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Dans le contexte pandémique de la COVID-19, les personnes aînées se sont retrouvées confinées et isolées, et ce, même dans le cadre d’un milieu de vie collective. Cet article fait état d’une étude de la portée sur les bienfaits d’un chœur intergénérationnel pour personnes aînées et les stratégies à considérer pour sa mise en place. L’analyse de 16 études sur ce sujet a permis de se familiariser avec les résultats, les recommandations et les pistes de recherche en lien avec le bien-être et le sens de satisfaction que retirent les personnes aînées qui participent à un chœur, de même que des interventions en chant choral à privilégier. De plus, cette activité qui est peu couteuse et bénéfique est considérée comme une intervention de nature préventive qui contribue au bien-être des personnes aînées et à leur prise en charge pour un vieillissement en santé. Par ailleurs, les résultats suggèrent de continuer à documenter l’efficacité des stratégies proposées pour les améliorer ou les adapter afin de maximiser les effets positifs d’une telle activité sur le bien-être physique, social, émotionnel et cognitif des personnes aînées.
Loneliness and social isolation are prevalent concerns among older adults and can lead to negative health consequences and a reduced lifespan. New technologies are increasingly being developed to help address loneliness and social isolation in older adults, including monitoring systems, social networks, robots, companions, smart televisions, augmented reality (AR) and virtual reality (VR) applications. This systematic review maps human-centered design (HCD) and user-centered design (UCD) approaches, human needs, and contextual factors considered in current technological interventions designed to address the problems of loneliness and social isolation in older adults. We conducted a scoping review and in-depth examination of 98 papers through a qualitative content analysis. We found 12 studies applying either an HCD or UCD approach and observed strengths in continuous user involvement and implementation in field studies but limitations in participant inclusion criteria and methodological reporting. We also observed the consideration of important human needs and contextual factors. However, more research is needed on stakeholder perspectives, the functioning of applications in different housing environments, as well as studies that include diverse socio-economic groups.
To construct an evidence-based practice programme for the nutrition management of older adults in nursing homes. The programme will provide a basis for improving or solving the nutrition management problems of older adults in nursing homes.
Design:
The study is based on guideline evidence and Delphi method. The evidence was comprehensively searched, assessed and summarized, and the best evidence and a preliminary programme for nutrition management of older adults in nursing homes were aggregated. Then, the Delphi method was used to assess the applicability of the preliminary programme and the obstacle factors to modify, supplement and improve the nutrition management programme.
Setting:
Baseline survey data were collected from three nursing homes in Ningxia, China, and guideline evidence was obtained through systematic searches of the Cochrane Library, PubMed and other scientific databases, as well as relevant official websites.
Participants:
A total of 350 older adults residing nursing homes and 160 nurses participated in the baseline survey. To ensure the programme’s applicability and identify potential implementation obstacles, fifteen experts from local grade A hospitals, nursing homes and community health centres were consulted for review.
Results:
A fourteen-item, fifty-six-best-evidence nutrition management programme for older adults in nursing homes was developed based on five guideline evidences and baseline survey findings.
Conclusions:
This is a systematic and comprehensive nutritional management programme for older adults in nursing homes based on guideline evidence, which can provide a standardised basis for the implementation of scientific nutritional management in nursing homes in Ningxia. Managers should promote the translation of evidence into practice in accordance with the specific circumstances of individual nursing homes.
This position paper focuses on healthy ageing for the frailest and institutionalized older adults in the context of the recent pandemic. The paper aims to identify and discuss hindering and promoting factors for healthy ageing in this context, taking both health safety and a meaningful social life into account, in a pandemic situation and beyond.
Background:
The recent COVID-19 pandemic has highlighted the vulnerability of frail older adults residing in long-term care institutions. This is a segment of the older population that does not seem to align well with the recent policy trend of healthy and active ageing. The need for healthy ageing in this population has been voiced by professionals and interest organizations alike, alluding to inadequate support systems during the pandemic, conditioned by both previous and newly emerging contextual factors. Supporting healthy ageing in older adults in nursing homes and other residential care settings calls for attending to meaningful social life as well as to disease control.
