Social support and long-term mortality in the elderly: Role of comorbidity

Several studies have demonstrated a global increase in morbidity and mortality in elderly subjects with low social support or high comorbidity. However, the relationship between social support and comorbidity on long-term mortality in elderly people is not yet known. Thus, the present study was performed to evaluate the relationship between social support and comorbidity on 12-year mortality of elderly people. A random sample of 1288 subjects aged 65-95 years interviewed in 1992 was studied. Comorbidity by Charlson Comorbidity Index (CCI) score and Social Support by a scale in which total score ranges from 0 to 17, assigning to lowest social support the highest score, were evaluated. At 12-year follow-up, mortality progressively increase with low social support and comorbidity increasing (from 41.5% to 66.7% and from 41.2% to 68.3%, respectively; p < 0.001). Moreover, low social support progressively increases with comorbidity increasing (and 12.4 ± 2.5 to 14.3 ± 2.6; p < 0.001). Accordingly, multivariate analysis shows an increased mortality risk of 23% for each increase of tertile of social support scale (Hazard ratio = HR = 1.23; 95% CI = 1.01-1.51; p = 0.045). Moreover, when the analysis was performed considering different degrees of comorbidity we found that social support level was predictive of mortality only in subjects with the highest comorbidity (HR = 1.39; 95% CI = 1.082-1.78; p = 0.01). Thus, low social support is predictive of long-term mortality in the elderly. Moreover, the effect of social support on mortality increases in subjects with the highest comorbidity.     

Incidence of dementia and cause of death in elderly Japanese emigrants to Brazil before World War II

In 1997 we examined the prevalence of dementia among the Japanese elderly immigrants living in the São Paulo metropolitan area (n = 166). Herein, we followed up on these subjects for causes of death and dementia incidence. We were able to contact 108 subjects: 54 were already dead. The most common cause of death was cardiac disease. For dementia, 31.6% of the dead subjects were found to have developed dementia before they died, and 20.8% of the living subjects were demented. As for the baseline the clinical dementia rating (CDR), 20.8% of CDR 0 and 50.0% of CDR 0.5 subjects developed dementia in the dead group; whereas in the living group, 23.9% of CDR 0 and 52.6% of CDR 0.5 developed dementia. As a whole, the incidence was 34.2‰ per 1000 person-years. Cardiac disease as the most common cause of death was probably due to the higher prevalence of diabetes mellitus. Compared with the previous study, the lower incidence of dementia from the CDR 0.5 group may have been due to a higher mortality rate. This is the first study on the incidence of dementia in elderly Japanese immigrants in Brazil.     

Postural balance and falls in elderly nursing home residents enrolled in a ballroom dancing program

The aim of this study was to investigate the influence of a ballroom dancing program on the postural balance of institutionalized elderly residents. The sample consisted of 59 sedentary elderly residents of long-stay institutions who were randomly assigned to a ballroom dancing experimental group (EG, n = 30) or a control group (CG, n = 29). The ballroom dancing program consisted of three 50-min sessions each week on alternate days over a 12-week period. The dances included the foxtrot, waltz, rumba, swing, samba and bolero. The medical records of the subjects were reviewed to determine the number of falls they experienced in the three months prior to the intervention. Postural static balance was assessed using a Lizard (Med. EU., Italy, 2010) stabilometric and posturometric platform. Only patients in the EG lost a significant amount of weight (Δ = −2.85 kg) when comparing the pre- and post-test postural balance assessments. The intergroup comparison revealed a reduced lower limb weight distribution difference in the EG post-test compared to the CG post-test (p = 0.012). In the intragroup comparison, the EG patients experienced significantly fewer falls post-test relative to pre-test (p < 0.0001). This improvement was not observed for patients in the CG. In the intergroup analysis, we observed fewer falls in the EG post-test compared to the CG post-test (p < 0.0001). Therefore it was conclude that sedentary elderly people living in long-term institutions can improve their balance via a ballroom dancing program. This activity improved balance and reduced the number of falls in this elderly population.     

