Cardiac rehabilitation in older adults: New options

Cardiac rehabilitation (CR) is an important component in the continuum of care for patients with cardiovascular diseases, including the older population. Benefits of CR which include mortality benefit, decreased hospitalizations, increased functional capacity all extend to an older population. In Medicare beneficiaries which represent an older population, utilization of CR continues to remain low despite evidence that suggests lower hospitalization rates, Medicare costs, and improved symptoms. Given poor referral rates, enrollment rates, and completion rates, a call for new strategies has been made by all major societies. However, several barriers exist. Newer models of CR constructed to overcome these barriers are reviewed below. Some of these new strategies include alternative site CR or home-based CR and the utilization of technology.     

居家心脏康复和中心心脏康复对冠心病患者心肺适能的影响

目的 探索居家心脏康复(HBCR)和中心心脏康复(CBCR)对冠心病(CHD)患者心肺适能的影响.方法 选取2018年11月至2019年10月在解放军总医院心脏康复中心门诊就诊的18～80岁的CHD患者,采用随机数表和信封法将患者分为HBCR组和CBCR组,分别以HBCR或CBCR干预3个月.对比2组患者干预前后的峰值...     

Linguistic disparities in health care access and health status among older adults

BACKGROUND: English proficiency may be important in explaining disparities in health and health care access among older adults. SUBJECTS: Population-based representative sample (N=18,659) of adults age 55 and older from the 2001 California Health Interview Survey. METHODS: We examined whether health care access and health status vary among older adults who have limited English proficiency (LEP), who are proficient in English but also speak another language at home (EP), and who speak English only (EO). Weighted bivariate and multivariate survey logit analyses were conducted to examine the role of language ability on 2 aspects of access to care (not having a usual source of care, delays in getting care) and 2 indicators of health status (self-rated general health and emotional health). RESULTS: Limited-English proficient adults were significantly worse off (1.68 to 2.49 times higher risk) than EO older adults in 3 of our 4 measures of access to care and health status. Limited-English proficient older adults had significantly worse access to care and health status than EP older adults except delays in care. English proficient adults had 52% increased risk of reporting poorer emotional health compared with EO speakers. CONCLUSIONS: Provision of language assistance services to patients and training of providers in cultural competence are 2 means by which health care systems could reduce linguistic barriers, improve access to care, and ultimately improve health status for these vulnerable populations.     

Physical health,subjective health,and psychological distress in older adults: Reciprocal relationships concurrently and over time

This study addresses the reciprocal associations between physical health (objectively assessed and self-rated) and psychological distress among older adults. Psychological distress (both depressive symptoms and anxiety level) made a significant independent contribution to the prediction of concurrent and future negative perception of one’s health, over and above objective health. As anxious and depressive components of psychological distress intensify, a negative outlook on life includes an increased negative view of one’s health among older adults. Conversely, negative subjective health independently predicted both depressive symptoms and anxiety level, concurrently and over time, over and above objective health. It thus appears that negative health appraisal heralds psychological distress, manifested as depressive symptoms and also anxiety among older adults. Taken together these findings draw the picture of a vicious circle of negative health appraisal leading to depression and anxiety, these in turn leading to further negative perception of health. His research and teaching activities are in the domain of psychogerontology, especially clinical geropsychology. His research interests include the treatment of depression, and reminiscence and autobiographical memory. Sabine Sèvre-Rousseau, Psy.D., defended her thesis in developmental psychology at the University of Paris V, Sorbonne. She was the coordinator of the mental health division of the Quebec Research Network on Aging during this study. She is also teaching psychology and statistical sciences at the Universities of Montreal and Sherbrooke. His research and teaching activities are in the domain of clinical geropsychology. In terms of research, he has a special interest for the etiology, assessment, and treatment of agitation and depression. Michel Préville, Ph.D., is associate professor at the Université de Sherbrooke, and Researcher at the Research Center on Aging, Scherbrooke Geriatric University Institute. He is director of the Mental Health Division of the Quebec Research Network on Aging.     