Methods:
Findings and early conclusions leading up to the position paper were presented with peer discussions involving healthcare professionals and researchers at two joint EFPC PRIMORE workshops 2021 and 2022, as well as other international research seminars on long-term care. The following aspects of long-term care and COVID-19 were systematically discussed in those events, with reference to relevant research literature: 1. Long-term care policies, 2. pre-COVID state of long-term care facilities and vulnerability to the pandemic, 3. factors influencing the extent of spread of infection in long-term care facilities, and 4. the challenge of balancing between strict measures for infection control and maintaining a meaningful social life for residents and their significant others.
Findings:
A policy shift towards ageing at home and supporting the healthiest of older adults seems to have had unwarranted effects both for frail older adults, their significant others, and professional care staff attending to their needs. Resulting insufficient investment in primary health care staff and in the built environment for frail older adults in nursing homes were detrimental both for the older adults living in nursing homes, their significant others, and staff. More investment in staff and in physical surroundings might improve the quality of care and the social life of older adults in nursing homes in a non-pandemic situation and be a resource for primary health care staff ensuring both protection from health hazards and a meaningful social life for frail older adults in a pandemic or epidemic situation. As for investing in the physical surroundings, smaller nursing homes are advantageous, with singular resident rooms and for developing out-and indoor spaces for socializing and for meeting with families and other visitors. Regarding investment in staff, there is a documented need for educated staff in full-time positions. Use of part-time or temporary staff should be limited.
Background and Aim: Puerto Rico is experiencing a rapidly aging society. In old age, it is common to experience one or more chronic diseases that require special attention. If not properly addressed, these health conditions can reduce functionality in daily activities. Some risk factors that can affect health and functionality include sedentary lifestyle, social isolation, and unhealthy lifestyles. To reduce these risk factors, it is necessary to implement health promotion measures aimed at improving the well-being of older adults. Brain Dance has a positive impact on the health of older adults. Its benefits include increasing circulation, reorganizing the neurological system, reducing stress, maintaining joint flexibility, and being aware of the communication between body and mind. The aim was to promote the health of older adults through the 8 Movement Patterns of Brain Dance at CAMPEA, Santa Monica, Bayamón, during the months of March to May 2023.
Methods: A collaboration agreement was established between the Geriatric Research and Education Center and CAMPEA to train older adults and service providers on the benefits of Brain Dance, and educational materials were provided to complement the activities.
Results: The program was implemented as designed. A total of 12 older adults, 60+ practiced Brain Dance and 6 direct services providers were trained on the benefits of Brain Dance in older adults. An infographic with the Eight Movements Patterns was designed and distributed to older adults and services providers.
Conclusions: Older adults reported that engaging in Brain Dance helped them to increase their confidence, bring back memories from the past, strengthen their group interactions, gain new knowledge, develop new skills, self- discover, pay greater attention to the connection between their mind and body, and achieve a state of joy.
Transportation plays a vital role in meeting the daily activity needs of individuals, including older adults. One major gap in the existing ageing and mobility literature is that most studies are situated in the Global North despite Global South cities facing comparatively faster ageing. This article’s primary purpose is to examine the daily lived experiences of transportation use among older adults in Mexico City. Secondarily it explores contextual differences among individuals living in two neighbourhood types – those with high or low access to public transportation networks. We conducted semi-structured interviews with 22 older adults and isolated four central themes that encapsulate their experiences of transportation in Mexico City. The extensive and well-run structured-transit system in central Mexico City was the source of many positive experiences for older adults, especially regarding affordability, high network connectivity and overall sense of safety and comfort. This was true for most participants across neighbourhood types and socio-economic statuses. Conversely, in peripheral neighbourhoods dominated by less-structured transportation modes, negative experiences included complaints about vehicle drivers, crime and safety, comfort and convenience. This article’s contributions are showing (1) consistency with existing Global South literature whereby older adults tend to use public transportation more widely and hold similar complaints related to poor experiences as older adult passengers; (2) that Mexico City exemplifies older adult transportation experiences that are dramatically different from car-dependent societies in the Global North; and (3) how older adults’ experiences with public transportation can vary significantly based on residential location within the city.
