Efficacy of a horticultural activity program for reducing depression and loneliness in older residents of nursing homes in Taiwan

Promoting psychological health in older populations is important. This study evaluated a horticultural activity program for reducing depression and loneliness in older residents of nursing homes in Taiwan. A convenience sample of 150 older residents of three nursing homes were recruited and randomly assigned to either an experimental group or a control group. The experimental group (n = 75) participated in an 8-week horticultural activity program. The control group (n = 75) received routine care. Generalized estimating equations analyses revealed significant time by treatment interaction effects for depression (p < .001) and loneliness (p < .001). This study provides a reference for improving psychological health in older people.     

The association between unexplained falls and cardiac arrhythmias: A scoping literature review

BackgroundFalls in older adults are common. Age is a risk factor for falls and with an ageing population, presentation to the emergency department (ED) resulting from falls is rising. Reasons for falls in older adults are numerous and include cardiac arrhythmias. However, older patients who present with falls do not appear to be routinely screened for cardiac arrhythmias.ObjectivesTo determine the association between cardiac arrhythmias and unexplained falls in older adults presenting to the ED and to identify the processes for cardiac screening in patients presenting to the ED after an unexplained fall.MethodsA scoping literature review was conducted because of the scarce number of primary research articles using an investigational design to undertake a detailed systematic review. Several databases were searched using the search terms: emergency department; trauma centers; arrhythmias cardiac; fall; and accidental fall.Data sourcesA structured and systematic search using MEDLINE, Embase, and PubMed was conducted from 2002 to December 2017.ResultsFive quantitative studies were included in this review that reported on adults who presented to the ED after an unexplained fall. Several factors associated with falls and cardiac arrhythmias were extracted from the data. These included age, past history of falls, current medications, comorbidities, electrocardiography, and other cardiac findings.ConclusionFalls in the elderly population account for a significant number of presentations to the ED. A number of known factors are associated with falls in elderly patients, including cardiovascular causes, yet specific individualised factors are largely unknown. There is no routine screening process for the identification of cardiovascular risk factors in those who present to the ED with an unexplained fall. Further research is needed to identify specific cardiac factors associated with the risk of unexplained falls in this patient cohort and to transfer these findings into a routine screening process.     

Changes in cognitive function among older adults: A latent profile transition analysis

Cognitive decline in late life is a crucial health problem. It is important to understand the consistency and change of older adults’ cognitive function in late life. Data for older adults (78 years and above) from the Health and Retirement Study (N = 1680) were used to explore meaningful subtypes of cognitive function and transitions patterns between those profiles across times. Age, gender, levels of education and nursing home were incorporated as covariates to explore the association between these variables and cognitive function transition pattern. Three cognitive function subgroups (Normal Cognitive Function, Fluid Intelligence Impairment and Cognitive Impairment) were identified. Individuals in Normal Cognitive Function status had a high probability to convert to the Fluid Intelligence Impairment status whereas the Cognitive Impairment status appeared a predominant tendency for stability. Increasing age played a significant role in fluid intelligence impairment and cognitive impairment process. Female and individuals with nursing home might be at higher risk of subsequent fluid intelligence impairment, while higher education did not protect against fluid intelligence impairment. These findings highlighted the usefulness to adopt a person-centered approach rather than a variable-centered approach, suggesting directions for future research and tailored interventions approaches to older adults with particular characteristics.     

Association of unmet need with self-rated health in a community dwelling cohort of disabled seniors 75 years of age and over

