examination of the social networks and social isolation in older and younger adults living with HIV/AIDS

This study examined social networks and social isolation in older (50 years or more) and younger (ages 20 to 39) adults with HIV/AIDS. The author conducted interviews with 88 individuals living with HIV/AIDS in the Pacific Northwest. Both groups' social networks had similar patterns; however, older adults were more likely to live alone. More than 38 percent of older adults and 54 percent of older adults of color were at risk of social isolation compared with 25 percent of those 20 to 39 years of age. Older men and older adults of color had significantly lower scores on the social network scale than others. Having a confidant and receiving instrumental support were significantly correlated with reduced HIV stigma. Implications for social work practitioners are discussed.     

Cost-benefit analysis of vaccination against four preventable diseases in older adults: Impact of an aging population

ObjectiveThis exploratory study estimates the economic value of the current vaccination program and increased coverage against four preventable diseases in older adults in the United States (US).MethodsA population-based, age-structured economic model was used to conduct a cost-benefit analysis of vaccination against influenza, pertussis, herpes zoster, and pneumococcal disease among US adults aged 50 years and older, accounting for aging of the population. The model used separate decision trees for each disease to project the discounted number of vaccinated individuals, number of disease cases, and direct medical and indirect costs (2018 US$) over a 30-year period. Benefit-cost ratios (BCRs) and net present values were calculated for two primary analyses comparing current vaccination coverage versus no vaccination and comparing increased coverage versus current coverage. Key parameter values were varied in deterministic sensitivity analyses.ResultsCurrent adult vaccination coverage (vs. no vaccination) is estimated to result in nearly 65 million averted disease cases, $185 billion averted costs of cases, and $136 billion in incremental vaccination costs over a 30-year period from a societal perspective (BCR = 1.4). Increased vaccination coverage (vs. current coverage) is associated with over 33 million additional averted disease cases, $96 billion additional averted costs of cases, and nearly $83 billion in incremental vaccination costs, resulting in a societal BCR of 1.2 over 30 years. Deterministic sensitivity analyses demonstrated that results were most sensitive to disease incidence, vaccine efficacy, and productivity costs for time required for vaccination.ConclusionsStudy results highlight the economic value of vaccination programs for older adults in the US and indicate that efforts to further increase vaccination coverage may be warranted and economically justifiable.     

AIDS in adults 50 years of age and over: characteristics,trends and spatial distribution of the risk

Objective

to analyze the sociodemographic characteristics, epidemic trend and spatial distribution of the risk of AIDS in adults 50 years of age and over.

Method

population-based, ecological study, that used secondary data from the Notifiable Disease Information System (Sinan/AIDS) of Paraíba state from the period January 2000 to December 2010.

Results

during the study period, 307 cases of AIDS were reported among people 50 years of age or over. There was a predominance of males (205/66, 8%), mixed race, and low education levels. The municipalities with populations above 100 thousand inhabitants reported 58.5% of the cases. There was a progressive increase in cases among women; an increasing trend in the incidence (positive linear correlation); and an advance in the geographical spread of the disease, with expansion to the coastal region and to the interior of the state, reaching municipalities with populations below 30 thousand inhabitants. In some locations the risk of disease was 100 times greater than the relative risk for the state.

Conclusion

aging, with the feminization and interiorization of the epidemic in adults 50 years of age and over, confirms the need for the induction of affirmative policies targeted toward this age group.     

Multipoint near-infrared spectrometry for real-time monitoring of protein conformational stability in powdered infant formula

Abstract

Powdered infant formula (PIF) can be the sole source of nutrition for babies and infants. Monitoring conformational changes in protein during manufacture of PIF is critical in order to maintain its nutritional value. This study presents the development of a calibration model for monitoring conformational changes in PIF protein by applying a novel multipoint near-infrared (NIR) spectrometry. NIR spectra were collected for PIF and PIF proteins, casein and whey protein isolate, before and after heat treatment. Results show that principal component analysis showed discrimination between native protein at room temperature and protein conformational changes caused at elevated temperature. Partial least squares regression analysis showed good calibration models with correlation coefficients ranging between 87% and 99% for the prediction of protein quality. This novel multipoint NIR spectrometry could serve as a simple in-line tool to rapidly monitor protein quality during processing stages, contributing to product nutritional value.     

