Strengthening Active Aging through Older People’s Association and Economic Activity of the Older People in Nepal

Aging is a natural lifelong process ending in death. Many older people are living in poverty. Older people are generally considered dependent on others as they grow older. The purpose of this article is to explore the entrepreneurship activities of Nepalese older adults. Data for this study were collected from the project Help Age International (HAI) implemented in Nepal. Qualitative data observations and interviews were used to collect data. The findings of this study show the formation of the Older People’s Association (OPA) has supported many older people to participate outside the home in various social activities. Moreover, regular deposits through OPAs offer little help. OPAs support older people in their need of financial support to implement minor entrepreneurship. Older people who received support were pleased and were actively involved in their activities and also regularly deposited money in them. Subsequently, older people’s participation in social activities has increased and also helped to lower elderly abuse, loneliness, and depression. Local governments should promote such activities which will help with healthy aging.

Older Adult Compendium of Physical Activities:Energy costs of human activities in adults aged 60 and older

Purpose:To describe the development of a Compendium for estimating the energy costs of activities in adults>60 years(OA Compendium).Methods:Physical activities(PAs)and their metabolic equivalent of task(MET)values were obtained from a systematic search of studies published in 4 sport and exercise databases(PubMed,Embase,SPORTDiscus(EBSCOhost),and Scopus)and a review of articles included in the 2011 Adult Compendium that measured PA in older adults.MET values were computed as the oxygen cost(VO_(2),mL/kg/min)during PA divided by 2.7 m L/kg/min(MET_(60+))to account for the lower resting metabolic rate in older adults.Results:We identified 68 articles and extracted energy expenditure data on 427 PAs.From these,we derived 99 unique Specific Activity codes with corresponding MET_(60+)values for older adults.We developed a website to present the OA Compendium MET_(60+)values:https://pacompendium.com.Conclusion:The OA Compendium uses data collected from adults>60 years for more accurate estimation of the energy cost of PAs in older adults.It is an accessible resource that will allow researchers,educators,and practitioners to find MET_(60+)values for older adults for use in PA research and practice.

Safety and efficacy comparison of remimazolam and propofol for intravenous anesthesia during gastroenteroscopic surgery of older patients:A meta-analysis

BACKGROUND Remimazolam is characterized by rapid action and inactive metabolites.It is used as the general anesthetic for many clinical surgeries.In this study,we performed a meta-analysis to evaluate whether remimazolam is superior to propofol for gastroenteroscopy in older patients.AIM To compare the adverse events and efficacy of remimazolam and propofol during gastroenteroscopy in older adults.METHODS The PubMed,Web of Science,the Cochrane Library databases were queried for the relevant key words"remimazolam,""and propofol,""and gastrointestinal endoscopy or gastroscopy."The search scope was"Title and Abstract,"and the search was limited to human studies and publications in English.Seven studies wherein remimazolam and propofol were compared were included for the metaanalysis.RESULTS We selected seven randomized controlled trials involving 1445 cases for the analysis.Remimazolam reduced the hypotension(relative risk,RR=0.44,95%CI:0.29-0.66,P=0.000),respiratory depression(RR=0.46,95%CI:0.30-0.70,P=0.000),injection pain(RR=0.12,95%CI:0.05-0.25,P=0.000),bradycardia(RR=0.37,95%CI:0.24-0.58,P=0.000),and time to discharge[weighted mean difference(WMD)=-0.58,95%CI:-0.97 to-0.18,P=0.005],compared to those after propofol administration.No obvious differences were observed for postoperative nausea and vomiting(RR=1.09,95%CI:0.97-1.24,P=0.151),dizziness(RR=0.77,95%CI:0.43-1.36,P=0.361),successful sedation rate(RR=0.96,95%CI:0.93-1.00,P=0.083),or the time to become fully alert(WMD=0.00,95%CI:-1.08-1.08,P=0.998).CONCLUSION Remimazolam appears to be safer than propofol for gastroenteroscopy in older adults.However,further studies are required to confirm these findings.

