Validation of the Geriatric Anxiety Inventory in Chilean older people

ObjectiveCurrently in Chile there is a lack of validated tools for measuring anxiety in the elderly population. Considering this, the purpose of this study was to validate the Geriatric Anxiety Inventory (GAI) in the country.MethodAn analysis of the psychometric properties of the GAI was carried out, using a non-clinical sample of 301 older adults in the Metropolitan and Valparaíso regions of Chile. Older people were asked about anxiety, rumination, depression, well-being and sociodemographic data.ResultsAn excellent internal reliability was obtained with a Cronbach score of 0.931. An adequate convergent validity was observed with the Depression scales (CES-D) (Rho = 0.549, p < .01), Rumination (RSS) (Rho = 0.618; p < 0.01) and Experiential avoiding (Rho = 0.485; p < 0.01). On the other hand, the discriminant validity of the psychological well-being scale presented a negative correlation of Rho = -0.699 (p < 0.01). Finally, and Exploratory Factor Analysis was made, revealing a one-dimensional model of the instrument.ConclusionThe Geriatric Anxiety Inventory has very good psychometric properties measuring anxiety in elderly people, being an adequate instrument for the screening of anxiety on this population.     

Inpatient healthcare‐associated bloodstream infections in older people

This retrospective study describes inpatient healthcare‐associated bloodstream infections (HABSI) in older adults and explores whether urinary catheters (presence/insertion/removal) were related to HABSI events. One hundred and sixty‐seven HABSI events were identified, predominantly (124, 74%) with Gram‐negative bacteria. HABSI was attributed to a urinary source in 110 patients (66%), with over half (63, 57%) of these associated with urinary catheters. Catheter‐associated HABSI may be avoidable and potential preventative strategies are discussed.     

Determination of the costs of falls in the older people according to the decision tree model

Purpose of the researchThe primary aim of this study is to hypothetically examine the costs of falls experienced by the older people living in the community and fall prevention interventions implemented by nurses using the decision tree model. The secondary purpose of the study is to determine the factors affecting the cost of falls.The materials and methodsThis study was planned as a costing and cost-effectiveness study. Two thousand seventy-five patient files were examined by following the research criteria. In the present study, a hypothetical analytical decision tree model was used. Three different scenarios were set up in the study, and the decision tree analyses were performed according to these scenarios. Falls will decrease by 12 % in the pessimistic scenario, by 27 % in the optimal scenario, and by 39 % in the optimistic scenario. The SPSS 22.0 (2014) and TreeAge Pro Suit (2009) programs were used for data analysis.The principal resultsThe average cost for a person admitted to a hospital due to falls was $396.51 ± $1429.35.It was determined that costs varied according to the type of the injury.The results of this present study demonstrated that the three scenarios tested were costly but also more effective. Hence, the applicability of these interventions should be considered by policy makers taking both the costs and effectiveness into account.Major conclusionsMultidisciplinary research should be carried out in order to increase the effectiveness of the fall prevention programs to be implemented in the future, and multifaceted fall prevention programs should be developed.     

Use of pain relieving drugs in community-dwelling older people with and without type 2 diabetes

AimsTo analyze the use of pain medication among community-dwelling people aged 65 years or older with and without type 2 diabetes in primary care.MethodsA total of 187 patients with and 176 patients without diabetes were randomly selected from a primary care sample of 389 patients with diabetes and 604 age- and gender-matched controls. Pain status was defined as no pain, nociceptive pain or neuropathic pain. Pain medication (paracetamol, NSAID, opioids, neuropathic pain medication) use was based on electronic patient records and checked by a physician during a health examination.ResultsSome pain was present in 90 (51%) patients without and in 106 (57%) patients with diabetes (p = 0.55). Of the patients without diabetes, 109 (62%) and with diabetes 123 (66%) used some pain medication (p = 0.45). The respective proportions for the regular use were 13% and 11% and for the as needed use 56% and 61%. Diabetes was not associated with any of the pain medications used. The use of pain-relieving drugs was most common for neuropathic pain.ConclusionsThe present study indicated that community-dwelling people with and without diabetes used pain medication similarly. Pain medication was used mostly as needed instead of being regular.     