Modeling efficiency at the process level: an examination of the care planning process in nursing homes

Objective. To examine the efficiency of the care planning process in nursing homes.
Methods: We collected detailed primary data about the care planning process for a stratified random sample of 107 nursing homes from Kansas and Missouri. We used these data to calculate the average direct cost per care plan and used data on selected deficiencies from the Online Survey Certification and Reporting System to measure the quality of care planning. We then analyzed the efficiency of the assessment process using corrected ordinary least squares (COLS) and data envelopment analysis (DEA).
Results: Both approaches suggested that there was considerable inefficiency in the care planning process. The average COLS score was 0.43; the average DEA score was 0.48. The correlation between the two sets of scores was quite high, and there was no indication that lower costs resulted in lower quality. For-profit facilities were significantly more efficient than not-for-profit facilities.
Conclusions. Multiple studies of nursing homes have found evidence of inefficiency, but virtually all have had measurement problems that raise questions about the results. This analysis, which focuses on a process with much simpler measurement issues, finds evidence of inefficiency that is largely consistent with earlier studies. Making nursing homes more efficient merits closer attention as a strategy for improving care. Increasing efficiency by adopting well-designed, reliable processes can simultaneously reduce costs and improve quality.     

我国长期照护保险需求影响因素分析——基于江苏省的实证研究

目的:对我国长期照护保险需求的影响因素进行探究,为我国建立完善长期照护保险制度提供参考。方法:以江苏省调研数据为例,采用因子分析、多元回归和Logistic回归等计量方法进行分析。结果:(1)从主观态度角度来看,护理费用、家属支付能力、保险观念、护理需求和慢性病认知均与长期照护保险需求存在正相关关系,并且影响显著;(2)从人口统计学角度来看,文化程度高的居民购买长期照护保险的意愿更高。结论:我国应充分考虑长期照护保险需求的影响因素,提高城乡居民收入,加大宣传力度,鼓励护理机构多层次发展,构建以政府为主导的长期照护服务体系。     

Carboxymethyl-lysine,an advanced glycation end product,and decline of renal function in older community-dwelling adults

Background  Advanced glycation end products (AGEs) are bioactive molecules found in greater concentrations in foods that have been processed at high temperatures. AGEs have been associated with impaired renal function in diabetes and in uremia. The relationship between AGEs and renal function in community-dwelling adults has not been well characterized. Aim of the study  The objective was to determine whether plasma AGEs are independently associated with chronic kidney disease (CKD) and predictive of renal function in older adults. Methods  The relationship between plasma carboxymethyl-lysine (CML), an AGE, and CKD (≥ stage 3 of National Kidney Foundation classification; estimated glomerular filtration rate [eGFR] <60 ml/min/1.73 m²) and eGFR at 3- and 6-years follow-up was examined in a population-based study of aging, the InCHIANTI study, in Tuscany, Italy. Results  Of 1,008 adults, aged ≥65 years, 153 (15.2%) had CKD at enrollment. Mean (standard deviation [S.D.]) plasma CML was 365 (110) ng/ml. Plasma CML was associated with CKD (odds ratio [O.R.] expressed per 1 S.D., 1.53, 95% confidence interval [C.I.] 1.27–1.84, P < 0.0001) in a multivariate logistic regression model, adjusting for potential confounders. Plasma CML was associated with eGFR (β = −2.77, standard error [S.E.] = 0.51, P < 0.0001) at baseline, 3-year (β = −2.54, S.E. = 0.61, P < 0.0001) and 6-year follow-up visits (β = −1.21, S.E. = 0.70, P = 0.08) in multivariate linear regression models, adjusting for potential confounders. The associations between plasma CML and prevalent CKD, eGFR, and eGFR at 3- and 6-year follow-up were significant and nearly unchanged after exclusion of adults with diabetes. Conclusion  Plasma CML is independently associated with CKD and is an independent predictor of decline in renal function in older community-dwelling adults.     