This scoping review aimed to evaluate the effect of exercise combined with vitamin D supplementation on skeletal muscle health in older individuals. We implemented a systematic search of electronic databases, including PubMed, the Cochrane Library, Web of Science and Embase, which was conducted from the time of library construction to January 2024. Eligible studies were randomised controlled trials including men and women aged ≥ 65 years or mean age ≥ 65 years; exercise training and vitamin D supplementation; outcomes of muscular strength, function, muscular power, body composition and quality of life; and results compared with those of exercise intervention alone. The results showed thirteen studies including 1483 participants were identified. The proportions of male and female sex were 22·05 and 77·95 %, respectively. Exercise intervention methods included resistance exercises and multimodal exercise training. All vitamin D interventions involved supplementation with vitamin D3. A significant increase was identified in short physical performance battery and stair climbing but not in skeletal muscle mass, skeletal strength, the timed up and go test and gait speed in older adults after exercise combined with vitamin D supplementation. In conclusion, exercise combined with vitamin D supplementation has additive health effects on short physical performance battery and stair climbing. Furthermore, when vitamin D was deficient at baseline, the combined effect of exercise and vitamin D intervention significantly increased the timed up and go test and gait speed in older adults. In future randomised controlled trials on this topic, baseline vitamin D nutritional status, health condition and sex should be considered.
Previous studies have shown that patients who are readmitted to the hospital from a skilled nursing facility (SNF) have a higher mortality rate. The objective of this study is to determine factors associated with high mortality rate for older adults who require hospital readmission while on presumed short stay in SNF to trigger a goals-of-care discussion.
Methods
Retrospective study of 847 patients aged 65 and above who were discharged from 1 large urban academic medical center to multiple SNF in 2019.
Results
Charts of 847 patients admitted to SNF after an acute hospital stay were reviewed; their overall 1-year mortality rate was 28.3%. The 1-year mortality rate among individuals readmitted to the hospital within 30 days of discharge to SNF was 50%, whereas for those who did not require readmission, the rate was 22%. For the most common diagnostic categories of nervous system, and musculoskeletal, patients with readmission to hospital within 30 days of discharge to SNF had a roughly threefold higher 1-year mortality rate. Worse frailty score on hospital readmission, poor nutrition, and weight loss were the most impactful individual factors carrying a higher degree of mortality of up to 83%.
Significance of results
Hospital discharge to SNF and readmission from SNF within 30 days, further decline in functional status, and malnutrition characterize high-risk groups that should trigger care preference and prognostic discussions with patients as these events may be markers of vulnerability and are associated with high 1-year mortality rates.
To improve transitions in care, a new patient navigation (PN) program was introduced to support older adults with complex care needs transition from hospital to home. The patient navigator is a community social worker embedded in the hospital’s care teams. A cohort observational design was used to conduct the study by analysing the patient navigator’s clinical notes and hospital’s administrative data to describe the characteristics of patients, scope of the patient navigator’s activities, and patient outcomes. Ninety patients were assigned to the patient navigator’s caseload (November 2019–November 2021) in which the average age was 78.9 (range 55–95). The most frequent PN intervention types were referrals to community services (66%, n = 59) and discharge planning (61%, n = 55). The patient navigator supported 66% patients (n = 59) in returning home and provided follow-up care for 74 days (average). This study provides important insights into the patient navigator’s role to guide decision makers in implementing PN programs for older adults in a hospital setting.
Older adults often have a heightened awareness of death due to personal losses. In many low- and middle-income countries, including Nigeria, conversation about end-of-life issues and advanced care planning (ACP) among older adults is gradually emerging. Our study explored older adults’ knowledge and perceptions towards advanced directives and end-of-life issues in a geriatric care setting in Nigeria.
Methods
A cross-sectional study was conducted among older adults (aged ≥60 years) in a geriatric outpatient clinic. Data were collected using an interviewer-administered, semi-structured questionnaire, tested at a significance level set at alpha 0.05.
Results
The study included 204 participants with a mean age of 71.3 ± 7.2 years, predominantly female (67.2%). Few of the participants have heard about end of life (20.1%), living will (19.1%), power of attorney (19.6%), and ACP (25.9%). About 29.9% of the respondents considered having a living will, of which about 34.4% have written one. Only 23 (11.3%) would consider discussing ACP in the future, 32 (15.7%) would discuss place of care, and 30 (14.7%) place of death. Preparedness for end of life and knowledge of ACP was higher among males, those with formal education, and those with good self-rated health (p < 0.05).
