The Influence of Older Adults' Activity Selection on Their Progeny's Expectations for Their Own Future

Progeny of Suburban Senior Club Members were interviewed to ascertain their perceptions of their parents' retirement and predictions for their own later lives. Interrelationships among the parents and their children with respect to leisure choices are presented as well as motivational considerations for future research. Parental modelling has implications for provision of services to older adults of the future.     

Living Arrangements of Older Women and Men in Kuwait

The main objectives of this article are toanalyze the correlates of living arrangementsof persons aged 60 or above in the oil-rich,Muslim country of Kuwait and to examine whetheror not patterns of co-residence differ bygender. Data were obtained from a nationallyrepresentative survey of households of Kuwaitinationals, and this paper is based on the 687older Kuwaiti residents of these households.Living arrangements were generally similar forwomen and men. Eighty nine percent of women and94 percent of men co-reside in households with atleast one son or daughter. Only 0.3 percent of menand 1.9 percent of women live alone.Socio-demographic characteristics of women andmen differed significantly; 58 percent of women werewidowed compared with 5 percent of men. Logisticregression analysis showed that women had twotimes higher odds than men of living withouttheir children. The odds of residing withoutchildren also increased with the respondent'sage and education but decreased with increasingwealth. Continued rapid demographic,socioeconomic, and cultural change in Kuwaitforetells continued decline in co-residencewith children, and the implications of suchchange in a small city-state merits furtherresearch.     

Care Needs and Caregivers: Associations and Effects of Living Arrangements on Caregiving to Older Adults in India

As the ageing phenomenon continues in India, we explore the care needs of older adults and identify caregivers for specific care needs across living arrangements. Using the United Nations Population Fund (UNFPA) conducted Building Knowledge Base on Population Ageing in India (BKPAI 2011) data comprising 9850 older adults, we employed statistical methods to analyze the data, find associations and used binary logistic regression to model the adjusted and unadjusted effects of living arrangements on caregiving to older adults for specific care needs. Care-requiring situations considered were acute sickness, sickness requiring hospitalization, chronic morbidity, functional disability represented by ADL and IADL limitations, and locomotor disability. Results indicate that living arrangements of older adults were significantly associated with health, functional status and disability as well as caregiving patterns. Our results suggest that co-residence with children and all others was beneficial to older adults in obtaining care from a family caregiver for their hospitalization and chronic morbidity needs while living with spouse or living with a partner was advantageous for older adults in receiving care for their ADL limitations and during hospitalizations. Mean number of children was also significantly associated with the availability of a caregiver during hospitalization, locomotor disability, chronic morbidity and acute sickness. The study also highlights a little known phenomenon, that there was familial help available to older adults who lived alone. Notably, non-family sources of caregiving were steadily becoming visible (as high as 8–10 % of the caregiving component) especially among older adults living alone.     

Traditional Expectations Versus US Realities: First- and Second-Generation Asian Indian Perspectives on End-of-Life Care

BACKGROUND  

Although end-of-life care preferences vary across racial/ethnic groups, little is known about how cultural values affect end-of-life care preferences among South Asian immigrants and their offspring in the US.     

Late Life Immigration and Quality of Life among Asian Indian Older Adults

Late-life immigration among seniors for purposes of family reunification is a growing phenomenon in developed countries. Using the World Health Organization’s Quality of Life instrument short form (WHOQOL-BREF) and other psychosocial measures related to the political/legal context of immigration, and personal and environmental autonomy (mastery, immigration status, access to transportation, and language barrier), this study examined quality of life (QoL) in Asian Indian seniors (N = 109), who immigrated to the United States to reunite with their adult children. The sample scores on Overall QoL and QoL domains (physical and psychological health, social relationships, and environment) were similar to established norms. Although all QoL domains correlated significantly with Overall QoL at the bivariate level, multivariate analysis showed that only environmental domain contributed significantly to Overall QoL. Linear regressions indicated: Mastery contributed significantly to Overall QoL and all QoL domains; access to transport contributed to Overall QoL, physical health, and environmental QoL; immigration status (a proxy for political/legal context) contributed to environmental QoL whereas language barrier contributed to none. Implications for improving perceptions of QoL, mastery, access to transport and other services are discussed.     