Health related quality of life and its associated factors among community-dwelling older people in Sri Lanka: A cross-sectional study

BackgroundPopulation ageing has become a public health issue as it is associated with increased morbidity, institutionalization and death. These may directly affect health-related quality of life (HRQOL) of older people.PurposeThe aim of the study was to investigate HRQOL and its associated factors among community-dwelling older people in Kandy district, Sri Lanka.MethodThis cross-sectional survey involved 1300 older people. The Euro 5D-3L, International Physical Activity Questionnaire, body mass index, handgrip strength were used to measure HRQOL, physical activity and nutritional status of older people respectively. Factors associated with health-related quality of life were identified through complex sample logistic regression analysis.ResultsMajority of older people (81.9%) reported poor health-related quality of life. Middle old (aOR: 12.06, 95% CI: 5.76, 25.23), very old (aOR: 174.74, 95% CI: 39.74, 768.38), vegetarian diets (aOR: 2.13, 95% CI: 1.14, 3.96), under-nutrition (aOR: 3.41, 95% CI: 1.65, 7.04) and over-nutrition (aOR: 1.85, 95% CI: 1.04, 3.28) were significantly associated with poor HRQOL. Using dentures (aOR: 0.05, 95% CI: 0.28, 0.90) was found as a protective factor for poor HRQOL.ConclusionsHRQOL was poor among community-dwelling older people in Kandy district. Nutrition-related factors need to be further investigated to improve HRQOL among older people.     

Factors associated with consistent condom use by employees in the brewery industry in Nigeria

Many employees of large organisations in Nigeria face significant risks for HIV infection, especially due to occasional or regular job transfers, involvement in casual sexual encounters and lack of consistent condom use. The current study analysed the determinants of consistent condom use in 710 sexually active men (N = 617) and women (N = 93) recruited from the country's brewery industry. Results showed that only 12% of the employees consistently used a condom. Men who used condoms for all sexual encounters were more likely to be single, had 12 – 18 years of schooling, worked as intermediate level staff, thought a condom was useful to prevent HIV infection, and perceived that condoms hinder sexual satisfaction. Women who consistently used condoms were more likely to have 7 – 12 years of schooling. It is appropriate that brewery authorities develop work place programmes to enhance condom use among employees in order to prevent the spread of HIV infection.     

Cancer risk in older people receiving statin therapy: a meta-analysis of ran-domized controlled trials

Background Although statins are well tolerated by most aged people, their potential carcinogenicity is considered as one of the biggest factors limiting the use of statins. The aim of the present study was to determine the risk of cancer in people aged over 60 years receiving statin therapy. Methods A comprehensive search for articles published up to December 2015 was performed, reviews of each randomized controlled trials (RCTs) that compared the effects of statin mono-therapy with placebo on the risk of cancer in people aged > 60 years were conducted and data abstracted. All the included studies were evaluated for publication bias and heterogeneity. Pooled odds ratios (OR) estimates and 95% confidence intervals (CIs) were calculated using the random effects model. Results A total of 12 RCTs, involving 62,927 patients (31,517 in statin therapy group and 31,410 in control group), with a follow-up duration of 1.9–5.4 years, contributed to the analysis. The statin therapy did not affect the overall incidence of cancer (OR = 1.03, 95% CI: 0.94–1.14, P = 0.52); subgroup analyses showed that neither the variety nor the chemical properties of the statins accounted for the incidence of cancer in older people. Conclusions Our meta-analysis findings do not support a potential cancer risk of statin treatment in people over 60 years old. Further targeted researches with a longer follow-up duration are warranted to confirm this issue.     

Interaction of central obesity and sarcopenia on nutritional status in the community-dwelling older people