Bowel preparation protocol for hospitalized patients ages 50 years or older:A randomized controlled trial

BACKGROUND The incidence and mortality rate of colorectal cancer progressively increase with age and become particularly prominent after the age of 50 years.Therefore,the population that is≥50 years in age requires long-term and regular colonoscopies.Uncomfortable bowel preparation is the main reason preventing patients from undergoing regular colonoscopies.The standard bowel preparation regimen of 4-L polyethylene glycol(PEG)is effective but poorly tolerated.AIM To investigate an effective and comfortable bowel preparation regimen for hospitalized patients≥50 years in age.METHODS Patients were randomly assigned to group 1(2-L PEG+30-mL lactulose+a lowresidue diet)or group 2(4-L PEG).Adequate bowel preparation was defined as a Boston bowel preparation scale(BBPS)score of≥6,with a score of≥2 for each segment.Non-inferiority was prespecified with a margin of 10%.Additionally,the degree of comfort was assessed based on the comfort questionnaire.RESULTS The proportion of patients with a BBPS score of≥6 in group 1 was not significantly different from that in group 2,as demonstrated by intention-to-treat(91.2%vs 91.0%,P=0.953)and per-protocol(91.8%vs 91.0%,P=0.802)analyses.Furthermore,in patients≥75 years in age,the proportion of BBPS scores of≥6 in group 1 was not significantly different from that in group 2(90.9%vs 97.0%,P=0.716).Group 1 had higher comfort scores(8.85±1.162 vs 7.59±1.735,P<0.001),longer sleep duration(6.86±1.204 h vs 5.80±1.730 h,P<0.001),and fewer awakenings(1.42±1.183 vs 2.04±1.835,P=0.026)than group 2.CONCLUSION For hospitalized patients≥50 years in age,the bowel preparation regimen comprising 2-L PEG+30-mL lactulose+a low-residue diet produced a cleanse that was as effective as the 4-L PEG regimen and even provided better comfort.

Marital Status as a Moderator:Exploring the Relationship between Social Engagement and Depressive Symptoms in China’s Older Adult Population

Objective This study aims to explore the complex relationship between social engagement and depressive symptoms among older adults in China,focusing particularly on the moderating role of marital status.Methods This study used data from the latest Chinese Longitudinal Healthy Longevity Survey(CLHLS).The analysis used the latent class analysis to delineate personality clusters and hierarchical linear regression,supplemented by the PROCESS macro,to investigate the effects of social engagement and marital status on depressive symptoms.Results The analysis encompassed 7,789 respondents(mean age:82.53[s=11.20]years),with 54%female.The personality analysis categorized participants into four clusters,with the majority(77.60%)classified as Confident Idealists,who exhibited the lowest levels of depressive symptoms.Hierarchical linear regression analysis yielded several significant findings:Higher levels of social engagement were significantly associated with fewer depressive symptoms(t=-7.932,P<0.001,B=-0.463).Marital status was a significant factor;married individuals reported fewer depressive symptoms compared to their unmarried counterparts(t=-6.368,P<0.001,B=-0.750).There was a significant moderating effect of marital status on the relationship between social engagement and depressive symptoms(t=-2.092,P=0.037,B=-0.217).Conclusion This study demonstrates that,among Chinese older adults,both social engagement and marital status significantly influence depressive symptoms.Higher social engagement,particularly in other activities like doing household chores,gardening,reading newspapers or books,and playing cards or Mahjong,is associated with fewer depressive symptoms,especially among married individuals.