Depressive symptoms and self-rated health in community-dwelling older adults: a longitudinal study

OBJECTIVES: To test whether baseline depressive symptoms in older adults increase the risk of subsequent decline in self-rated health and decrease the likelihood of subsequent improvement in self-rated health. DESIGN: A 2-year prospective cohort study. SETTING: Six thousand seven hundred fourteen community-dwelling older persons who completed the first and second wave of the Asset and Health Dynamics among the Oldest-Old Survey in the United States. PARTICIPANTS: Community-dwelling older people in the United States. MEASUREMENTS: Baseline depressive symptoms were measured using a short-form of the Center for Epidemiological Studies Depression Scale. Self-rated health was measured using a single item of global health rating. RESULTS: After adjustment for covariates, a high burden of depressive symptoms at baseline was predictive of greater decline in self-rated health (odds ratio (OR) for decline in those with high burden of depressive symptoms vs those without = 1.47, 95% confidence interval (CI) = 1.26-1.70). Likewise, high burden of depressive symptoms at baseline predicted less improvement in self-rated health (OR for improvement in those with high burden of depressive symptoms vs those without = 0.57, 95% CI = 0.50-0.65). CONCLUSIONS: Depressive symptomatology is an independent risk factor for subsequent changes in self-rated health in older adults. Thus, early prevention and intervention of depressive symptoms in community-dwelling older adults might be critical to promote and maintain their self-rated health.     

Individual's perspective of local community environment and health indicators in older adults

Aim: This study evaluated the relationship between individual's perspective of local community environment and health in older people. Methods: A survey about quality of life in older adults in Spain was applied to a representative sample of 1106 community‐dwelling people (mean age ± SD = 72.07 ± 7.83 years, 43.67% males). Local community (Community Wellbeing Index, neighborhood problems, time in the neighborhood), psychosocial and sociodemographic measures were considered. Four health outcomes (self‐perceived health status, functional independence, depression and number of chronic medical conditions) were studied. Multivariate logistic analyses were carried out. Results: At least two local community measures were independently associated with each health outcome. Satisfaction with community services significantly contributed to all models; it was positively related with self‐rated health and functional independence, and negatively associated with depression and chronic medical conditions. Conclusion: The individual's perspective of the local community environment was associated with health outcomes in older adults. This can be useful in the development of policies committed to promoting social integration and active aging in the community. Geriatr Gerontol Int 2013; 13: 130–138 .     

The prevalence and risk factors for sarcopenia in older adults and long-living older adults

PurposeSarcopenia is a muscular syndrome that is related to several adverse risks. The present study aimed to evaluate the prevalence of risk of sarcopenia and associated factors in older adults and long-living older adults.MethodsA crosssectional epidemiological study of older adults patients at a geriatric outpatient clinic. The older adults were evaluated for sarcopenia risk using the SARC-F questionnaire supplemented with the measurement of the calf circumference. In addition, nutritional status was characterized using the Mini Nutritional Assessment, and the relationship of sarcopenia with associated factors (comorbidities, polypharmacy, smoking).ResultsA total of 100 eligible older adults with a mean age of 77.2 ± 1.8 years in the older adults and 86.3 ± 4.2 years in the long-living older adults (p < 0.001) were evaluated. The long-living older adults (OR = 6.1; 95 % CI: 1.44–16.09; p = 0.01) and older adults at risk of malnutrition (OR = 13.6; 95 % CI: 1.55–11.38; p < 0.05) had a higher risk of sarcopenia, whereas BMI ≥ 27 kg/m 2 (OR = 0; 95 % CI: 0–0.06; p < 0.001) was a protective factor. The risk of sarcopenia was six times higher in the over-80 s (95 % CI = 1.44, 16.09), while the older adults with malnutrition or at nutritional risk ran a 13 times higher risk of sarcopenia (95 % CI = 1.55, 11.38).ConclusionThe prevalence of risk of sarcopenia was higher in the long-living older adults and the older adults at nutritional risk, making its early evaluation in clinical practice important.     