Significance of results
The study highlighted gap in awareness and engagement in ACP among older adults in a country like Nigeria. This lack of knowledge can lead to inadequate end-of-life care and unpreparedness for critical health decisions for older adults in Africa. Thus, improving awareness and understanding of ACP can empower older adults, ensuring their end-of-life preferences are respected, enhancing the quality of care, and reducing the emotional and financial burden on families.
This study investigated the association between screen time and ultra-processed food (UPF) consumption across the lifespan, using data from the 2019 Brazilian National Health Survey, a cross-sectional and population-based study. A score was used to evaluate UPF consumption, calculated by summing the positive answers to questions about the consumption of ten UPF subgroups on the previous day. Scores ≥5 represented high UPF consumption. Daily time spent engaging with television or other screens was self-reported. Crude and adjusted models were obtained through Poisson regression and results were expressed in prevalence ratios by age group. The sample included 2315 adolescents, 65 803 adults and 22 728 older adults. The prevalence of UPF scores ≥5 was higher according to increased screen time, with dose–response across all age groups and types of screen time. Adolescents, adults and older adults watching television for ≥6 h/d presented prevalence of UPF scores ≥5 1·8 (95 % CI 1·2, 2·9), 1·9 (95 % CI 1·6, 2·3) and 2·2 (95 % CI 1·4, 3·6) times higher, respectively, compared with those who did not watch television. For other screens, the prevalence of UPF scores ≥5 was 2·4 (95 % CI 1·3, 4·1) and 1·6 (95 % CI 1·4, 1·9) times higher for adolescents and adults using screens for ≥ 6 h/d, respectively, while for older adults, only screen times of 2 to < 3 and 3 to < 6 h were significantly associated with UPF scores ≥5. Screen time was associated with high consumption of UPF in all age groups. Considering these associations when planning and implementing interventions would be beneficial for public health across the lifespan.
Supportive public policies are suggested as ways to lessen gentrification’s impact for older adults. While explicit policies designed to help older adults with gentrification are rare, literature on age-friendly cities is a close proxy. We utilized three North American cases undergoing gentrification: New York City, NY, and Denver, CO, in the United States and Hamilton, in Ontario, Canada, to present existing neighbourhood-based policies as social determinants of health in housing, resource access, healthcare, transportation, and communal places. Age-friendly policy application gap examples and COVID-19’s impact were included. Using a qualitative comparative case study method, we found policies were not specifically designed to address older adults’ gentrification needs. With the call for age-friendly designations, the role of gentrification in neighbourhoods with older populations must be included. We call for gentrification-specific policies for older adults to provide greater safeguards especially when events such as COVID-19 compete for existing, over-stretched resources.
National guidance recommends that relatives of people with dementia receive support to develop coping strategies. STrAtegies for RelaTives (START) is an evidence-based manualised intervention for delivery on a one-to-one basis by trained graduate psychologists to family carers of people with dementia. However, implementation of START in standard National Health Service (NHS) provision has proved difficult. We describe collaboration between a Talking Therapies service and a Memory Service to co-facilitate and run START as a group. We consider implementation outcomes according to RE-AIM domains showing: the collaboration reached higher number of carers than other implementation initiatives (reach); there was significant reduction in caregiver anxiety and a trend towards significant reduction in depression (effectiveness); feedback from service users and clinicians on the service model has been positive (adoption); delivery has been supported by the written and audio materials (implementation); and the initiative has sustained over five years, despite the COVID-19 pandemic and staff turnover (maintenance). Finally, we discuss implications and potential future development.
Key learning aims
(1) To develop knowledge about the content of the STrAtegies for RelaTives (START) coping intervention for family carers of people with dementia.
(2) To understand the similarities between low-intensity cognitive behavioural therapy for anxiety and depression, as provided by Psychological Wellbeing Practitioners (PWPs), and START psychoeducational content and skills exercises.
(3) To reflect on the rationale for group delivery of START.
(4) To consider the benefits of collaboration between Talking Therapies and Memory Services for implementing START.
