Analysis of Distribution of Public Toilets within Walking Range around Communities of the Elderly under the Model of Community Home-based Care for the Elderly: A Case Study of Changxindian, Fengtai District, Beijing

In recent years,under the influence of multiple factors such as traditional ideas and living economic conditions,the aging population in China continues to increase.Most of the elderly are more inclined to aged at home,and the first places for elderly activities are communities and the surrounding environment,which greatly affects the convenience of life and happiness of the elderly.In this paper,Changxindian area in Fengtai District of Beijing was as the research object,and detailed calculation and analysis were carried out by using POI data and arcGIS software.The relative location of residential areas and surrounding public toilets was explored,and the best location of public toilets in the daily walking area under the model of community home-based care for the elderly was further studied.

Analgesic Effect of Combined Spinal-Epidural Anesthesia and its Effect on TNF-α and CRP Levels in Elderly Patients with Hip Fracture During Surgical Treatment

Objective:To observe the analgesic effect of combined spinal and epidural anesthesia on older patients undergoing hip fracture surgery.Method:One hundred and twenty elderly hip fracture surgery patients treated in our hospital from January 2021 to December 2022 were selected and randomly divided into two groups,with 60 cases in the experimental group and 60 in the control group.The experimental group was given combined spinal-epidural anesthesia intervention measures,while the control group was given epidural anesthesia intervention measures.The analgesic effect,tumor necrosis factor-alpha(TNF-α),C-reactive protein(CRP)levels,and other observation indicators were analyzed after anesthesia intervention.Result:After the intervention,the analgesic effect and the evaluation results of the subjects in the experimental group were better than those in the control group(P<0.05);the obtained values of TNF-αand CRP levels in the experimental group were higher than those of the control group(P<0.05).Conclusion:The combined spinal-epidural anesthesia intervention demonstrated positive outcomes.The analgesic effect of patients during surgery and their inflammatory factor levels improved,which makes this intervention worthy of clinical application and promotion.

Analysis of the Effectiveness of Clopidogrel Combined with Aspirin in the Treatment of Coronary Heart Disease in Community-Dwelling Elderly

Objective:To analyze the combined therapeutic effect of clopidogrel(CLO)and aspirin(ASP)on coronary heart disease(CHD)in community-dwelling elderly.Methods:Thirty elderly patients with CHD who were admitted to the Xinxin Community Health Service Station,Pangzhuang Street,Quanshan District,Xuzhou City,from November 2020 to November 2022 were selected and randomly grouped into an observation group and a control group,with 15 cases in each group.The observation group was given the combination of CLO and ASP and the reference group was given only ASP.The total effective rate and other treatment indicators between the two groups were compared.Results:The total effective rate of the observation group(93.33%)was higher than that of the reference group(60.00%)(P<0.05).The adverse drug reaction rate(13.33%)and long-term cardiovascular adverse event rate(6.67%)of the observation group were lower than those of the reference group at 46.67%and 40.00%respectively,(P<0.05).Before treatment,the two groups had no difference in the quality-of-life scores(P>0.05).After treatment,the quality-of-life scores of the observation group were higher than those of the reference group(P<0.05).Conclusion:CLO combined with ASP improved the therapeutic effect of community-dwelling elderly patients with CHD,reduced adverse reactions during medication,prevented adverse cardiovascular events,and comprehensively improved the patient’s quality of life.

Effectiveness of Atorvastatin Combined with Trimetazidine in the Treatment of Coronary Heart Disease in the Elderly and Their Effect on Cardiac Function

Objective:To analyze the effect of atorvastatin combined with trimetazidine in the treatment of elderly coronary artery disease and the effect on patients’cardiac function.Methods:60 cases of elderly coronary artery disease patients were divided into 2 groups by randomization method,and all of them received conventional symptomatic treatment,while atorvastatin was added to the control group and trimetazidine was combined with atorvastatin in the observation group,and the clinical indexes were compared.Results:After treatment,the angina attack,cardiac function indexes,and inflammatory factor levels of the observation group were better than those of the control group(P<0.05),and the differences in adverse reactions between the two groups were not significant(P>0.05).Conclusion:Combined treatment of coronary heart disease in the elderly with atorvastatin and trimetazidine can positively reduce angina symptoms,improve cardiac function,and reduce inflammatory reactions,and the effect is definite.

