Verapamil and vasospastic angina： underuse in the elderly population

The first case of Prinzmetal angina was described in 1959 by Prinzmetal, et al. Since this description, several triggering factors have been associated with vasospastic angina （VA） and included： illicit drugs such as cocaine, amphetamine or marijuana, but also bitter-orange, alcohol, butane, chemotherapy drugs, over-the-counter medication and different antibiotics. Smoking is also a major risk factor for developing VA.t21 Thus, except for smoking, many of conventional atherosclerosis risk factors do not appear to be applicable to VA.t21 However, vasospastic angina can also occur without any triggering factor.

Prophylactic use of implantable cardioverter-defibrillators in the elderly population

Introduction Sudden cardiac death (SCD) accounts for approximately 300,000 deaths each year in the United States. Ventricular fibrillation, as the initial event, had been reported in 65%-85% of these patients.1 An implantable cardioverterdefibrillator (ICD) is the single most effective life saving device to date. The advances in medicine and technology have led to wide spread utilization of defibrillators in developed countries.

A Prospective Study of Maintenance Electroconvulsive Therapy in an Elderly Depressed Population

Objective: This study was conducted to discern the efficacy of maintenance electroconvulsive therapy (M-ECT) in a population of depressed elderly individuals with treatment-resistant depression. Methodology: Twenty-nine (N = 29) individuals over the age of 65 years of age and older were assigned to a control or treatment group on the basis of their decision to receive M-ECT (treatment group) or to refrain from receiving the treatment (control group). A battery of psychometric tests designed to measure severity of depression, quality of life, and cognition were administered at baseline as well as at 6-month and 1-year intervals. Results: Statistical analysis of the data indicated no significant differences in the efficacy of M-ECT between the control and treatment groups in any of the tests administered during the participation of the study. Conclusion: The results of the study suggest that there is no added benefit for patients administered M-ECT. However, study sample size and availability of alternative treatment regimens for the control group limit generalizability of these findings and warrant further investigation.

Developed Fall Detection of Elderly Patients in Internet of Healthcare Things

Falling is among the most harmful events older adults may encounter.With the continuous growth of the aging population in many societies,developing effective fall detection mechanisms empowered by machine learning technologies and easily integrable with existing healthcare systems becomes essential.This paper presents a new healthcare Internet of Health Things(IoHT)architecture built around an ensemble machine learning-based fall detection system(FDS)for older people.Compared to deep neural networks,the ensemble multi-stage random forest model allows the extraction of an optimal subset of fall detection features with minimal hyperparameters.The number of cascaded random forest stages is automatically optimized.This study uses a public dataset of fall detection samples called SmartFall to validate the developed fall detection system.The SmartFall dataset is collected based on the acquired measurements of the three-axis accelerometer in a smartwatch.Each scenario in this dataset is classified and labeled as a fall or a non-fall.In comparison to the three machine learning models—K-nearest neighbors(KNN),decision tree(DT),and standard random forest(SRF),the proposed ensemble classifier outperformed the other models and achieved 98.4%accuracy.The developed healthcare IoHT framework can be realized for detecting fall accidents of older people by taking security and privacy concerns into account in future work.

Pregabalin induced balance disorder,asthenia,edema,and constipation in an elderly adult:A case report

BACKGROUND Pregabalin is widely used to treat neuropathic pain associated with postherpetic neuralgia.To our knowledge,this is the first report on simultaneously occurring dose-related adverse drug reactions(ADRs)of balance disorder,asthenia,peripheral edema,and constipation in an elderly patient after pregabalin.CASE SUMMARY A 76-year-old female with a history of postherpetic neuralgia was prescribed pregabalin(300 mg daily).After taking pregabalin for 7 d,the patient developed balance disorder,weakness,peripheral pitting edema(2+),and constipation.On days 8-14,the pregabalin dose was reduced to 150 mg/d based on creatinine clearance.The patient’s peripheral edema improved significantly with the disappearance of all other adverse symptoms.On day 15,the pregabalin dose was increased to 225 mg/d to relieve pain.Unfortunately,the symptoms mentioned earlier gradually reappeared after 1 wk of pregabalin treatment.However,the complaints were not as severe as when taking 300 mg/d pregabalin.The patient consulted her pharmacist by telephone and was advised to reduce the dose of pregabalin to 150 mg/d and add acetaminophen(0.5 g,q6h)to relieve pain.The patient’s ADRs gradually improved over the following week.CONCLUSION Older patients should be prescribed a lower initial dose of pregabalin.The dose should be titrated to the maximum tolerable dose to avoid dose-limiting ADR.Dose reduction and the addition of acetaminophen may help limit ADR and improve pain control.