Cardiometabolic and panvascular multimorbidity associated with motoric cognitive risk syndrome in older adults

Background Motoric cognitive risk(MCR)syndrome as a pre-dementia syndrome often co-occurring with chronic health condi-tions.This study aims to investigate the prevalence of MCR and its association with cardiometabolic and panvascular multimorb-idity among older people living in rural China.Methods This population-based study included 1450 participants who were aged≥60 years(66.2%women)and who underto-ok the second wave examination of the Confucius Hometown Aging Project in Shandong,China when information to define MCR was collected.Data were collected through in-person interviews,clinical examinations,and laboratory tests.Cardiometabolic and pa-nvascular multimorbidity were defined following the international criteria.MCR was defined as subjective cognitive complaints and slow gait speed in individuals free of dementia and functional disability.Multivariable logistic regression models were used to exa-mine the associations of MCR with multimorbidity.Results MCR was present in 6.3%of all participants,and the prevalence increased with advancing age.Cerebrovascular disea-se,ischemic heart disease,heart failure,and increased serum cystatin C were associated with increased likelihoods of MCR(mult-ivariable-adjusted odds ratio range:1.90-3.02,P<0.05 for all).Furthermore,there was a dose-response relationship between the nu-mber of cardiometabolic diseases and panvascular diseases and the likelihood of MCR.The multivariable-adjusted odds ratio(95%CI)of MCR associated with cardiometabolic and panvascular multimorbidity were 2.47(1.43-4.26)and 3.85(2.29-6.47),respectiv-ely.Conclusions Older adults with cardiometabolic and panvascular multimorbidity are at a higher likelihood of MCR.These fin-dings may have implications for identifying older adults at pre-dementia state as targets for early preventive interventions to delay dementia onset.

Nomogram predicting the cardiovascular disease mortality for older patients with colorectal cancer:A real-world population-based study

BACKGROUND Cardio-oncology has received increasing attention especially among older patients with colorectal cancer(CRC).Cardiovascular disease(CVD)-specific mortality is the second-most frequent cause of death.The risk factors for CVDspecific mortality among older patients with CRC are still poorly understood.AIM To identify the prognostic factors and construct a nomogram-based model to predict the CVD-specific mortality among older patients with CRC.METHODS The data on older patients diagnosed with CRC were retrieved from The Surveillance,Epidemiology,and End Results database from 2004 to 2015.The prognostic factors and a nomogram-based model predicting the CVD-specific mortality were assessed using least absolute shrinkage and selection operator and Cox regression.RESULTS A total of 141251 eligible patients with CRC were enrolled,of which 41459 patients died of CRC and 12651 patients died of CVD.The age at diagnosis,sex,marital status,year of diagnosis,surgery,and chemotherapy were independent prognostic factors associated with CVD-specific mortality among older patients with CRC.We used these variables to develop a model to predict CVD-specific mortality.The calibration curves for CVD-specific mortality probabilities showed that the model was in good agreement with actual observations.The C-index value of the model in the training cohort and testing cohort for predicting CVD-specific mortality was 0.728 and 0.734,respectively.CONCLUSION The proposed nomogram-based model for CVD-specific mortality can be used for accurate prognostic prediction among older patients with CRC.This model is a potentially useful tool for clinicians to identify high-risk patients and develop personalized treatment plans.

Effect of continuous nursing on rehabilitation of older patients with joint replacement after discharge

BACKGROUND Joint replacement is a common treatment for older patients with high incidences of hip joint diseases.However,postoperative recovery is slow and complications are common,which reduces surgical effectiveness.Therefore,patients require long-term,high-quality,and effective nursing interventions to promote rehabilitation.Continuity of care has been used successfully in other diseases;however,little research has been conducted on older patients who have undergone hip replacement.AIM To explore the clinical effect of continuous nursing on rehabilitation after discharge of older individuals who have undergone joint replacement.METHODS A retrospective analysis was performed on the clinical data of 113 elderly patients.Patients receiving routine nursing were included in the convention group(n=60),and those receiving continuous nursing,according to various methods,were included in the continuation group(n=53).Harris score,short form 36(SF-36)score,complication rate,and readmission rate were compared between the convention and continuation groups.RESULTS After discharge,Harris and SF-36 scores of the continuation group were higher than those of the convention group.The Harris and SF-36 scores of the two groups showed an increasing trend with time,and there was an interaction effect between group and time(Harris score:F_(intergroup effect)=376.500,F_(time effect)=20.090,Finteraction effect=4.824;SF-36 score:F_(intergroup effect)=236.200,Ftime effect=16.710,Finteraction effect=5.584;all P<0.05).Furthermore,the total complication and readmission rates in the continuation group were lower(P<0.05).CONCLUSION Continuous nursing could significantly improve hip function and quality of life in older patients after joint replacement and reduce the incidence of complications and readmission rates.