End of Life Care for Older Russian Immigrants - Perspectives of Russian Immigrants and Hospice Staff

This pilot study examined immigrant Russian seniors and adult children’s views on end-of-life care, and hospice staff members’ experiences providing care to diverse immigrant clients, in areas of North Carolina with a high proportion of immigrants. Data were collected through individual in-depth interviews with informants, including Russian immigrant seniors, Russian adult children, and hospice staff, and analyzed by qualitative techniques. Findings indicate that there is little awareness of end-of-life care options among the Russian immigrant community in North Carolina. End-of-life care is rarely discussed within the family of first generation Russian immigrants but second-generation families are more open to doing so. First generation immigrant Russian seniors in our study do not seem to want any specialized end-of-life care often due to lack of awareness, and prefer family care. Second generation seniors’ attitudes are more accepting of this type of care. Hospice staff serve all those who seek care, receive training to serve diverse clients, and prioritize professional policies. There is sometimes potential for a gap between hospice policies regarding care and immigrant families’ expectations for care. Results suggest a great need for community outreach to immigrant groups to raise awareness of end-of-life care, including advance directives and hospice care and the role of interpreters in health care settings.     

Preferences of Physicians and Their Patients for End-of-Life Care

OBJECTIVE: Both physicians and patients view advance directives as important, yet discussions occur infrequently. We assessed differences and correlations between physicians' and their patients' desires for end-of-life care for themselves. MEASUREMENTS AND MAIN RESULTS: Study physicians (n = 78) were residents and faculty practicing in an inner-city, academic primary care general internal medicine practice. Patients (n = 831) received primary care from these physicians and were either at least 75 or between 50 and 74 years of age, with selected morbid conditions. Physicians and patients completed identical questionnaires that included an assessment of their preferences for six specific treatments if they were terminally ill. There were significant differences between physicians' and patients' preferences for all six treatments (p < .0001), with physicians wanting less treatment than their patients for five of them. Patients desiring more care (p < .01) were more often male (odds ratio [OR] 1.7), African-American (OR 1.6), and older (OR 1.02 per year). There were no such correlates with physicians' preferences. A treatment preference score was calculated from respondents' desires to receive or refuse the six treatments. Physicians' scores were highly correlated with those of their enrolled primary care patients (r = .51, p < .0001). CONCLUSIONS: Although patients and physicians as groups differ substantially in their preferences for end-of-life care, there was significant correlation between individual academic physicians' preferences and those of their primary care patients. Reasons for this correlation are unknown.     

Immigration and Acculturation: Impact on Health and Well-Being of Immigrants

Among migrants who arrived in the USA and Europe, communicable diseases such as dermatologic, gastrointestinal, and respiratory infections are frequent; non-communicable diseases including chronic diseases such as hypertension and diabetes, and vaccine-preventable diseases are also prevalent. Refugees are often not up to date on routine immunizations and screenings for chronic diseases and cancer. In addition, many immigrants have trauma-related mental health problems, which are often not addressed by the healthcare systems where they reside. Determining the healthcare needs of specific immigration groups should lead to the establishment of evidence-based guidelines for providing screening and healthcare services to immigrant populations, for the benefit of the individuals concerned, as well as the host countries.     