Self-rated health (SRH) is a measure of perceived health that has been shown to predict use of community services, functional decline, pain, and mortality. Many factors associated with SRH have been identified, but unmet need for physical assistance with activities of daily living (ADL) has not yet been examined. The objective of this paper is to examine the association between unmet need and SRH while accounting for the effects of other, previously identified, correlates of SRH. We conducted a secondary analysis of a population-based study of 839 residents of Montréal, Québec who were 75 years of age or older, not cognitively impaired, and living in the community. Multivariable logistic regression was used to evaluate the association between met and unmet personal ADL (PADL) and instrumental ADL (IADL) need for physical assistance with SRH. Among 508 disabled community-dwelling elderly, for each additional unmet IADL need, subjects were 1.70 (95% CI: 1.11–2.61) times more likely to report poorer SRH. For each additional unmet PADL need, subjects were 2.26 (95% CI: 1.31–3.91) times more likely to report poorer SRH. Subjects at increased risk of malnutrition, with greater comorbidity and whose income was insufficient to meet their needs were also more likely to report poorer SRH. After adjustment for important correlates, unmet PADL and IADL needs retain a statistically significant association with poorer SRH, with nutritional status, comorbid conditions, and income satisfaction being important confounders of the relationship.     

The eldest of older adults living with HIV: response and adherence to highly active antiretroviral therapy

Objective

The study objective was to analyze the characteristics and the response to therapy in the eldest of the older adults living with human immunodeficiency virus.

Methods

The study included a cohort of patients with human immunodeficiency virus aged 55 years or more on initiating highly active antiretroviral therapy (HAART). Immunologic and virologic response, morbidity, and mortality were assessed. Patients were categorized as aged less than 65 years and 65 years or more.

Results

A total of 112 patients were included (82 patients aged < 65 years and 30 patients aged ≥ 65 years). There were no differences between the age groups in baseline characteristics, survival, and virologic response. There was a trend toward better adherence and a lower CD4+ cell increase after HAART in the older group.

Conclusion

A relationship was found between lower CD4+ cell increase after HAART and advanced age. We found the best adherence to treatment in the eldest of the older adults, and this has been shown to be the only protective independent factor related to virologic failure.     

张家界市1995-2012年老年人HIV感染者死亡及其影响因素分析

目的 分析张家界市1995-2012年老年人HIV感染者死亡及其影响因素.方法 将全国艾滋病疫情报告系统中1995-2012年户籍和现住址均为张家界市的老年人HIV感染者作为研究对象,结合张家界市的人口数据计算死亡率;采用Kaplan-Meier法估计老年人HIV感染者生存率曲线,用Cox回归模型分析其死亡的影响因素.结果 张家界市老年人HIV年平均死亡率为2.56/10万,并呈逐年上升趋势(x2趋势=164.38,P＜0.001),其中位生存时间为25.00个月.Cox回归模型分析显示:是否进行抗病毒治疗(RR=0.141,95％ CI:0.073～0.271),艾滋病确诊年限(RR=0.468,95％ CI:0.297～0.738)和CD4+T淋巴细胞基线计数数量(RR=0.271,95％ CI:0.162 ～0.454)是HIV感染者死亡的主要影响因素.结论 张家界市老年人HIV死亡率有逐年升高的趋势.是否进行抗病毒治疗、CD4+T淋巴细胞基线计数和艾滋病确诊年限是其死亡的主要影响因素.     

A cross-sectional assessment of oxidative DNA damage and muscle strength among elderly people living in the community

Objectives

The mechanism by which muscle weakness leads to an increased risk of death remains a subject of interest. In this context, the aim of this study is to assess the relationship between urinary 8-hydroxy-2′-deoxyguanosine (8-OHdG) and muscle strength, and other risk factors contributing to poor muscle strength in older persons.

Methods

This was a cross-sectional study in which a total of 86 participants, both men and women, aged 65 years or above were screened for urinary 8-OHdG, and muscle strength as measured by handgrip strength.

Results

Handgrip strength was lower in participants who had history of acute or chronic disease. Urinary 8-OHdG level was negatively associated with muscle strength, and the association remained after adjusting for confounding factors.

Conclusions

Urinary 8-OHdG is associated with muscle strength. These findings may be clinically relevant as there is a possibility of controlling oxidative DNA damage by healthy behaviors related to lifestyle.     