Gut microbiota changes associated with frailty in older adults:A systematic review of observational studies

BACKGROUND Frailty is a complex aging-related syndrome characterized by a cumulative loss of physiological reserve and increased vulnerability to adverse clinical outcomes,including falls,disability,incapacity and death.While an increasing number of studies suggest that the gut microbiota may play a key role in the pathophy-siology of frailty,direct evaluation of the association between gut microbiome alterations and frailty in older adults remains limited.AIM Seven electronic databases(China National Knowledge Infrastructure,VIP,SinoMed,Wanfang,PubMed,Web of Science and EMBASE)were searched for articles published before October 31,2023 to identify observational studies that compared the microbiomes of older adults with and without frailty.The diversity and composition of the gut microbiota were the main outcomes used to analyze the associations of changes in the gut microbiota with frailty in older adults.The quality of the included studies was assessed via the Newcastle-Ottawa Scale and the Agency for Healthcare Research and Quality.RESULTS Eleven observational studies with 912 older adults were included in this review.Consistent results revealed a significant difference in the gut microbiota composition between frail and non-frail older adults,with a significant decrease inαdiversity and a significant increase inβdiversity in frail older adults.The pooled results revealed that at the phylum level,four microbiota(Actinobacteria,Proteo-bacteria,Verrucomicrobia and Synergistetes)were significantly enriched,and two microbiota(Firmicutes and Fusobacteria)were significantly depleted in frail older adults.At the family level,the results consistently revealed that the abundances of 6 families,most of which belong to the Actinobacteria or Proteo-bacteria phylum,were greater in frail than in non-frail older adults.At the genus or species level,consistent results from more than two studies revealed that the abundances of the genera Prevotella,Faecalibacterium,and Roseburia were significantly lower in frail older adults;individual studies revealed that the abundances of some genera or species(e.g.,Megamonas,Blautia,and Megasphaera)were significantly lower,whereas those of other genera or species(e.g.,Bifidobacterium,Oscillospira,Ruminococcus and Pyramidobacter)were significantly greater in frail older adults.CONCLUSION This systematic review suggests that changes in the gut microbiota are associated with frailty in older adults,which is commonly reflected by a reduction in beneficial species and an increase in pathogenic species.However,further studies are needed to confirm these findings.

Cardiovascular risk factors among older persons with cognitive frailty in middle income country

BACKGROUND Cognitive frailty,characterized by the coexistence of cognitive impairment and physical frailty,represents a multifaceted challenge in the aging population.The role of cardiovascular risk factors in this complex interplay is not yet fully understood.AIM To investigate the relationships between cardiovascular risk factors and older persons with cognitive frailty by pooling data from two cohorts of studies in Malaysia.METHODS A comprehensive approach was employed,with a total of 512 communitydwelling older persons aged 60 years and above,involving two cohorts of older persons from previous studies.Datasets related to cardiovascular risks,namely sociodemographic factors,and cardiovascular risk factors,including hypertension,diabetes,hypercholesterolemia,anthropometric characteristics and biochemical profiles,were pooled for analysis.Cognitive frailty was defined based on the Clinical Dementia Rating scale and Fried frailty score.Cardiovascular risk was determined using Framingham risk score.Statistical analyses were conducted using SPSS version 21.RESULTS Of the study participants,46.3%exhibited cognitive frailty.Cardiovascular risk factors including hypertension(OR:1.60;95%CI:1.12-2.30),low fat-free mass(OR:0.96;95%CI:0.94-0.98),high percentage body fat(OR:1.04;95%CI:1.02-1.06),high waist circumference(OR:1.02;95%CI:1.01-1.04),high fasting blood glucose(OR:1.64;95%CI:1.11-2.43),high Framingham risk score(OR:1.65;95%CI:1.17-2.31),together with sociodemographic factors,i.e.,being single(OR 3.38;95%CI:2.26-5.05)and low household income(OR 2.18;95%CI:1.44-3.30)were found to be associated with cognitive frailty.CONCLUSION Cardiovascular-risk specific risk factors and sociodemographic factors were associated with risk of cognitive frailty,a prodromal stage of dementia.Early identification and management of cardiovascular risk factors,particularly among specific group of the population might mitigate the risk of cognitive frailty,hence preventing dementia.