Around 55 million people worldwide live with dementia, and more are expected due to population ageing. We aimed to investigate associations between healthy diet and mild cognitive impairment and dementia in 1753 older adults aged 60–64 from the PATH (Personality and Total Health Through Life Cohort) study. Healthy diet was defined by the Mediterranean-DASH diet Intervention for Neurological Delay (MIND) and two dietary guideline quality scores (Dietary Guideline Index (DGI) and Index Diet Quality (IDQ)), which were calculated from baseline FFQ. Higher dietary scores indicated higher diet quality. Incidence of Alzheimer’s disease/vascular dementia (National Institute of Neurological Disorders criteria) and mild cognitive impairment (Winbald criteria) was assessed after 12 years of follow-up using validated questionnaires with nominated proxies. Logistic regression explored associations between dietary scores and cognitive function, adjusting for demographics, lifestyle factors and medical preconditions. Adjusted logistic regression comparing the per unit linear increase in diet scores showed MIND (OR = 0·82, 95 % CI = 0·68, 0·99), but not DGI (0·99 (0·97, 1·00)) or IDQ (1·12 (0·95, 1·32)), was significantly associated with lower odds of developing cognitive impairment. In conclusion, a healthier neuroprotective dietary pattern is associated with better cognitive function over time, whereas dietary patterns generated from general dietary guidelines did not show a significant association. Further research and well-designed clinical studies are needed to determine the effects of the MIND diet on cognitive impairment in older adults without a family history of dementia.
This study provides researchers, practitioners, and policy makers with a profile of older adults’ travel behaviour and the older adult population that reports unmet travel needs. In addition, we quantified associations between reporting an unmet travel need and measures of health and social connectedness. Data came from the second follow-up survey of the Canadian Longitudinal Study on Aging, collected from 2018 to 2021 (n = 14,167). Nine in ten (90.2%) older adults aged 65 years and older indicated that driving is the main way they get around. Older adults with an unmet travel need were more likely to be women, have lower household incomes and education levels, and have a mobility limitation. People with an unmet travel need had 2.7 times the odds of reporting fair or poor general health (OR = 2.66, 95% CI: 2.19, 3.22) and 3.1 times the odds of feeling socially isolated (OR = 3.10, 95% CI: 2.57, 3.72) compared to those without an unmet need.
The prospective association between sleep duration and the development of late-life depressive symptomology is unclear.
Aims
To investigate sleep duration from midlife to late life in relation to risk of depressive symptoms in late life.
Method
A total of 14 361 participants from the Singapore Chinese Health Study were included in the present study. Daily sleep duration was self-reported at baseline (mean age of 52.4 years; 1993–98), follow-up 2 (mean age of 65.2 years; 2006–10) and follow-up 3 (mean age of 72.5 years; 2014–16) interviews. Depressive symptoms were evaluated using the Geriatric Depression Scale at follow-up 3 interviews. Modified Poisson regression models were performed to estimate relative risks and 95% confidence intervals of late-life depressive symptoms in relation to sleep duration at baseline and the two follow-up interviews.
Results
Compared with sleeping 7 h per day, a short sleep duration of ≤5 h per day at baseline (i.e. midlife) was related to a higher risk of depressive symptoms (relative risk 1.10, 95% CI 1.06–1.15), and this risk was not affected by subsequent prolongation of sleep. Conversely, a long sleep duration of ≥9 h per day at baseline was not related to risk of depressive symptoms. At follow-up 3 (i.e. late life), both short sleep (relative risk 1.20, 95% CI 1.16–1.25) and long sleep (relative risk 1.12, 95% CI 1.07–1.18) duration were cross-sectionally associated with depressive symptoms.
Conclusion
Short sleep duration in midlife, regardless of subsequent prolongation, is associated with an increased risk of depression in late life. Contrariwise, both short and long sleep duration in late life co-occur with depressive symptoms.
Medications with anticholinergic properties are associated with a range of adverse effects that tend to be worse in older people.
Aims
To investigate medication regimens with high anticholinergic burden, prescribed for older adults under the care of mental health services.
Method
Clinical audit of prescribing practice, using a standardised data collection tool.