ObjectivesTo investigate the interrelationships between central obesity, sarcopenia and nutritional status in the elderly.MethodsWe enrolled 501 elderly (women: 47.5 %) with complete datasets. Biochemical and anthropometric data were measured after an overnight fast. Basic characteristics, psychosocial and behavioral factors, nutritional status, and history of chronic disease came from structured questionnaires. Central obesity was defined as waist circumference ≥ 90 cm for men, ≥ 80 cm for women. Sarcopenia was defined by the Asian consensus. Nutritional status was assessed using Mini Nutritional Assessment scores: abnormal nutritional status ≤ 23.5. Multiple logistic regression analysis was done to determine the independent factors of an abnormal nutritional status.ResultsNinety (18.0 %) participants had an abnormal nutritional status, 300 (59.9 %) had central obesity, 52 (10.4 %) sarcopenia and 3 (0.6 %) sarcopenic obesity. Central obesity (OR = 0.455, 95 % CI: 0.244-0.847) and total lymphocyte count (OR = 0.526, 95 % CI: 0.315-0.880) were negatively and sarcopenia (OR = 3.170, 95 % CI: 1.485–6.767), current smoking (OR = 4.071, 95 % CI: 1.357–12.211), and total number of chronic diseases (OR = 1.484, 95 % CI: 1.234–1.785) were positively associated with abnormal nutritional status. An analysis of the combine effects of central obesity and sarcopenia on nutritional status showed that significantly fewer participants with central obesity but not sarcopenia had abnormal nutrition than participants with sarcopenia with or without central obesity (12.8 % vs 38.5 or 65.4 %, p < 0.001).ConclusionsCentral obesity and sarcopenia were interactively associated with the nutritional status of older people living in a rural community.     

Glucose monitoring in new users of second-generation antipsychotics in older people

ObjectiveTreatment guidelines published world-wide have highlighted concerns of increased metabolic risks associated with second-generation antipsychotics (SGAs).The aim of the study was to evaluate blood glucose monitoring rates for SGA new users in older people aged 65 years and above during the study period 2006–2012, and investigate the pre-post 2007 Best Practice Advocacy Centre’s (bpac^nz) glucose monitoring recommendation in New Zealand.MethodsThe study was a population-based retrospective cohort of SGA new users (365 days without pre-exposure to antipsychotics). Pharmaceutical collections data were extracted and used to identify older people dispensed SGAs and linked to the National Minimum Dataset and Laboratory Claims collection. WHO Methodology’s Anatomical Therapeutic Chemical method’s classification was used to characterise the SGAs dispensed.ResultsOf the 25,603 new users dispensed SGAs, 63.5% received glycaemic control monitoring at least once during the study period. Of these, only 20.1% were monitored at baseline, 38.7% were monitored for glycaemic control within the first 90 days. Glycaemic control monitoring within the first 180 days increased to more than half (57.5%) of the SGA new users. Proportion of individuals monitored were independent (χ² = 6.1; P = 0.4) of pre-post bpac^nz recommendation.ConclusionsBlood glucose monitoring was underutilized in new SGA users. No significant improvement in glycaemic control monitoring was observed after the 2007 bpac^nz consensus statement release at baseline, 90 days and at 180 days. Prescribers must be cautioned about the metabolic risks posed by SGAs and recommend glycaemic control monitoring.     

Social exclusion of older people in deprived urban communities of England

Addressing the causes and consequences of social exclusion represents a key theme in European social policy, reflecting growing awareness of the social costs which arise when individuals, families and communities become cut off from wider society. Conceptually, however, social exclusion remains underexplored in gerontology. The article suggests that exclusion represents a useful means of exploring the situation of older people in different environmental settings. Social exclusion in old age is conceptualised as a multi-dimensional phenomenon comprising of: exclusion from material resources; exclusion from social relations; exclusion from civic activities; exclusion from basic services; and neighbourhood exclusion. Drawing on a survey of 600 people aged 60 and over in deprived neighbourhoods of three English cities, the article develops indicators to represent each dimension of exclusion and seeks to assess the nature of social exclusion faced by older people in deprived neighbourhoods. Results reveal a considerable proportion of older people experiencing social exclusion in at least one form. The sample fell into three categories: 33% were not excluded on any of the five domains; 31% experienced exclusion on a single domain; 36% were vulnerable to the cumulative impact of multiple forms of exclusion. Multiple social exclusion was significantly correlated with respondents ethnic origin, educational status, housing tenure, perceived health status and quality of life. It is concluded that social exclusion represents a useful means of depicting disadvantage experienced by older people living in deprived urban neighbourhoods, and that it would be useful to extend the analysis to other types of residential setting.     