Impact of Exercise on Depression in Older Adults:Potential Benefits,Risks,and Appropriate Application Strategies

As the global elderly population increases,depression within this group has become a significant public health concern.Although exercise has been recognized for its potential to improve depression in the elderly,the benefits,risks,and implementation strategies remain contentious.This review attempts to examine the impact of exercise on depression in older adults,including potential benefits,risks,and suggestions for application.Our analysis highlights the benefits of aerobic and resistance training,which can significantly alleviate depressive symptoms and enhance overall quality of life.Despite these benefits,the review acknowledges the complexity of the exercise-depression interaction in the elderly,necessitating personalized exercise regimens.Potential risks,such as muscle and joint pain,are pointed out,emphasizing the importance of tailored,supervised exercise programs.The review calls for future research to focus on identifying the most effective types of exercise and regimens for this population,considering factors such as age,gender,and existing health conditions.Lastly,it advocates for the inclusion of exercise in comprehensive treatment plans for depression in older adults,viewing it as a promising step toward achieving holistic mental health care in a growing demographic.

Bowel preparation experiences and needs before follow-up colonoscopy in older adult postoperative colorectal cancer patients: A qualitative study

BACKGROUND The bowel preparation process prior to colonoscopy determines the quality of the bowel preparation,which in turn affects the quality of the colonoscopy.Colono-scopy is an essential procedure for postoperative follow-up monitoring of colorec-tal cancer(CRC)patients.Previous studies have shown that advanced age and a history of colorectal resection are both risk factors for inadequate bowel prepara-tion.However,little attention has been paid to the bowel preparation experiences and needs of predominantly older adult postoperative CRC patients.AIM To explore the experiences and needs of older adult postoperative CRC patients during bowel preparation for follow-up colonoscopy.METHODS Fifteen older adult postoperative CRC patients who underwent follow-up colonoscopy at a tertiary hospital in Shanghai were selected using purposive sampling from August 2023 to November 2023.The phenomenological method in qualitative research was employed to construct an interview outline and conduct semi-structured interviews with the patients.Colaizzi's seven-step analysis was utilized to organize,code,categorize,summarize,and verify the interview data.RESULTS The results of this study were summarized into four themes and eight sub-themes:(1)Inadequate knowledge about bowel preparation;(2)Decreased physiological comfort during bowel preparation(gastrointestinal discomfort and sleep deprivation caused by bowel cleansing agents,and hunger caused by dietary restrictions);(3)Psychological changes during different stages of bowel preparation(pre-preparation:Fear and resistance due to previous experiences;during preparation:Irritation and helplessness caused by taking bowel cleansing agents,and post-preparation:Anxiety and worry while waiting for the colonoscopy);and(4)Needs related to bowel preparation(detailed instructions from healthcare professionals;more ideal bowel cleansing agents;and shortened waiting times for colonoscopy).CONCLUSION Older adult postoperative CRC patients'knowledge of bowel preparation is not adequate,and they may encounter numerous difficulties and challenges during the process.Healthcare professionals should place great emphasis on providing instruction for their bowel preparation.