Impact of Malnutrition on Hospitalization Outcomes for Older Adults Admitted for Sepsis

BackgroundMalnutrition is a major determinant of health outcomes among the older adult population. Our goal was to evaluate the impact of malnutrition on hospitalization outcomes for older adults who were admitted with a diagnosis of sepsis.MethodsThe National Inpatient Sample was queried for all patients who were admitted with a primary diagnosis of sepsis from January to December 2016. These patients were identified using the International Classification of Diseases, Tenth Revision (ICD-10) diagnosis code A419. Patients who were diagnosed with malnutrition were identified using ICD-10 codes E43, E440, E441, E45, and E46. Outcomes of hospitalization were modeled using logistic regression for binary outcomes and generalized linear models for continuous outcomes.ResultsOverall, a total of 808,030 patients were admitted for sepsis. Those diagnosed with malnutrition were 15.6% (126,335) of the total. The mean age (standard error of the mean) was 78 years (0.03). On multivariate analysis, malnutrition correlated with increased odds for mortality: adjusted OR (aOR) 1.20; 95% confidence interval [CI], 1.15-1.26; P < .001; septic shock: aOR 1.50; 95% CI, 1.44-1.57; P < .001; and intubation: aOR 1.45; 95% CI, 1.38-1.52; P < .001. It was also associated with higher odds for acute kidney injury and stroke. Malnutrition correlated with a 53% increase in the length of stay, with mean ratio 1.53; 95% CI, 1.51-1.56; P < .01; and a 54% increase in cost, with mean cost ratio 1.54; 95% CI, 1.51-1.58; P < .001.ConclusionAmong the geriatric population diagnosed with sepsis, malnutrition is an independent predictor for poor hospitalization outcomes.     

Characteristics and Impact of Life Turning Points for Older Adults

This research examines the characteristics of turning points, events considered as being significant in one’s life. One hundred and forty-nine turning points, as reported by 53 older adults were investigated. They were characterized according to: age at occurrence of turning point, domain, specific or thematic nature, and areas of functioning on which the turning point had an impact. Compared to men, women reported significantly more turning points related to the health domain. Turning points were distributed through the life span, with some concentration at midlife. Family was the sphere most influenced by turning points. The different domains of turning points corresponded to the specific spheres of impact. Turning points were more often related to discrete events than to a series of events clustered under a theme. Identity and social role processes appear most influential in leading older adults to identify particular life circumstances as turning points in their lives.

The Impact of Older Age and Sex on Motion Discrimination

Background/Study Context: Reports of age-related differences on motion discrimination tasks have produced inconsistent findings concerning the influence of sex. Some studies have reported that older women have higher thresholds than older men, with others finding that women have higher motion thresholds regardless of age group. Reports of the age at which declines in motion discrimination first occur also differ, with some studies reporting declines only in groups aged over 70 years, with others reporting that age-related decline occurs at a younger age. The current study aimed to determine whether the sex differences found occur because relative to men, women have greater difficulty extracting motion signals from noise (Experiment 1) or have greater difficulty making use of the available motion cues (Experiment 2) in these complex moving stimuli. In addition, the influence of these manipulations on groups aged under and over 70 years was explored.

Methods: Motion discrimination measures were obtained using 39 older adults aged between 60 and 85 years (21 women) and 40 younger adults aged between 20 and 45 years (20 women). In Experiment 1, coherent motion and relative motion displacement thresholds were obtained. In Experiment 2, coherent motion thresholds were obtained for stimuli containing either 150 or 600 dots.

Results: In Experiment 1, the older group had significantly higher thresholds on the relative motion displacement and coherent motion tasks than a younger group. No differences in motion sensitivity were found in the older groups aged under or over 70 years. Women regardless of age group had significantly higher thresholds than men on both tasks. In Experiment 2, the older group had higher coherence thresholds than the younger group, and the number of dots presented had no influence on thresholds, for the older group or older women specifically. In the younger group, women had higher coherence thresholds than men with presentation of 150 but not 600 dots. There were 51% of the older group who showed evidence of age-related decline on all the motion coherence tasks conducted, with half of these in each the group aged under and over 70 years.

Conclusion: Difficulties with noise exclusion failed to explain the sex differences found. The increased number of motion cues present when a larger number of dots were included was sufficient to reduce coherence thresholds in younger women but not older men or women. In addition to age, developmental history and sex may provide further predictors in older individuals of decline on measures of motion discrimination.     