What can local authorities do to improve the social care-related quality of life of older adults living at home? Evidence from the Adult Social Care Survey

Local authorities spend considerable resources on social care at home for older adults. Given the expected growth in the population of older adults and budget cuts on local government, it is important to find efficient ways of maintaining and improving the quality of life of older adults. The ageing in place literature suggests that policies in other functions of local authorities may have a significant role to play. This study aims to examine the associations between social care-related quality of life (SCRQoL) in older adults and three potential policy targets for local authorities: (i) accessibility of information and advice, (ii) design of the home and (iii) accessibility of the local area. We used cross-sectional data from the English national Adult Social Care Survey (ASCS) 2010/2011 on service users aged 65 years and older and living at home (N=29,935). To examine the association between SCRQoL, as measured by the ASCOT, and three single-item questions about accessibility of information, design of the home and accessibility of the local area, we estimate linear and quantile regression models. After adjusting for physical and mental health factors and other confounders our findings indicate that SCRQoL is significantly lower for older adults who find it more difficult to find information and advice, for those who report that their home design is inappropriate for their needs and for those who find it more difficult to get around their local area. In addition, these three variables are as strongly associated with SCRQoL as physical and mental health factors. We conclude that in seeking to find ways to maintain and improve the quality of life of social care users living at home, local authorities could look more broadly across their responsibilities. Further research is required to explore the cost-effectiveness of these options compared to standard social care services.     

Prevalence and Correlates of Hearing and Visual Impairments in European Nursing Homes: Results From the SHELTER Study

Background

Visual and hearing impairments are known to be related to functional disability, cognitive impairment, and depression in community-dwelling older people. The aim of this study was to examine the prevalence of sensory impairment in nursing home residents, and whether sensory impairment is related to other common clinical problems in nursing homes, mediated by functional disability, cognitive impairment, and depressive symptoms.

Methods

Cross-sectional data of 4007 nursing home residents in 59 facilities in 8 countries from the SHELTER study were analyzed. Visual and hearing impairments were assessed by trained staff using the interRAI instrument for Long-Term Care Facilities. Generalized linear mixed models adjusted for functional disability, cognitive impairment, and depressive symptoms were used to analyze associations of sensory impairments with prevalence of clinical problems, including behavioral symptoms, incontinence, fatigue, falls, problems with balance, sleep, nutrition, and communication.

Results

Of the participants, 32% had vision or hearing impairment (single impairment) and another 32% had both vision and hearing impairments (dual impairment). Residents with single impairment had significantly higher rates of communication problems, fatigue, balance problems, and sleep problems, as compared with residents without any sensory impairment. Those with dual impairment had significantly higher rates of all clinical problems assessed in this study as compared with those without sensory impairment. For each clinical problem, the magnitude of the odds ratio for specific clinical problems was higher for dual impairment than for single impairment.

Conclusion

Visual and hearing impairments are associated with higher rates of common clinical problems among nursing home residents, independent of functional disability, cognitive impairment, and depressive symptoms.     

分析助产护理干预在高龄产妇分娩中的应用

目的：探讨助产护理干预措施应用到高龄产妇中对分娩的影响效果。方法：从2012年5月至2014年5月期间,我院产科接受的高龄分娩产妇中,随机选取了112例高龄产妇作为研究对象。随机分成两组,助产护理干预组和常规护理组,分别56例高龄产妇。给予常规护理组高龄产妇基本常规护理,助产护理干预组高龄产妇给予助产护理干预,对两组高龄产妇新生儿窒息率、分娩方式、产后出血量以及产程时间进行分析比较。结果：助产护理干预组高龄产妇新生儿窒息率2例（3．57％）,自然分娩例29（51．78％）,常规护理组新生儿窒息率例6（10．71％）,自然分娩例15（26．78％）,助产干预护理组生产效果明显优于常规护理组,另外,助产干预护理组产程时间缩短,产后出血量减少,护理效果显著,两组差异（P〈O,05）结论：对高龄产妇实施助助产护理干预,能减少低新生儿窒息率,提高高龄产妇自然分娩率,缩短产程时间,减少产后出血量,对提高产妇分娩质量发挥着重要意义,值得临床推广。