Factors influencing safe glucose-lowering in older adults with type 2 diabetes: A PeRsOn-centred ApproaCh To IndiVidualisEd (PROACTIVE) Glycemic Goals for older people: A position statement of Primary Care Diabetes Europe

Diabetes in later life is associated with a range of factors increasing the complexity of glycaemic management. This position statement, developed from an extensive literature review of the subject area, represents a consensus opinion of primary care clinicians and diabetes specialists. It highlights many challenges facing older people living with type 2 diabetes and aims to support primary care clinicians in advocating a comprehensive, holistic approach. It emphasises the importance of the wishes of the individual and their carers when determining glycaemic goals, as well as the need to balance intended benefits of treatment against the risk of adverse treatment effects. Its ultimate aim is to promote consistent high-quality care for older people with diabetes.     

Identifying sources of strength: resilience from the perspective of older people receiving long-term community care

This study seeks to explore the sources of strength giving rise to resilience among older people. Twenty-nine in-depth interviews were conducted with older people who receive long-term community care. The interviews were subjected to a thematic content analysis. The findings suggest that the main sources of strength identified among older people were constituted on three domains of analysis; the individual-, interactional and contextual domain. The individual domain refers to the qualities within older people and comprises of three sub-domains, namely beliefs about one’s competence, efforts to exert control and the capacity to analyse and understand ones situation. Within these subdomains a variety of sources of strength were found like pride about ones personality, acceptance and openness about ones vulnerability, the anticipation on future losses, mastery by practising skills, the acceptance of help and support, having a balanced vision on life, not adapting the role of a victim and carpe-diem. The interactional domain is defined as the way older people cooperate and interact with others to achieve their personal goals. Sources of strength on this domain were empowering (in)formal relationships and the power of giving. Lastly, the contextual domain refers to a broader political-societal level and includes sources of strength like the accessibility of care, the availability of material resources and social policy. The three domains were found to be inherently linked to each other. The results can be used for the development of positive, proactive interventions aimed at helping older people build on the positive aspects of their lives.     

Political disempowerment among older people in Hong Kong

The democratic elections that took place in Hong Kong before and after 1997 presented a unique opportunity for older people, politicians and government officials to take action to promote the participation of older people. There were, however, few significant projects undertaken to this end. This paper reports on recent research on political participation of older people in Hong Kong which found that they were active in voting but they were passive in other forms of participation. Factors affecting participation are more significantly related to politicians' mobilization than to civic education or work done by centres for the elderly. In the field, there is little awareness of using more effective strategies to address older people's political powerlessness. Strategies identified include: educational talks in local elderly centres, mock election games and meeting with candidates from different political parties. All these activities were locally based and not well articulated, and there were few concerted efforts to promote the political power and influence of older people at the central level. The present situation of older people in Hong Kong remains one of political powerlessness and the piecemeal strategies used to address the issue have so far had little impact. This paper suggests that political powerlessness is not a natural result of old age. It is a problem which is socially constructed. An analysis of the factors shaping this situation is presented. It also presents some suggested strategies for gerontological practice in promoting political empowerment among older people in Hong Kong.     

Temporal trends in the utilisation of preventive medicines by older people: A 9-year population-based study

BackgroundFor older individuals with multimorbidity the appropriateness of prescribing preventive medicines remains a challenge.ObjectiveInvestigate the prevalence and temporal trends in utilisation of preventive medicines in older New Zealanders from 2005 to 2013 stratified according to age, sex, ethnicity and district health board domicile.MethodsA repeated cross-sectional analysis was conducted on pharmaceutical dispensing data for all individuals’ ≥65 years. Variable medication possession ratio (VMPR) was used to measure adherence. Prescribing of low-dose aspirin, clopidogrel, dipyridamole, warfarin, dabigatran, statins and bisphosphonates with a VMPR ≥ 0.8 were examined.ResultsAspirin utilisation increased by 19.55% (95% CI: 19.39–19.70), clopidogrel by 2.93% (95% CI: 2.88–2.97) and dipyridamole decreased by 0.65% (95% CI: −0.70 to −0.59). Utilisation of aspirin with clopidogrel increased by 1.78% (95% CI: 1.74–1.81) and aspirin with dipyridamole increased by 0.54% (95% CI: 0.50–0.58%).Warfarin decreased by 0.87% (95% CI: −0.96 to −0.78) and dabigatran increased by 0.65% (95% CI: 0.60–0.70). Statins increased by 7.0% (95% CI: 6.82–7.18) and bisphosphonates decreased by 2.37% (95% CI: −2.44 to −2.30). Aspirin, clopidogrel, dabigatran and statins utilisation showed a greater increase in males. Interestingly, clopidogrel, warfarin and statins use increased in older adults aged 85+ compared to the younger age groups (65–84 years).ConclusionTo our knowledge, this is the first study investigating the prevalence and trends of preventive medicines use in older people in New Zealand. This study may facilitate further research to examine the appropriateness of prescribing these medicines in older people with multimorbidity.     