Influences on Care Preferences of Older People with Advanced Illness: A Systematic Review and Thematic Synthesis

Objectives

To determine and explore the influences on care preferences of older people with advanced illness and integrate our results into a model to guide practice and research.

Design

Systematic review using Medline, Embase, PsychINFO, Web of Science, and OpenGrey databases from inception to February 2017 and reference and citation list searching. Included articles investigated influences on care preference using qualitative or quantitative methodology. Thematic synthesis of qualitative articles and narrative synthesis of quantitative articles were undertaken.

Setting

Hospital and community care settings.

Participants

Older adults with advanced illness, including people with specific illnesses and markers of advanced disease, populations identified as in the last year of life, or individuals receiving palliative care (N = 15,164).

Measurements

The QualSys criteria were used to assess study quality.

Results

Of 12,142 search results, 57 articles were included. Family and care context, illness, and individual factors interact to influence care preferences. Support from and burden on family and loved ones were prominent influences on care preferences. Mechanisms by which preferences are influenced include the process of trading‐off between competing priorities, making choices based on expected outcome, level of engagement, and individual ability to form and express preferences.

Conclusion

Family is particularly important as an influence on care preferences, which are influenced by complex interaction of family, individual, and illness factors. To support preferences, clinicians should consider older people with illnesses and their families together as a unit of care.     

Drugs of Abuse and Their Impact on Viral Pathogenesis

Commonly misused substances such as alcohol, cocaine, heroin, methamphetamine, and opioids suppress immune responses and may impact viral pathogenesis. In recent years, illicit use of opioids has fueled outbreaks of several viral pathogens, including the human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV). This review focuses on the myriad of mechanisms by which drugs of abuse impact viral replication and disease progression. Virus–drug interactions can accelerate viral disease progression and lead to increased risk of virus transmission.     

The Impact of Marital Status and Gender on Leisure Values of Older Adults

The ability to provide leisure programming in senior living environments is critical to older adults’ quality of life and successful aging. In this cross-sectional study, using social behavior theory as a foundation, 128 older adults who reside in a senior living environment completed a survey to identify leisure values with a focus on marital status and gender. An independent t-test found that older men and women of all marital statuses value leisure for physiological and aesthetic reasons. In addition, older women and widows value leisure for social reasons more than men and other marital statuses. Implications for designing leisure programs are discussed.     

The Effects of Religious Participation and Familial Assistance on Mental Health among Older Chinese and Korean Immigrants: Multiple Mediator Analyses

Older Asian immigrants are one of the fastest growing segments of the U.S. population and a growing number of them reside in non-traditional destination cities. However, there is a paucity of research on older Asian immigrants living in these non-traditional destination cities, and how this residential choice impacts their stress and mental health. In the current study, we examined how stressors and social support contribute to the overall mental health of older Asian immigrants who lack access to culturally responsive formal social support services. Using a convenience sample of older Chinese (n?=?120) and Korean (n?=?118) immigrants living in Arizona, we conducted multiple mediator analyses, focusing specifically on how ethnicity would differentially influence mediating effects of religious participation and familial assistance in the relationships between physical/acculturative stressors and mental health outcomes. The results showed that among older Chinese immigrants, religious participation significantly mediated the relationships between both physical/acculturative stressors and mental health, while there was no significant mediation effect detected among older Korean immigrants. Although Asian Americans are often perceived as a monolithic homogeneous group, the multiple mediator models suggest significant differences in the use of cultural/information resources in coping with life stressors and their impact on mental health outcomes between the older Chinese and Korean immigrants in our study. The study findings suggest a need for developing and strengthening formal social services in non-traditional destination cities that are culturally and linguistically responsive to those older Asian immigrants.     

Everyday Challenges in Context: The Influence of Contextual Factors on Everyday Problem Solving Among Young,Middle-Aged,and Older Adults

The authors examined the experimental effects of social context on everyday problem–solving performance by older, middle-aged, and younger adults. Participants were presented with six everyday problems constructed by framing two behavioral challenges in social contexts representative of the lives of older, middle-aged, and younger adults. As predicted, participants performed best when problems were situated in contexts representative of their own age group. Older adults also outperformed the other age groups on problems set in older adult contexts, suggesting that when problems are set in ecologically relevant contexts, one may not observe previously reported age-related declines in performance.     