Results
Fifty-seven trusts/healthcare organisations submitted data on medicines prescribed for 7915 patients: two-thirds (66%) were prescribed medication with anticholinergic properties, while just under a quarter (23%) had a medication regimen with high anticholinergic burden (total score ≥3 on the anticholinergic effect on cognition (AEC) scale). Some 16% of patients with a diagnosis of dementia or mild cognitive impairment were prescribed medication regimens with a high anticholinergic burden, compared with 35% of those without such diagnoses. A high anticholinergic burden was mostly because of combinations of commonly prescribed psychotropic medications, principally antidepressant and antipsychotic medications with individual AEC scores of 1 or 2.
Conclusions
Adults under the care of older people's mental health services are commonly prescribed multiple medications for psychiatric and physical disorders; these medication regimens can have a high anticholinergic burden, often an inadvertent consequence of the co-prescription of medications with modest anticholinergic activity. Prescribers for older adults should assess the anticholinergic burden of medication regimens, assiduously check for adverse anticholinergic effects and consider alternative medications with less anticholinergic effect where indicated. The use of a scale, such as the AEC, which identifies the level of central anticholinergic activity of relevant medications, can be a helpful clinical guide.
As Western society becomes increasingly digitally dependent and many older adults actively engage in the online world, understanding the experiences of those who largely do not use digital technology in their daily lives is crucial. Individual interviews were conducted (pre-pandemic) with 23 older adults who, based on self-identification, did not regularly use digital technology, exploring how their experiences as limited digital technology users may have impacted their daily lives. An iterative collaborative qualitative analysis demonstrated three main themes: internet concerns, frustrations with digital technology, and conflicting motivators to use digital technology. Findings suggest that addressing digital concerns and providing effective digital skill learning opportunities may encourage some older adults to become more digitally engaged. However, as people, including older adults, can be uninterested in using these technologies, organizations and institutions should work to offer ways to support people of all ages who are not engaged online.
Growing numbers of people help and support family members, friends or others due to long-term health problems, disability or older age–related needs. While care-giving can bring fulfilment and meaning to peoples’ lives, it can negatively affect individuals’ financial wellbeing. Much of the evidence in this area is quantitative, while the subjective, in-depth experience of how unpaid care decisions affect financial wellbeing remains relatively underexplored. This scoping review explores what is known about how unpaid carers experience and understand the financial consequences of providing care. It identified 35 studies containing qualitative evidence and, through thematic analysis, identified four overarching themes: (1) direct and indirect costs of caring; (2) social, cultural and institutional care and work decision-making; (3) the unequal cost of caring; and (4) personal finance and carer wellbeing. Findings indicate that unpaid caring affects financial wellbeing in multiple, overlapping ways. The financial consequences are experienced unequally, with systems, circumstances and contexts serving to exacerbate or reduce these negative effects. Crucially, our analysis reveals the paucity of qualitative research specifically focused on unpaid carers’ financial wellbeing. There is a significant gap in the literature regarding whether, and how, individuals understand the future financial implications of unpaid care-giving, or whether longer-term financial consequences are considered when making decisions about care. Future research designed to address this gap, with greater emphasis on the personal, social and structural influences on care-related financial decision-making, could offer important insights for developing policies and practices aimed at improving the financial wellbeing of carers as they age.
Anxiety is a common comorbid feature of late-life depression (LLD) and is associated with poorer global cognitive functioning independent of depression severity. However, little is known about whether comorbid anxiety is associated with a domain-specific pattern of cognitive dysfunction. We therefore examined group differences (LLD with and without comorbid anxiety) in cognitive functioning performance across multiple domains.
Method:
Older adults with major depressive disorder (N = 228, ages 65–91) were evaluated for anxiety and depression severity, and cognitive functioning (learning, memory, language, processing speed, executive functioning, working memory, and visuospatial functioning). Ordinary least squares regression adjusting for age, sex, education, and concurrent depression severity examined anxiety group differences in performance on tests of cognitive functioning.
Results:
Significant group differences emerged for confrontation naming and visuospatial functioning, as well as for verbal fluency, working memory, and inhibition with lower performance for LLD with comorbid anxiety compared to LLD only, controlling for depression severity.
Conclusions:
Performance patterns identified among older adults with LLD and comorbid anxiety resemble neuropsychological profiles typically seen in neurodegenerative diseases of aging. These findings have potential implications for etiological considerations in the interpretation of neuropsychological profiles.