The Impact of Big Five Personality Traits on Older Europeans’ Physical Health

Investigating the role of Big Five personality traits in relation to various health outcomes has been extensively studied. The impact of “Big Five” on physical health is here explored for older Europeans with a focus on examining age groups differences. The study sample included 378,500 respondents derived from the seventh data wave of Survey of Health, Aging and Retirement in Europe (SHARE). The physical health status of older Europeans was estimated by constructing an index considering the combined effect of well-established health indicators such as the number of chronic diseases, mobility limitations, limitations with basic and instrumental activities of daily living, and self-perceived health. This index was used for an overall physical health assessment, for which the higher the score for an individual, the worst health level. Then, through a dichotomization process applied to the retrieved Principal Component Analysis scores, a two-group discrimination (good or bad health status) of SHARE participants was obtained as regards their physical health condition, allowing for further con-structing logistic regression models to assess the predictive significance of “Big Five” and their protective role for physical health. Results showed that neuroti-cism was the most significant predictor of physical health for all age groups un-der consideration, while extraversion, agreeableness and openness were not found to significantly affect the self-reported physical health levels of midlife adults aged 50 up to 64. Older adults aged 65 up to 79 were more prone to open-ness, whereas the oldest old individuals aged 80 up to 105 were mainly affected by openness and conscientiousness. .

Relationship between Nonexercise Activity Thermogenesis and Calf Circumference in Older Women

Purpose: Frailty is a state of declined vitality of the body and mind with age in which life functions are impaired. In addition, there is a difference in the susceptibility of older women to frailty compared with that of older men. Therefore, assessing and encouraging physical activity in older adults before they become frail is essential. We aimed to clarify the relationship between calf circumference and body composition and assess the potential association between calf circumference and physical activity indices in older women. Methods: This cross-sectional study included 18 healthy older adults (age 69.0 ± 5.7 years). The physical characteristics, calf circumference, body composition, calf muscle thickness, and physical activity questionnaire that included items on exercise-related activity thermogenesis (EAT) and nonexercise activity thermogenesis (NEAT) were assessed. The association between calf circumference and these additional measures was examined. Results: Positive and significant correlations were found between the calf circumference and body weight, body mass index (BMI), skeletal muscle mass, skeletal muscle mass index, calf muscle thickness, total questionnaire score, and NEAT score (r = 0.66 - 0.87). However, no significant correlations were observed between the calf circumference and EAT scores. Conclusion: Calf circumference in older women may reflect NEAT activity. Improving NEAT activity is an important health-promoting factor in older women.

The Relationship Between Social Isolation, Psychological Resilience, and Psychological Well- Being Among Older People in the Community

Objective:To explore the relationship between social isolation,psychological resilience,and psychological well-being in community-dwelling older adults.Methods:A questionnaire survey was conducted with 265 community-dwelling older adults using the Social Isolation Scale for the Elderly(C-SIS),the 10-item Brief Psychological Resilience Scale,and the Comprehensive Happiness Questionnaire(MHQ).The results were statistically analyzed using SPSS 27.0.Results:The highest score on the Social Isolation Scale for Community Elderly was 23,with a mean entry score of 2.36±0.62.A score of 14 was the cut-off point,with scores of≤14 classified as social isolation.There were 136 cases with scores below 14,resulting in a social isolation incidence rate of 51.3%.The median(P50)psychological resilience score was 27,indicating a higher level of resilience.The total score on the Psychological Well-being Scale was 161,suggesting a moderate to slightly higher level of well-being.Social isolation had a direct negative effect on psychological well-being,while psychological resilience had a positive effect.Conclusion:Older adults should be supported in reducing the incidence of social isolation and increasing psychological resilience to enhance psychological well-being and promote successful aging.

Associations between residence and cognitive function among Chinese older adults: the mediating role of leisure activity