The effects of multidimensional exercise on functional decline, urinary incontinence, and fear of falling in community-dwelling elderly women with multiple symptoms of geriatric syndrome: A randomized controlled and 6-month follow-up trial

This study assessed the effects of multidimensional exercises on functional decline, urinary incontinence, and fear of falling in community-dwelling Japanese elderly women with multiple symptoms of geriatric syndrome (MSGS). Sixty-one participants were randomly assigned either to an intervention (n = 31) or to a control group (n = 30). For 3-month period, the intervention group received multidimensional exercise, twice a week, aiming to increase the muscle strength, walking ability, and pelvic floor muscle (PFM). Outcome variables were measured at baseline, and after intervention and follow-up. The functional decline of the intervention group decreased from 50.0% at baseline to 16.7% after intervention and follow-up (Q = 16.67, p < 0.001). For urinary incontinence, the intervention group decreased from 66.7% at baseline to 23.3% after intervention and 40.0% at follow-up (Q = 13.56, p = 0.001), whereas the control group showed no improvement. Intervention group showed greater and significant decrease in the score of MSGS compared to control group (F = 12.66, p = 0.001). Within the subjects that showed improvement to normal status of MSGS, a significantly higher proportion demonstrated increased maximum walking speed at follow-up (Q = 6.50, p = 0.039). These results suggest that multidimensional exercise is an effective strategy for reducing geriatric syndromes in elderly population. An increase in walking ability may contribute to the improvement of MSGS.     

Prediction of symptomatic depression by discriminant analysis in Japanese community-dwelling elderly

Although a number of studies have examined depression risk factors for elderly persons, little attention has been paid to the prediction of individuals at risk. This study constructed a predictive model for discrimination between individuals at a higher risk of depression and normal subjects in Japanese community-dwelling elderly persons, using linear discriminant analysis. Data were collected from 754 non-institutionalized elderly men and women aged 65 years and older living in the community in Japan, using face-to-face interviews in 2002. Stepwise linear discrimination analysis was used to construct a predictive model to select individuals who have a higher risk of depression. The stepwise discriminant analysis selected the five predictor variables (frequent hearing problems, poor appetite, less financial leeway, low emotional support and less subjective usefulness) and yielded a statistically significant function (λ = 0.816; χ² = 113.0, df = 5, p < 0.001). This function showed that the rate of correct prediction was 78.2% for depressed. The calculated discriminate function based on the above five predictor variables (hearing problem, less appetite, less financial leeway, low emotional support and less subjective usefulness) is useful for detecting individuals at high risk of depression and preventing its development among community-dwelling elderly persons. Prospective studies are needed to confirm the validity and feasibility of the model for earlier screening for depression among such people.     

Influence of history of smoking on the physical capacity of older people

Among the elderly, smoking is related to death and it contributes to disability associated with chronic diseases. This study aims to verify the influence of a history of smoking on the physical capacity of elderly people, and its relationship with the gender. Elderly people beginning to practice physical activity reported questions about their smoking history and underwent a physical evaluation, consisted by hemodynamic data (blood pressure, heart rate and maximum oxygen consumption), body mass index (BMI), muscular strength, flexibility and balance. Mann-Whitney test and Spearman's test was used to data analysis. The sample consisted of 127 subjects, among whom 26.8% were ex-smokers. There were a higher number of nonsmoking women (p < 0.001) than others, and women smoked fewer packets per day (p = 0.047). Among the women, those ex-smokers were younger and more flexible in comparison with those nonsmokers (p < 0.05). Among the men, the ex-smokers were older and walked more slowly than nonsmokers (p < 0.05). There was a correlation between the BMI and duration of smoking time. Smoking cessation benefits the elderly, since the physical variables showed no long-term harm associated with the history of smoking when compared with those of elderly without this habit.     

Suicide attempts and burden of physical illness among depressed elderly inpatients

There is little data on suicide among elderly depressed patients seeking psychiatric help. Recent studies have demonstrated that physical illness may increase this risk. We aimed to assess, retrospectively, the association between suicide and physical illness among depressed elderly psychiatric patients. All medical records of patients admitted during a 10-year period to an acute psychiatric ward, after having attempted suicide, were reviewed. Inclusion criteria were: age > 65 years, diagnosis of a depressive disorder and intact cognition. The comparison group consisted of previous or subsequent admissions, closest (by date), of elderly patients, matching the inclusion criteria, but without previous record of attempting suicide, into the same ward. The cumulative illness rating scale (CIRS) score was calculated for each patient. 78 admissions of elderly depressed patients, who had attempted suicide before hospitalization, were examined. The comparison group (n = 87) consisted of the subsequent admission of a similar but not suicidal pre-admission patient. The CIRS total score was significantly higher among suicidal patients (10.2 vs. 8.0; p = 0.0008). Suicidal patients scored higher in the vascular and the respiratory sections of CIRS. Our results support reported findings of higher rates of illness among suicidal elderly patients. The CIRS may be considered an additional tool in assessing risk for suicide in elderly psychiatric subjects.     