An empirical evaluation of social support and psychological well-being in older Chinese and Korean immigrants

Objectives. To examine, among older Chinese and Korean immigrants: (1) the concept and measurement of perceived social support; (2) levels of social support and psychological well-being by living arrangement; and (3) whether social support is positively related to psychological well-being.

Design. A convenience sample of 200 self-identified Chinese and Koreans, aged 65 years and older, were interviewed. Psychometric analysis was conducted to examine the reliability and validity of a new social support measure. Bivariate and multivariate analyses were used to examine the relationship between social support and psychological well-being.

Results. Factor analysis revealed a four-factor solution of social support and adequate psychometrics of all social support scales was found. Multivariate results suggest that Koreans have more depression than Chinese (p?

Conclusions. A new multidimensional social support measure for use with older Chinese and Koreans could be useful upon further validation. These results suggest that older Chinese and Koreans’ psychological well-being may be negatively affected when they live with their adult children. More depression in Koreans may be related to difficulties in expanding their social network beyond Korean-speaking people.     

Evaluation of BioThrax® and AV7909 anthrax vaccines in adults 66 years of age or older

BackgroundMultiple Anthrax vaccines are licensed or in development for post-exposure prophylaxis in individuals 18 to 65 years of age. No information exists on anthrax vaccines in populations over the age of 65. It is critical that we assess the capacity of anthrax vaccines to generate a protective immune response in older individuals. In this study, we compared BioThrax® to a formulation containing a CpG adjuvant (AV7909).MethodsWe conducted a Phase 2 clinical study to evaluate safety and immunogenicity of three vaccination schedules of the AV7909 vaccine candidate and one vaccination schedule of BioThrax® vaccine in adults over 65 years of age. A total of 305 subjects were enrolled to assess safety and immunogenicity by seroprotection rates, toxin neutralizing antibody titers, and anti-Protective Antigen ELISA titers.ResultsCompared to BioThrax, AV7909 elicited a more robust immune response in older subjects, especially with three doses of AV7909 at Days 1, 15, and 29, or two doses at Days 1 and 29. These trends were true with both seroprotection rates as defined by the percentage of subjects with 50 percent neutralization factors greater than 0.56, and geometric mean antibody titers. The responses to both AV7909 and BioThax were lower in older subjects compared to those aged 18–50.ConclusionThe immunogenicity data suggest that the CpG adjuvant in the AV7909 vaccine helps to elicit a more robust immune response in subjects over the age of 65. Alternative dosing strategies may be considered in this population given the high seroprotection rates with Day 1 and 29, or Day 1, 15, and 29 regimens.Trial Registration: clinicaltrials.gov Identifier: NCT03518125.     