Self-rated health (SRH) and socioeconomic position (SEP) among urban home-dwelling older adults

The main purpose of this study was to examine the association of education and adequacy of income with self-rated health (SRH) among home-dwelling older people aged 75 and over living in the urban area. A cross-sectional survey from 2008 was used to study 1395 older adults aged 75 and over living in one of the central areas of the city center of Helsinki, the capital of Finland. Associations of SRH with, education and adequacy of income were tested using ordinal regression model. Those with a lower level of education had higher level of poor health. Self-assessed adequacy of income had also a strong association with SRH. For the oldest respondents this association was even stronger than the association between education and SRH. Subjective evaluation of financial situation should be used as a key indicator of socioeconomic position (SEP) in studies examining inequalities in health especially among older adults.     

Self-reported health status of vietnamese and non-Hispanic white older adults in california

Vietnamese Americans are a rapidly growing minority group in the United States, yet little is known about their health status. Chronic medical conditions and self-rated health of older Vietnamese Americans were compared with those of non-Hispanic white adults living in California using the 2001 and 2003 California Health Interview Surveys (CHISs). The CHIS employed a random-digit-dial telephone survey, and its sample is representative of California's noninstitutionalized population. The sample included 359 Vietnamese and 25,177 non-Hispanic white adults aged 55 and older. Vietnamese and non-Hispanic white adults were compared in terms of limitations in activities of daily living, chronic medical conditions (diabetes mellitus, hypertension, heart disease, asthma), mental health care, and self-reported health, adjusting for age, sex, and education. Vietnamese were more likely than white participants to report needing help for mental health problems (adjusted odds ratio (aOR)=2.1, 95% confidence interval (CI)=1.4-3.1) but less likely to have had their medical providers discuss their mental health problems with them (aOR=0.3, 95% CI=0.1-0.5). In addition, Vietnamese participants reported significantly worse health than white adults on five of eight domains of the Medical Outcomes Survery 12-item Short Form survey (P<.006). Clinicians caring for older Vietnamese individuals should be aware of the high risk for mental health needs in this population and should initiate discussions about mental health with their patients. Further research is needed to better understand why older Vietnamese Americans are at higher risk for worse self-reported health than older white adults.     

Improving health care student attitudes toward older adults through educational interventions: A systematic review

ABSTRACT

Educational institutions should aim to positively influence the attitudes of future health care practitioners toward older patients to ensure the provision of quality patient care. This systematic review of the literature aims to determine the effectiveness of educational interventions designed to improve health care student behaviors and/or attitudes toward older people. The 29 studies included in this review utilized a variety of interventions, methods, and measurement tools. The most common type of educational intervention incorporated interaction with real patients. Few studies evaluated the impact of interventions on behavior; therefore, more observational studies are required. Overall interventions incorporating interactions with real patients who are independently living had a positive impact on student attitudes toward older adults. Clinically focused placements with patients who are ill may still have a place in the development of the patient-centered interview and assessment skills, along with improving confidence and competence, despite not having a favorable impact on attitudes.     

Concepts of dementia prevention in the health promotion among older adults: A narrative review

The number of older adults with dementia is predicted to markedly increase in the coming decades. A person suffers from dementia every 3 seconds globally, and one out of every 7 people suffers from dementia in Taiwan. The purpose of this narrative review is to integrate existing concepts of dementia prevention into health promotion and improve older adults’ quality of life. This narrative review was performed using the PubMed database by searching for basic research and systematic reviews on dementia prevention and health promotion among older adults. We established a framework for dementia prevention and health promotion with regard to the physical, mental, spiritual, and social health aspects. We identified the following strategies related to older adults towards dementia prevention and health promotion in follows: Physical health promotion: cognitive activities, physical activities, body mass index, balanced diet, rainbow diet, Mediterranean diet, dietary approaches to stop hypertension diet, mind diet, no smoking and drinking, avoiding the “three highs” (i.e., hyperglycemia, hyperlipidemia, and hypertension), and head trauma; Mental health promotion: Positive thinking, Brief Symptom Rating Scale (BSRS-5), depression scale, and ascertained dementia 8 questionnaire (AD8) screening; Spiritual health promotion: religious beliefs, spiritual music, meditative activities, mindfulness, yoga, Qi-gong, Tai-chi, and Baduanjin; and Social health promotion: A supportive family system, socialization, social support, social networks, social interaction, and social participation. The conclusion of this narrative review was to integrate the concepts of dementia prevention and health promotion among older adults.     