Effectiveness of exercise with or without thermal therapy for community-dwelling elderly Japanese women with non-specific knee pain: A randomized controlled trial

Knee pain is a common health problem in the elderly population, for which non-invasive treatments are recommended as a first line treatment in the management of knee pain. A randomized controlled trial was conducted to determine the effects of exercise with or without thermal therapy in community-dwelling elderly women with chronic knee pain. Women over 75 years of age with knee pain (n = 150) were randomly assigned into four groups; exercise (Ex) and heat/steam generating sheet (HSGS) (n = 38), Ex (n = 37), HSGS (n = 38), or health education (HE) (n = 37). The Ex group attended a 60-min comprehensive training program twice a week for 3-months. The HSGS group placed two sheets on the knee for five hours per day. Functional fitness, visual analog scale (VAS), and Japanese knee osteoarthritis measure (JKOM) were assessed at baseline and post-intervention. The results showed VAS improvements in the Ex + HSGS and HSGS groups. Total JKOM score, muscle strength, and functional mobility significantly improved in the Ex + HSGS group compared with the HE group. The odds ratio (OR) for VAS and functional mobility improvement was more than eight times as great in the Ex + HSGS group (OR = 8.60, 95% confidence interval (CI) = 2.82–32.73) compared with the education group. Ex or HSGS alone were insufficient in enhancing functional fitness or improving pain and quality of life. The combined effects of both Ex and heat therapy seems to have an added benefit of decreasing pain, improving physical function and increasing quality of life. Trial Registration Number: JMA-IIA00110.     

Nocturnal hyperglycaemia in type 2 diabetes with sleep apnoea syndrome

We assessed glycaemic status in 26 overweight or obese people with type 2 diabetes suspected of having sleep apnoea syndrome (SAS). In people with SAS (n = 13), nocturnal glycaemia was 38% higher, independent of body mass index (particularly during rapid eye movement sleep) compared with non-SAS subjects (p < 0.008).     

Are caregiving courses useful? An empirical study from Antalya, Turkey

In 2008, the National Social and Applied Gerontology Society (NSAGS) of Turkey held free caregiving courses for women, caring seniors, as a part of European Union (EU) programs. This course drew great attention and participation was common. The aim of this study was to evaluate the outcome of this course on participants and non-participants of this course. The test-sheet and an envelope with a stamp on it, were sent to the registered addresses of the women who applied for the course. One hundred twenty-four of total 276 questionnaire returned. The average age was 39.4 ± 9.6 years (±S.D.) and the level of education was low. Most of participants (80.6%) lived with the elderly in the same house; 83.9% of them also have a job besides their caring function. Most of the participants (82.1%) were still caring for their patients. The findings presented here are based on the comparison of two groups (i.e., caregivers who attended and who did not attend the course). After caregiving training, participants felt more an “inner peace” when caring for their elderly (p ≤ 0.05). Participants (39.5%) of the course felt more efficient concerning their duty as caregiver. Non-attenders to the course made more negative statements concerning their concentration to their caregiving functioning (55.2% vs. 40.7%) (p ≤ 0.05). Perception on stress showed better results in the group of participants, who attended the course (p < 0.05). More attenders (43%) of the course believed they could cope better with stress (p ≤ 0.05). This study showed that caregiving courses might be useful for caregivers of elderly people. The rapid increase of elderly people in need of care, will show a high demand for qualified caregivers. The NSAGS fulfilled an important duty by organizing these caregiving courses. This is an important signal showing that national gerontological organizations in Turkey might address the important needs concerning demographic aging in community.     

Factors of high impacts on the life of caregivers of disabled elderly

Elderly caregivers suffer physical and psychological consequences of the act of caring. The objective of this study was to characterize primary caregivers of elderly people in the community and identify the higher impacts of this activity on their life. We interviewed 127 caregivers about sociodemographic characteristics, presence of anxiety/depression (self-reporting questionnaire = SRQ), burden of care (caregiver burden scale = CBS); while their dependents were evaluated using sociodemographic questionnaires, health history, activities of daily living (ADL) scale and geriatric depression scale (GDS-15). The caregivers’ mean age was 55.1 ± 13.3 years; among them most were women and daughters with up to 4 years of education. The mean time as responsible for the elderly was 86.5 ± 96.3 months; 56% divided the caring responsibility and 28.2% had another occupation; 32.3% presented psychoemotional illness. There was a positive correlation between the CBS and the caregiver factors: psychoemotional disorders, time as responsible for the elderly and education level; as well as between the CBS and the elderly: number of activities with dependence, presence of depression and incontinences. The correlation between the elderly's personal income and number of visits received was negative. The identification of high impacts on the caregivers’ life would facilitate the professional approach.     