Association of Multiple Urinary Phthalates Metabolites with Diabetes Risk in Elderly Population

As a common environmental endocrine disruptor,phthalate exposure could affect the diabetes risk.However,it remains unclear whether phthalate exposure in the elderly population alters diabetes risk.We conducted a cross-sectional survey to explore the effect of urinary phthalate metabolites on diabetes in the elderly.We conducted a health survey of 200 elderly in northeastern China and measured urinary concentrations of 64 phthalate metabolites.We next evaluated the association between major phthalates and phthalate mixtures and diabetes in the elderly.The least absolute shrinkage and selection operator(LASSO)regression screened for mono(3-carboxypropyl)phthalate(MCPP),monoethyl phthalate(MEP),and mono(2-ethyl-5-hydroxyhexyl)phthalate(MEHHP)as important predictors for diabetes.Weighted quantile sum(WQS)regression and Bayesian Kernel Machine regression(BKMR)models consistently found MEHHP(Weights=51.9%,PIP=0.97)to have the greatest effect on diabetes risk in the elderly.Furthermore,MEHHP was associated with an increased risk of diabetes in the multipollutant logistic regression model(OR=2.148,95%CI:1.255 to 3.677).The overall effect of coexposure to MCPP,MEHHP,and MEP on the risk of diabetes in elderly population was significant and positive.In summary,we found that increased urinary MEHHP levels could increase the risk of diabetes in the elderly population.Co-exposure to MCPP,MEHHP and MEP may increase the risk of diabetes.

The Comparative Approach on Outdoor Leisure Behavior of Urban Elderly People:A Case Study in Beijing

With the income increase of elderly people in Beijing and the improvement of leisure facilities since 2000, the quality of elderly people leisure life in Beijing has obviously increased com- pared to ten years ago. According to the investigation and com- parative analysis on more than 900 elderly people, who usually exercise in public parks in Beijing City, we have found out several new features of elderly people＇s outdoor recreation in Belting： the increase of the leisure time, the expansion of leisure space, the in- dividuation of interest and the diversification of consumption. The leisure life quality evaluation index system of urban elderly people can be built based on these analyses. In order to accommodate the development tendency of elderly people＇s demand for leisure diversification, we should strengthen the organization and manage- ment of elderly people＇s leisure activity in urban construction, and pay more attention to function complementation between commu- nities and parks.

Deep Forest-Based Fall Detection in Internet of Medical Things Environment

This article introduces a new medical internet of things(IoT)framework for intelligent fall detection system of senior people based on our proposed deep forest model.The cascade multi-layer structure of deep forest classifier allows to generate new features at each level with minimal hyperparameters compared to deep neural networks.Moreover,the optimal number of the deep forest layers is automatically estimated based on the early stopping criteria of validation accuracy value at each generated layer.The suggested forest classifier was successfully tested and evaluated using a public SmartFall dataset,which is acquired from three-axis accelerometer in a smartwatch.It includes 92781 training samples and 91025 testing samples with two labeled classes,namely non-fall and fall.Classification results of our deep forest classifier demonstrated a superior performance with the best accuracy score of 98.0%compared to three machine learning models,i.e.,K-nearest neighbors,decision trees and traditional random forest,and two deep learning models,which are dense neural networks and convolutional neural networks.By considering security and privacy aspects in the future work,our proposed medical IoT framework for fall detection of old people is valid for real-time healthcare application deployment.

Shanghai expert consensus on clinical protocol for traditional Chinese medicine treatment of COVID-19 among the elderly population(second edition)

This document is the revised edition of the previously issued Shanghai Expert Consensus on Clinical Protocol for Traditional Chinese Medicine Treatment of COVID-19 among the Elderly Population.Based on the clinical experience and the Protocol for Diagnosis and Treatment of COVID-19(Trial 9th Edition),this revised edition provides treatment approaches and recommendations to proactively cope with Omicron variant and increase the therapeutic efficacy for coronavirus disease 2019 among the elderly population in Shanghai,China.