Effect of gender on communication of health information to older adults

OBJECTIVES: To examine the effect of gender on three key elements of communication with elderly individuals: effectiveness of the communication, perceived relevance to the individual, and effect of gender-stereotyped content. DESIGN: Survey. SETTING: University of Connecticut Health Center. PARTICIPANTS: Thirty-three subjects (17 female); aged 69 to 91 (mean+/-standard deviation 82+/-5.4). MEASUREMENTS: Older adults listened to 16 brief narratives randomized in order and by the sex of the speaker (Narrator Voice). Effectiveness was measured according to ability to identify key features (Risks), and subjects were asked to rate the relevance (Plausibility). Number of Risks detected and determinations of plausibility were analyzed according to Subject Gender and Narrator Voice. Narratives were written for either sex or included male or female bias (Neutral or Stereotyped). RESULTS: Female subjects identified a significantly higher number of Risks across all narratives (P=.01). Subjects perceived a significantly higher number of Risks with a female Narrator Voice (P=.03). A significant Voice-by-Stereotype interaction was present for female-stereotyped narratives (P=.009). In narratives rated as Plausible, subjects detected more Risks (P=.02). CONCLUSION: Subject Gender influenced communication effectiveness. A female speaker resulted in identification of more Risks for subjects of both sexes, particularly for Stereotyped narratives. There was no significant effect of matching Subject Gender and Narrator Voice. This study suggests that the sex of the speaker influences the effectiveness of communication with older adults. These findings should motivate future research into the means by which medical providers can improve communication with their patients.     

Gas exchange threshold to guide exercise training intensity of older individuals during cardiac rehabilitation

The gas exchange threshold (GET), which is determined during incremental exercise (Inc-Ex) testing, is often considered a safe training intensity for cardiac rehabilitation. However, there are only a limited number of reports on the actual implementation of this method. We assessed the applicability of GET-guided exercise using a constant load exercise (CL-Ex) protocol.We recruited 20 healthy older individuals (healthy, age: 69.4 ± 6.8 years) and 10 patients with cardiovascular diseases or risk factors (patient, age: 73.0 ± 8.8 years). On day 1, we determined the GET during symptomatic maximal Inc-Ex. On day 2, CL-Ex at work rate (watt: W) where the GET manifested during Inc-Ex (therefore, not corrected for the known oxygen response delay) was maintained for 20 minute. Arterialized blood lactate (BLa) levels were also determined.Oxygen uptake reached a steady state in all participants, with a mean respiratory exchange ratio of < 1.0. The mean BLa at the GET during Inc-Ex was 1.51 ± .29 mmol·l⁻¹ in the healthy group and 1.78 ± .42 mmol·L⁻¹ in the patient group, which was about .5 mmol·L⁻¹ above the resting level. During CL-Ex, BLa increased significantly over the value at the GET (Inc-Ex). However, it reached a steady-state level of 2.65 ± 1.56 (healthy) and 2.53 ± 0.95 (patient) mmol·L⁻¹. The %peak oxygen uptake, %peak heart rate, and %heart rate reserve during CL-Ex were 58.8 ± 11.5, 71.8 ± 10.3, and 44.9 ± 17.4, respectively. All participants could complete CL-Ex with mean perceived exertion ratings (Borg/20) of 11.8 ± 1.3 (healthy) and 12.2 ± 1.3 (patient). These heart rate-related indices and exertion ratings were all within the recommended international guidelines for cardiac rehabilitation.CL-Ex at the GET appears to be the optimal exercise intensity for cardiac rehabilitation.