Quality of Life and Old Age Social Welfare System for the Rural Elderly in China

China launched new rural social endowment insurance in 2009 in order to guarantee the basic livelihood of rural elderly. This study explores the quality of life for the Chinese rural elderly in this context. The survey was conducted in Jiangsu province and its content included four critical aspects: physical health, economic status, elderly care, and loneliness. Six hundred and sixty four (664) elders aged over 60 were investigated between July and August 2010. Our findings reveal that a portion (16.2%) of rural elderly people were still in poor health condition, those over 80?years were particularly in need of healthcare and medical payment tended to be more socialized. Besides, most of the rural elderly had little monetary support and their living standards were comparatively low. Child support, agricultural income, and rural pension were their main sources of livelihood. The functional ability of self-care declined gradually with aging. Although the families basically met their caring needs, there is lack of concern on this aspect by the local communities. A considerable proportion (12.5%) of rural elderly often felt lonely and majority of them were short of entertainment activities. According to these findings, adequate attention for rural elders?? living situation should be emphasized by improving the old-age social welfare system in China.     

The association between socioeconomic status, oral hygiene practice, denture stomatitis and oral status in elderly people living different residential homes

Oral hygiene practices and denture status of elderly people living in residential homes are different depending on the type of residential homes. In this study the elderly people living in three different residential homes were investigated for this purpose. A total of 269 subjects, 119 males (mean age 73.9 ± 8.8) and 150 females (mean age 78.5 ± 7.2) were involved in this study. All subjects were interviewed and clinically examined. Age, sex, educational status, financial status, general health, dental visiting, overnight denture wearing, brushing habits and frequency were recorded using a structured questionnaire. The prevalence of edentulism, the presence and type of dental prostheses, denture cleanliness and the presence of denture stomatitis were evaluated. Forty-one percent of subjects were non-educated. Fifty-one percent of subjects had low income. The majority of people (66.6%) were edentulous. Among the edentulous subjects 32% had full denture and 16% had no denture. Forty three percent of the subjects reported cleaning their dentures with water and 40% with a toothbrush only. Denture hygiene was good for 14% of the subjects. Denture stomatitis was observed in 44% of the subjects wearing dentures. There was statistically significant difference between residential homes and educational status, level of income, dental visiting, denture status, brushing methods and brushing frequency (p < 0.001). A positive relationship was observed between poor denture hygiene habits and the presence of denture-related stomatitis. The most important need within the residents of the residential home was the enhancement of oral care social insurance.     

Importance of high-density lipoprotein-cholesterol (HDL-C) levels to the incidence of cardiovascular disease (CVD) in the elderly

Studies about the impact of HDL-C levels on the incidence of cardiovascular disease (CVD) in the elderly are scarce. We decided to evaluate the relation of clinical and laboratory variables to the incidence of CVD events in the elderly stratified according to HDL-C behavior in an 8-year follow-up. We assessed 126 elderly (mean age: 70.01 ± 7.24 years; 33.3% were men) on two occasions (assessment 1 = A1, and assessment 2 = A2), with a minimum of 5-year interval. They underwent clinical and laboratory evaluation and were divided into three groups as follows: (1) GN (n = 52), normal HDL-C levels on A1 and A2; (2) GL (n = 36), low HDL-C levels on A1 and A2; (3) GV (n = 38), HDL-C levels varying from A1 to A2. The following CVD events were observed: coronary artery disease (angina pectoris = AP, myocardial infarction = MI, percutaneous/surgical coronary intervention); stroke; transient ischemic attack = TIA; carotid disease; and heart failure = HF. The groups did not differ in age or gender at A1 and A2. Triglyceride = TG mean levels were lower in GN at A1 (p = 0.007) and A2 (p < 0.001) than in GL. There were 14 CVD events in GN (26.9%), 23 (63.9%) in GL, and 13 (34.2%) in GV (χ² = 12.825; p = 0.002). In logistic regression analysis, we observed that the higher the systolic blood pressure (SBP) (odds ratio [OR] = 1.0231; p = 0.0338) and the lower the HDL-C (OR = 0.9363; p = 0.0035), the higher the incidence of CVD events. Persistently low HDL-C levels over 8 years of follow-up were a risk factor (RF) for the development of CVD events in the elderly.     