Background:Cognitive function is a current research hotspot,residence may be related to differences in cognitive function,and the mediating role of leisure activities are limited in Chinese research.This study used leisure activities as a mediating variable to investigate the mediating role of leisure activity between place of residence(city-town-rural)and cognitive function among Chinese older,this is where the innovation of the article comes in.Methods:Using cross-sectional data from the 2018 Chinese Longitudinal Healthy Longevity Survey,Pearson correlation analyses were employed to examine the relationships among various indicators.Mediation analyses were conducted using the SPSS PROCESS macro program,version 3.5,written by Hayes,to explore the mediating effects of leisure activity between place of residence and cognitive function in older adults.Results:A total of 10955 older adults were included in this study,with a mean age of(84.23±11.57)years.Among them,2739(24.8%)lived in the city,3627(33.1%)in town,and 4615(42.1%)in rural areas;their leisure activity score was(5.34±3.77),and their cognitive function score was(24.69±6.65).Place of residence,leisure activities,and cognitive function were significantly correlated(P<0.01).Using city as a reference,place of residence is negatively associated with cognitive function,and place of residence not only had a direct effect on cognitive function in older adults:town-cognitive function(effect=–0.399;95%confidence interval(CI)=(–0.685,–0.113));rural-cognitive function(effect=–0.42;95%CI=(–0.698,–0.141)).There were also indirect effects on cognitive function through the pathway of leisure activity:town-leisure activity-cognitive function(effect=–0.17;95%CI=(–0.246,–0.1)),rural-leisure activity-cognitive function(effect=–0.199;95%CI=(–0.272,–0.13)).Conclusion:Leisure activities play a partially mediating role between the impact of place of residence and cognitive function in Chinese older adults,and it is vital to pay attention to the impact of place of residence on the cognitive function of older adults in various aspects,and to increase the participation rate of older adults in leisure activities,which is beneficial to the prevention of cognitive decline and the protection of older adult’s physical and mental health.

The Association Between Daily Physical Activity and Risk of Hypertension in Middle-Aged and Older Adults:A Nationwide Cohort Study in China

Physical activity (PA) plays a key role in the treatment of hypertension, and moderate to vigorous PA has been documented to lower the risk of developing hypertension. However, dose-response relationships between PA and hypertension are not consistent, and little is known about this relationship within the Chinese middle-aged and older people. We investigated the relationship between PA and hypertension within this population using China Health and Nutrition Survey 1991-2015 data. Physical activity was expressed in terms of the metabolic equivalent task (MET) and participants were divided into groups according to quartiles, namely, Q1 (< 32.97 METs-h/w), Q2 (32.97-60.38 METs-h/ w), Q3 (60.38-98.95 METs-h/w), and Q4 (> 98.95 METs-h/w). Compared with the Q1 group, the odds ratio of risk with hypertension (95% CIs) after adjusting for confounding factors were 0.63 (0.35, 1.12), 0.49 (0.28, 0.86), and 0.62 (0.35, 1.09) for those in Q2, Q3, and Q4, respectively. Restricted cubic spline functions were used and a U-shaped relationship between physical activity and hypertension risk was found, indicative of an optimal level of physical activity, which was found to be 112 METs-h/w. Our data suggest maintenance of optimal levels of total daily physical activity may be important for preventing hypertension in Chinese adults over the age of 40.

Successful remimazolam sedation-epidural block in an older patient with severe chronic obstructive pulmonary disease:A case report

BACKGROUND Chronic obstructive pulmonary disease(COPD)is associated with high morbidity and mortality rates worldwide.Older patients have a degenerative cardiopulmonary function,weak compensatory capacity,and poor surgical tolerance.Therefore,the mode of anesthesia must be optimized.Remimazolam is a new ultrashort-acting benzodiazepine with a rapid onset of action,rapid metabolism,and mild effects on pulmonary circulation.Remimazolam sedation combined with an epidural block has not been reported in hypertensive older adults with severe COPD and inguinal mass resection.CASE SUMMARY We report the case of a 73-year-old man with hypertension and severe COPD,who underwent resection of an enlarged inguinal mass that he had noticed more than 7 mo before presentation.The patient presented with a“right inguinal mass”and was recommended to undergo an enlarged inguinal mass resection.Surgery was relatively challenging,due to the large mass(13 cm×8 cm×7 cm),hard texture,and poor mobility.Considering the advanced age of the patient,gradeⅢhypertension,and severe COPD,we administered remimazolam combined with an epidural block for anesthesia to ensure perioperative safety and careful consideration.The anesthetic effect was precise;the procedure was performed smoothly without any complications,and the patient was successfully anesthetized.However,anesthetic management in such cases has not yet been reported by previous studies.CONCLUSION Remimazolam sedation combined with an epidural block is safe and effective in older patients with hypertension and severe COPD.