Depression in patients with irritable bowel syndrome in Jos, Nigeria

INTRODUCTION Irritable bowel syndrome (IBS) has been widely studied in the western world and pathophysiologic mechanisms have been available to explain the constellation of symptoms[1]. IBS is a chronic disorder of unknown etiology clinically consisting o…     

The emergence of sedentary behaviour physiology and its effects on the cardiometabolic profile in young and older adults

It has recently emerged that sedentary behaviour is independent of a lack of physical activity as individuals can be sufficiently active, based on the recommended physical activity guidelines, but also spend the majority of their waking hours engaging in sedentary behaviour. Individuals who follow this pattern of physical activity and sedentary behaviour are known as ‘active couch potatoes’. Sedentary behaviour has been found to have detrimental effects on cardiometabolic markers associated with cardiovascular disease. Since the positive effects of moderate-to-vigorous intensity physical activity do not necessarily negate the deleterious effects of sedentary behaviour on cardiometabolic markers, it is postulated that engaging in light physical activity is an intervention that will successfully reduce levels of sedentary behaviour and may hence improve health markers of quality of life. We propose that such lifestyle changes may be particularly relevant to older populations as these engage in sedentary behaviour for the majority of their waking hours, thereby adding to the negative aging effect on cardiometabolic markers.     

Impact of a five-month detraining period on the functional fitness and physical activity levels on active older people

PurposeThis research was aimed at evaluating the effects of a five-month detraining period on the functional fitness level of a group of non-institutionalized and active older adults after taking part in a multi-component training program. A secondary aim was to determine how usual physical activity (PA) levels vary due to cessation of the program.MethodsWe tested sixty-five older people (mean age: 77.1 ± 6.2; 83% women) during the final week of an 8-month multi-component training program and during the first week after its resumption (five months later). We used the senior fitness test and the Minnesota Questionnaire to assess their functional fitness and their PA levels respectively.ResultsWe observed a significant worsening of lower-limb strength (p = 0.008), shoulder range of motion (p = 0.004), and dynamic balance (p < 0.001) once the detraining period was completed. There was a slight downward trend in the remaining functional fitness dimensions, and there were significant differences when comparing the amount of PA estimated at pre-detraining and post-detraining (5155 ± 2258 vs 3937 ± 2087 MET-min·wk⁻¹; p < 0.001). Older adults classified as very active showed a non-significant trend to smaller decreases in functional fitness once the detraining period was over, in comparison with those considered active.ConclusionsActive older people who regularly participated in a multicomponent training program showed a significant reduction in their strength, range of motion, and dynamic balance levels after a five-month detraining period. Self-reported PA decreased significantly during this time frame. Effective strategies are needed to increase PA levels in older people when systematic training programs are temporarily interrupted.     

Deintensification of hypoglycaemic medications-use of a systematic review approach to highlight safety concerns in older people with type 2 diabetes

Importance

Intensive treatment of older people with diabetes is common placing them at increased risk of adverse events such as hypoglycaemia and hospitalisation for drug errors. Little is known about when, how or for whom to deintensify hypoglycaemic medications.

Travel behaviour change in old age: the role of critical incidents in public transport

Older people’s travel behaviour is affected by negative or positive critical incidents in the public transport environment. With the objective of identifying such incidents during whole trips and examining how travel behaviour had changed, we have conducted in-depth interviews with 30 participants aged 65–91 years in the County of Stockholm, Sweden. Out of 469 incidents identified, 77 were reported to have resulted in travel behaviour change, 67 of them in a negative way. Most critical incidents were encountered in the physical environment on-board vehicles and at stations/stops as well as in pricing/ticketing. The findings show that more personal assistance, better driving behaviour, and swift maintenance of elevators and escalators are key facilitators that would improve predictability in travelling and enhance vulnerable older travellers’ feeling of security. The results demonstrate the benefit of involving different groups of end users in future planning and design, such that transport systems would meet the various needs of its end users.