The Impact of Dyspepsia Definition on Prevalence Estimates: Considerations for Future Researchers

Background: The role of Helicobacter pylori infection in functional dyspepsia is still controversial, and subgroups of patients with functional dyspepsia who may benefit from H. pylori eradication should be identified. Patients with functional dyspepsia and antrum‐predominant H. pylori‐positive chronic gastritis, it has been argued, have fewer symptoms after eradication therapy. In the present study, we analysed the clinical significance of antrum‐predominant gastritis on the long‐term prognosis of functional dyspepsia. Methods: Consecutive unselected dyspeptic patients were investigated in primary care and the patients with functional dyspepsia were enrolled in this long‐term follow‐up study. Altogether 182 patients were recruited: 65 with normal histology of the stomach, 36 with antrum‐predominant gastritis, 21 with corpus‐predominant gastritis and 60 with pangastritis. Patients' medical histories were reviewed after 6 to 7 years, with total number and outcome of repeated investigations analysed. At the end of follow‐up, all patients were invited for voluntary gastroscopy. Results: At the end of follow‐up, the proportion of asymptomatic patients ranged from 21% (normal histology) to 26% (antrum‐predominant gastritis). No statistically significant differences between groups appeared in regard to re‐visits or to proportion of patients examined by sigmoideo‐ or colonoscopy during follow‐up. Patients with antrum‐predominant gastritis less often underwent upper endoscopy. Peptic ulcer was more frequent (P?=?0.05) in patients with antrum gastritis than in other groups, but no other differences existed among any organic gastrointestinal findings. No significant differences between subgroups appeared among the 30% of patients using drugs for upper abdominal complaints during the previous year. Conclusions: Functional dyspepsia has an excellent long‐term prognosis. Antrum‐predominant gastritis in functional dyspepsia seems to carry an increased risk for peptic ulcer, and for this group in particular, H. pylori eradication should be considered. This finding requires confirmation in future studies performed in primary care.     

Heterogeneous phenotypes of insulin resistance and its implications for defining metabolic syndrome in Asian Indian adolescents

OBJECTIVE: To assess the phenotypic correlations of insulin resistance with obesity and its relationship with the metabolic syndrome in Asian Indian adolescents. DESIGN AND SUBJECTS: We analyzed clinical, anthropometric (body mass index [BMI], waist circumference [WC]) and laboratory (fasting blood glucose [FBG], lipids and fasting serum insulin) data from 793 subjects (401 males and 392 females) aged 14-19 years randomly selected from Epidemiological Study of Adolescents and Young (ESAY) adults (n=1447). The percentile cut-offs for 14-19 years age from ESAY cohort were used for defining abnormal values of variables. We devised three sets of definitions of metabolic syndrome by including BMI and fasting insulin levels with other defining variables. RESULTS: Nearly 28.9% of adolescents had fasting hyperinsulinemia despite normal values of BMI, WC, FBG, lipids, and blood pressure. Remarkably, NCEP criteria with appropriate percentile cut-off points for Asian Indian adolescents identified metabolic syndrome in only six (0.8%) subjects. Inclusion of both BMI and WC in the definition resulted in increase in the prevalence of metabolic syndrome to 4.3%. With inclusion of hyperinsulinemia, the prevalence of metabolic syndrome increased to 4.2% (from 0.8%) in the modified NCEP definition, 5.2% (from 0.9%) when BMI was substituted for WC, and 10.2 (from 4.3%) when both BMI and WC were included. CONCLUSIONS: Our data show marked heterogeneity of phenotypes of insulin resistance and poor value of NCEP definition to identify metabolic syndrome. We propose that BMI and fasting insulin should be evaluated in candidate definitions of metabolic syndrome in Asian Indian adolescents.