Distribution of dihydrofolate reductase (dhfr) and dihydropteroate synthase (dhps) mutant alleles in Plasmodium vivax isolates from Thailand

The analysis of prevalence and distribution of pvdhfr and pvdhps mutations were performed in 169 samples collected from patients with Plasmodium vivax infection who attended the malaria clinics in the provinces along the three international borders of Thailand (Thai-Myanmar, Thai-Cambodian, and Thai-Malaysian borders). SNP-haplotypes of the pvdhfr at amino acid positions 13, 33, 57, 58, 61, 117, and 173 and of the pvdhps at positions 383 and 553 were examined by nested PCR-RFLP. Significant differences in the prevalence and distribution of pvdhfr and pvdhps combination alleles were observed in P. vivax isolates collected from all the three border areas. The most prevalent combination alleles were triple mutant pvdhfr 57L/58R/117T alleles/double wild-type pvdhps alleles (n = 18), double mutant pvdhfr 58R/117N alleles/double wild-type pvdhps alleles (n = 10), and triple mutant pvdhfr 58R/61M/117N alleles/double wild-type pvdhps alleles (n = 52) or with single mutant pvdhps 383G allele (n = 28), respectively. These information on prevalence and patterns of pvdhfr and pvdhps polymorphisms obtained from the present study suggest the presence of SP pressure on P. vivax isolates in Thailand which could be linked to the introduction of malaria from neighboring countries. Results did not support the application of SP for P. vivax control program in Thailand as well as the neighboring countries.     

Aging and Caregiving in the Republic of Palau

Aging has been an important population trend of the twentieth century, with most elderly people living in developing countries. Little has been published on the healthcare needs of elderly in the Pacific Islands. The Pacific Islands Geriatric Education Center, at the University of Hawaii, has a mission to promote training in geriatric education in the Pacific Islands to improve healthcare to the elderly. The aim of this project was to develop and test a family caregiver training program for Palau and was achieved in two phases: (1) assessing needs by interviewing key informants and surveying elders and (2) evaluating the caregiver training program that was designed based on findings from the assessment. The Ecological Systems Theory provided the theoretical framework for this study. The needs assessment identified training and education of family caregivers as a top priority, with the Palauan culture of family caring for seniors presently threatened by caregiver burnout. Nearly all of the long-term care in Palau is provided by families, and elders have high prevalence of geriatric syndromes. A family caregiver train-the-trainer workshop was subsequently conducted in February 2011. Forty-four trainers, including 12 from other Pacific Islands, attended the workshop. To assess changes in knowledge and confidence to teach, we compared scores on pre- and post-questionnaires using paired t tests. The train-the-trainer workshop resulted in significantly improved self-assessed competence and confidence to teach in all geriatric syndromes, including dealing with difficult behaviors, gait and transfer training, caregiver stress relief, and resources for caregivers (p?<?0.0001). This successful intervention identified geriatric care needs in Palau and successfully trained family caregivers to meet these needs, and may be used as a model for similar interventions in other Pacific Islands.     

Thirst in the elderly with and without heart failure

Elderly patients with heart failure (HF) may be troubled by thirst, despite the fact that elderly have an impaired ability to sense thirst. The present study was undertaken to compare the intensity of thirst in patients with and without HF and to evaluate how this symptom relates to the health-related quality of life and indices of the fluid balance. Forty-eight patients (mean age 80 years) admitted to hospital with worsening HF (n = 23) or with other acute illness (n = 25) graded their thirst and estimated their health-related quality of life (HRQoL). Serum sodium was measured and urine samples were assessed for color and electrolyte content. The HF patients reported significantly more intensive thirst (median = 75 mm) compared with those in the control group (median = 25 mm; p < 0.0001). There was no statistically significant relationship between thirst and HRQoL, which was low overall. Serum sodium and urine color did not differ significantly between the groups, but the urine of the HF patients had a lower sodium concentration and osmolality. We conclude that elderly patients with worsening HF have considerably increased thirst and, hence, intense thirst should be regarded as a symptom of HF.     

Cultural barriers in oncology: Issues in obtaining medical informed consent from Japanese-American elders in Hawaii

In east-west cultural contexts medical decision-making by elderly Japanese-American oncology patients is made complex by cultural differences from mainstream service providers. Cultural, religious and practical factors thought to contribute to delays in obtaining informed consent for treatment in oncology from mentally competent Japanese-American elders in Hawai'i are identified in this study of health care professionals at Queen's Medical Center in Honolulu (n = 50). Circumstances under which Japanese-American elders sign informed consent documents without understanding them are also examined. Recommendations are offered by the participants and researchers for improvements to the informed consent process. Implications of the findings and recommendations are discussed for Health Care Practice with Japanese-American and other ethnic elderly patients in mainstream health care organizations.