Changes in the death probability of China’s elderly population and rethinking the definition of old age

A study of the age-specific death probability of China’s elderly population from 1982 to 2010 shows that,during the past 30 years,the death probability of China’s elderly population has decreased over time.This indicates that the health status of and meaning of age for the elderly population has been changing.At the same time,changes in economic,social and environmental factors and the development of science and technology have not only greatly changed the lifestyles and work situation of the elderly population,but also provided them with more opportunities to participate in economic and social activities,thus making today’s elderly people“healthier”and“younger”than those of previous generations.In conclusion,the findings of this paper suggest that it is necessary to rethink the traditional definition of elderly population.In addition,changes in the death probability of the elderly population of China also show significant gender and regional differences domestically,and there are gaps in the death probability of the elderly in China versus in developed countries,indicating that China still has a long way to go to complete a fundamental transformation of death patterns.A full understanding of such changes and differences will allow us to redefine old age and develop a new understanding of the aging society.Such an understanding can also help us to reconstruct the public policy system to meet the needs of a future society in which aging is the normal state of affairs.

An Analysis of the Relationship Between the Education Attainment and Economic Status of the Elderly Population in the Towns and Cities of China

Viewed from a macro scope,the cultureof a community is closely related to its econ-omy.Economy being the basis,the level ofeconomic growth determines the level ofcultural development.Conversely,culturecan act as the precursor and cultural devel-opment enhances economic growth.Likewise,the education attainment of an in-dividual reflects the same sort

Deficiency of Healthcare Accessibility of Elderly People Exposed to Future Extreme Coastal Floods:A Case Study of Shanghai,China

Socioeconomic development,subsidence,and climate change have led to high flood risks in coastal cities,making the vulnerable,especially elderly people,more prone to floods.However,we mostly do not know how the accessibility of life-saving public resources for the elderly population will change under future scenarios.Using Shanghai as a case,this study introduced a new analytical framework to fill this gap.We integrated for the first time models of coastal flooding,local population growth,and medical resource supply-demand estimation.The results show that under an extreme scenario of coastal flooding in the year 2050,in the absence of adaptation,half of the elderly population may be exposed to floods,the supply of medical resources will be seriously insufficient compared to the demand,and the accessibility of emergency medical services will be impaired by flooding.Our methodology can be applied to gain insights for other vulnerable coastal cities,to assist robust decision making about emergency responses to flood risks for elderly populations in an uncertain future.

Digital literacy and financial market participation of middle-aged and elderly adults in China

Digital literacy has become increasingly important for individuals to participate in regular economic activities,including employment,consumption,and investment.This paper quantitatively defines digital literacy with recently released household survey data in China and describes the digital divide across regions and ages.We further show that digital literacy increases risky asset ownership in the financial market among the middle-aged and elderly population.In this sense,this paper identifies a novel factor that affects financial investment.These findings imply that the digital divide may lead to the asset divide and wealth inequality.Family and social assistance to improve the digital literacy of disadvantaged population groups may increase financial inclusion as well.

The role of neutrophil to platelet ratio in predicting death in elderly patients with ST-elevation myocardial infarction receiving percutaneous coronary intervention

Background Despite receiving percutaneous coronary intervention(PCI),the mortality in elderly patients with ST-segment elevation myocardial infarction(STEMI)remains high.The aim of this study was to explore the prognostic value of neutrophil to platelet ratio(NPR)in elderly STEMI patients receiving PCI.Methods Patients≥65 years old with the diagnosis of STEMI who had received PCI was retrospectively enrolled between January 2010 and April 2016 in the Guangdong Provincial People's Hospital.The relationship between NPR and inhospital and 1-year mortality was evaluated.Results A total of 767 elderly patients with STEMI were included and divided into three groups according to the tertiles of NPR:<37(n=253),37-54(n=257),and≥54(n=257).Multivariate logistic regression analysis showed an independent correlation between elevated NPR and in-hospital death[odds ratio(OR)=1.02,95%confidential interval(CI):1.01-1.03,P<0.001].The receiver operating characteristic curve(AUC)analysis demonstrated a relatively high predictive value for NPR in identifying in-hospital death(AUC=0.765,95%CI:0.704-0.825,P<0.001,sensitivity=77.1%,specificity=69.0%,optimal cut-off value=54).As for 1-year mortality,multivariate Cox survival analysis revealed that NPR[hazard ratio(HR)=1.003,95%CI:1.001-1.004,P<0.001],as a continuous variable,and NPR>54(HR=2.70,95%CI 1.72-4.22,P<0.001),as a categorial variable,were both independent predictors for 1-year mortality.Conclusions NPR is a feasible predictor of poor prognosis for elderly patients with STEMI receiving PCI.