2014年中国40岁及以上人群肺功能检查率调查与分析

目的 了解中国≥40岁居民肺功能检查状况及其分布特征,为完善COPD综合防控策略与措施,评价综合防控效果提供依据。方法 对象来源于2014－2015年中国居民COPD监测调查,该监测覆盖中国31个省（自治区、直辖市）的125个监测县/区,采用多阶段分层整群抽样,共调查≥40岁常住居民75 107人,以面对面询问调查方式收集调查对象既往肺功能检查情况。对样本进行复杂抽样加权,估计≥40岁居民肺功能检查率及其95% CI。结果 74 591名调查对象纳入分析。中国≥40岁居民肺功能检查率为4.5%（95% CI：3.7%～5.2%）,男性高于女性（P<0.001）,城镇高于乡村（P<0.001）,且随居民文化程度增高呈上升趋势（P<0.001）。在职业分布中,离退休人员的肺功能检查率最高为10.8%（95% CI：8.2%～13.3%）,农林牧渔水利行业人群肺功能检查率最低为2.4%（95% CI：2.0%～2.9%）。有慢性呼吸系统疾病史、有呼吸道症状的居民肺功能检查率较高,分别为13.4%（95% CI：10.5%～16.4%）、15.0%（95% CI：10.5%～19.4%）。曾经吸烟者肺功能检查率为7.4%（95% CI：6.0%～8.8%）,略高于现在吸烟和从不吸烟者,分别为4.7%（95% CI：3.9%～5.5%）和3.9%（95% CI：3.0%～4.7%）。在不同特征人群中,小学以下文化程度的乡村居民肺功能检查率最低（1.8%,95% CI：1.2%～2.3%）,有呼吸道症状的城镇居民肺功能检查率最高（20.2%,95% CI：12.6%～27.8%）。结论 中国≥40岁居民肺功能检查水平极低,应采取有效措施,通过多种途径提高其肺功能检查率。     

Difficulties in recruiting older people in clinical trials: An examination of barriers and solutions

Limited information exists regarding optimal methods for the recruitment and retention of older people in clinical trials. The aim of this review is to identify common barriers to the recruitment of older people in clinical trials and to propose solutions to overcome these barriers. A review of literature was performed to identify common difficulties in recruiting older people. This in combination with our experience during recruitment for a randomized control trial, have highlighted numerous barriers. Population-specific recruitment strategies, simple informed-consent processes, and effective communication between the researcher and subject are effective strategies to overcome these barriers.     

Efficacy and immunogenicity of high-dose influenza vaccine in older adults by age,comorbidities, and frailty

BackgroundA randomized trial demonstrated that a high-dose inactivated influenza vaccine (IIV-HD) was 24.2% more efficacious than a standard-dose vaccine (IIV-SD) against laboratory-confirmed influenza illness in adults ≥65 years. To evaluate the consistency of IIV-HD benefits, supplemental analyses explored efficacy and immunogenicity by baseline characteristics of special interest.MethodsDouble-blind, randomized, active-controlled, multicenter trial. Adults ≥65 years were randomized 1:1 to receive IIV-HD or IIV-SD and followed for 6–8 months postvaccination for the occurrence of influenza. One third of participants were randomly selected to provide sera for measurement of hemagglutination inhibition antibody (HAI) titers. Efficacy (IIV-HD vs. IIV-SD) against laboratory-confirmed, protocol-defined influenza-like illness (PD-ILI) and HAI geometric mean titer (GMT) ratios (IIV-HD/IIV-SD) were evaluated by age, and number of high-risk comorbid and frailty conditions.ResultsEfficacy (95% confidence intervals) of IIV-HD relative to IIV-SD against laboratory-confirmed PD-ILI was 19.7% (0.4%; 35.4%) for participants 65–74 years, 32.4% (8.1%; 50.6%) for those ≥75 years, 22.1% (3.9%; 37.0%) for participants with ≥1 high-risk comorbidity, 23.6% (−3.2%; 43.6%) for those with ≥2 high-risk comorbidities, 27.5% (0.4%; 47.4%) for persons with 1 frailty condition, 23.9% (−9.0%; 47.2%) for those with 2 frailty conditions, and 16.0% (−16.3%; 39.4%) for those with ≥3 frailty conditions. There was no evidence of vaccine efficacy heterogeneity within age, comorbidity, and frailty strata (P-values 0.351, 0.875, and 0.838, respectively). HAI GMT ratios were significantly higher among IIV-HD recipients for all strains and across all subgroups.ConclusionsEstimates of relative efficacy consistently favored IIV-HD over IIV-SD. There was no significant evidence that baseline age, comorbidity, or frailty modified the efficacy of IIV-HD relative to IIV-SD. IIV-HD significantly improved HAI responses for all strains and in all subgroups. IIV-HD is likely to provide benefits beyond IIV-SD for adults ≥65 years, irrespective of age and presence of comorbid or frailty conditions.