Older liver grafts from donation after circulatory death are associated with impaired survival and higher incidence of biliary non-anastomotic structure

Background:Grafts from older donors after circulatory death were associated with inferior outcome in liver transplants in the past.But it has seemed to remain controversial in the last decade,as a result of modified clinical protocols,selected recipients,and advanced technology of organ perfusion and preservation.The present study aimed to examine the impact of older donor age on complications and survival of liver transplant using grafts from donation after circulatory death(DCD).Methods:A total of 944 patients who received DCD liver transplantation from 2015 to 2020 were included and divided into two groups:using graft from older donor(aged≥65 years,n=87)and younger donor(age<65 years,n=857).Propensity score matching(PSM)was applied to eliminate selection bias.Results:A progressively increased proportion of liver transplants with grafts from older donors was observed from 1.68%to 15.44%during the study period.The well-balanced older donor(n=79)and younger donor(n=79)were 1:1 matched.There were significantly more episodes of biliary nonanastomotic stricture(NAS)in the older donor group than the younger donor group[15/79(19.0%)vs.6/79(7.6%);P=0.017].The difference did not reach statistical significance regarding early allograft dysfunction(EAD)and primary non-function(PNF).Older livers had a trend toward inferior 1-,2-,3-year graft and overall survival compared with younger livers,but these differences were not statistically significant(63.1%,57.6%,57.6%vs.76.9%,70.2%,67.7%,P=0.112;64.4%,58.6%,58.6%vs.76.9%,72.2%,72.2%,P=0.064).The only risk factor for poor survival was ABO incompatible transplant(P=0.008)in the older donor group.In the subgroup of ABO incompatible cases,it demonstrated a significant difference in the rate of NAS between the older donor group and the younger donor group[6/8(75.0%)vs.3/14(21.4%);P=0.014].Conclusions:Transplants with grafts from older donors(aged≥65 years)after circulatory death are more frequently associated with inferior outcome compared to those from younger donors.Older grafts from DCD are more likely to develop NAS,especially in ABO incompatible cases.

The quality of older adults'involvement in clinical communication with general practitioners:evidence from rural towns in Australia

Objective:A study was conducted about the putative links of older rural Australians'health knowledge and preparation with their quality of involvement in patient-general practitioner(GP)communication during health intake visits.Methods:It was a cross-sectional study between January 2021 and April 2022.The 32-item quality of involvement in communication scale was designed and incorporated into the SurveyGizmo software.This online survey was administered by sending an email request to the Renmark Rotary Club,which actively promoted this study across five rural towns in South Australia.121 participants completed the surveys.Mean-sum scores were calculated based on the questionnaire responses to evaluate outcomes,specifically initiation of information,active participation,and emotional expression.We employed different methods including t-tests,ANOVA,and leaner regressions to analyse data.Results:The demographic profile of participants characterised by a female predominance(58.7%,71/121),a majority falling within the 65-<70 age bracket(47.1%,57/121),and a high level of educational attainment(58.7%had completed high school or higher,71/121).Additionally,35%of the participants predominantly spoke a language other than English at home.Regarding the initiation of information with GPs,the mean sum-score was(20.5+3.7),indicating a marginally above-average level of engagement.Contrarily,the active participation was suboptimal,as suggested by a mean sum score of(35.9±6.3).Furthermore,the emotional expression was relatively low,with a mean score of(13.9±1.8).Substantial variations were discerned in the quality of patient-GP communication,contingent upon factors such as educational background,language spoken at home,health literacy,and preparatory measures for clinical visits.Participants who predominantly spoke a language other than English at home demonstrated significantly lower levels of information initiation with their GPs(P<0.o01).Higher educational attainment was positively correlated with increased active participation(P<0.001).Enhanced health literacy and thorough visit preparation were significantly associated with increased levels of active participation(P<0.001).Conclusion:Meaningful engagement through recognition,empowerment,and support(health literacy programs)for older rural adults is suggested for improving their quality of involvement in communication with GPs.