Prognostic factors and predictive model for in-hospital mortality following hip fractures in the elderly

Purpose： The incidence of hip fractures is increasing within the aging population. Our objective was to identify and quantify the risk factors and develop a predictive model for the in-hospital mortality among hip fracture patients older than 65 years. Methods： This is a prospective study conducted on 331 hip fracture patients older than 65 years admitted to our hospital from 2011 to 2014. Patients＇ demographics, prehospitalization residential status, pre- fracture comorbidity data, anti-aggregant and anticoagulant medication, preoperative hemoglobin value, type of fractures, type of treatments, time to surgery, and complications were recorded. Results： The average age was 83 years, 73% female, and 57% of them sustained a femoral neck fracture. In 62.8% of patients, the number of pre-fracture baseline comorbidities was 〉2. The in-hospital mortality rate was 11.4%. In multivariate analysis, age over 90 years, congestive heart failure, asthma, rheumatologic disease, lung cancer, and not taking antiaggregant medication were independently associated with in-hospital mortality. A formula and risk stratification scoring for predicting the risk for in-hospital mortality was developed, Risk-adjustment model based on these variables had acceptable accuracy for predicting in-hospital mortality （c-statistic 0.77）. Conclusion： Advanced age, and five prefracture comorbidities have a strong association with in-hospital mortality in a hip fracture patient older than 65 years old. Our predictive model was specifically designed for the old hip fracture population. It has an accuracy similar to other risk models. The specificity, positive predictive value, and negative predictive value are high. In addition, it could discriminate a high risk patient from a low risk patient for in-hospital mortality.

Availability and social determinants of community health management service for patients with chronic diseases:An empirical analysis on elderly hypertensive and diabetic patients in an eastern metropolis of China

Objective:This study aimed to determine the availability of community health management services and the relevant social determinants for elderly patients with chronic diseases.Methods:All data were obtained from the 2013 random sampling household survey on an elderly population conducted by the School of Public Health of Peking University in an eastern metropolis in China.Information from the database of the above survey involving 1495 hypertensive or diabetic patients>60 years of age,as representatives of the city,were included.The study described the availability of follow-up services by community doctors among elderly hypertensive and diabetic patients during the 12 months before the survey.An ordinal multinomial logistic regression model was used to conduct the analysis on the influence of socio-economic background upon such availability.Results:Eighty-one percent of hypertensive patients and 84.7%of diabetic patients had not received any follow-up service from community doctors within 12 months prior to the survey.Among elderly hypertensive patients,those registered as non-agricultural household members,those with high and above-average income,as well as management personnel of government agencies,enterprises,and social programs have a greater chance of accepting follow-up service by community doctors because of their relatively higher socio-economic rankings.Among elderly diabetic patients,such socio-economic factors had no significant influence on the availability of the follow-up service for chronic diseases.Conclusion:The coverage of community health management services for elderly hypertensive and diabetic patients needs improvement.More effort should focus on promoting the availability of community health management services for elderly hypertensive patients,especially those with lower socio-economic status.

Twenty years’ follow-up on elder people’s health and quality of life

With a brief overview on changes of elderly people and related socio-economic and policy changes during the last two decades in China,this review introduces the Chi-nese Longitudinal Healthy Longevity Survey(CLHLS).The review also tracks fol-low-up survey waves that came after the initial CLHLS and the evolution of CLHLS questionnaire design over this 20 year period.The CLHLS database contains approximately 130 thousand records of surviving and deceased elderly people aged 65 and above.There is information on the demographics of the elderly population,as well as information on health status,the cognitive abilities of the elderly,their lifestyles,their ability to perform daily activities,and self-assessments of the elderly.There is also information on elderly care providers and family members.The review introduces the sampling design used by CLHLS,lists core information collected by the survey,and identifies major items added to follow-up surveys,including to the 2018 survey.It summarizes how CLHLS data is used and related publications.

Analysis of the Efficacy and Safety of Recombinant Tissue Plasminogen Activator for Chinese Patients over 80 Years of Age with Acute Ischemic Stroke： A Pilot Study

Dear Editor,Recombinant tissue plasminogen activator（rt-PA）remains the only proven therapy for acute ischemic stroke patients who meet the selection criteria for treatment[1–3].A small number of studies have investigated the efficacy of rt-PA for elderly stroke patients in Japanese and Caucasian populations[4,5].According to the American Heart Association/American Stroke Association Guidelines,