An Interpretable Depression Prediction Model for the Elderly Based on ISSA Optimized LightGBM

Depression is one of the most severe mental health illnesses among senior citizens.Aiming at the low accuracy and poor interpretability of traditional prediction models,a novel interpretable depression predictive model for the elderly based on the improved sparrow search algorithm(ISSA)optimized light gradient boosting machine(LightGBM)and Shapley Additive exPlainations(SHAP)is proposed.First of all,to achieve better optimization ability and convergence speed,various strategies are used to improve SSA,including initialization population by Halton sequence,generating elite population by reverse learning and multi-sample learning strategy with linear control of step size.Then,the ISSA is applied to optimize the hyper-parameters of light gradient boosting machine(LightGBM)to improve the prediction accuracy when facing massive high-dimensional data.Finally,SHAP is used to provide global and local interpretation of the prediction model.The effectiveness of the proposed method is validated by a series of comparative experiments based on a real-world dataset.

Do Child Characteristics Matter to Mitigate the Widowhood Effect on the Elderly’s Mental Health? Evidence from China

This study empirically examines whether child characteristics mitigate the negative impact of widowhood on the elderly’s mental health using follow-up survey data from the China Health and Retirement Longitudinal Study(CHARLS).A total of 5,326 older adults aged 60 years and older are selected from three waves of panel data(2013,2015,and 2018).Thefindings suggest that respondents who experienced widowhood exhibit an increase in depressive symptoms.However,the higher income of children and frequent face-to-face emotional interactions improve the mental health of the widowed elderly.Moreover,heterogeneity analyses show that the buffering effect of higher child income is more significant among men and the Midwestern widowed elderly,and frequent face-to-face emotional interactions are more effective in improving the psychological status of women and the Midwes-tern widowed elderly.In the special social and cultural background of China,family members remain the main support for the elderly,and the current social pension system is still imperfect.Therefore,children should strengthen emotional communication with their parents while increasing their economic income.In that way,widowhood can achieve both material and spiritual prosperity.The government should identify the vulnerable groups among the elderly widows and introduce policies aimed at improving their mental health and reducing the disparity in mental health status.

A Preliminary Study of Medical Books on Health Care for the Elderly and Prolonging Life in the Early 20th Century

The present research of Chinese medical history lack detailed discussions on Chinese medicine philology of the elderly and the various sorting of related literature of physiology and diseases both at home and abroad.Based on previous literature,the article aims to introduce the publishing trend of medical books on health cultivation and prolonging life on since modern times,generally describe its significance,and initially analyze the contents related to health cultivation for the elderly.The article finds out that after the scientific concepts were imported into China in large quantities from the beginning of the 20th century,the past superstitions rose again.The sciences of nutrition,bacteriology,and physiology in such books had all verified that the road to immortality was possible.The concept of longevity at the time emphasized a concept that could be controlled by science.With the advancement of scientific research and health concepts,people believed that they could eventually achieve immortality.It was obvious that people were filled with optimism about science at that time,thus gradually subverting the definition of the elderly.

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.

Improvement of the Legal System for Addressing the Issue of Elderly Care in China in the Context of Population Aging

Rapid population aging is a social reality facing China at present,and the issue of elderly care has become a hot topic of social concern.Legislation to address the issue of elderly care in the context of population aging should follow systematic concepts to achieve“vertical and horizontal integration.”In terms of content,it is necessary to formulate specific legal approaches around“the elderly and children,”with a focus on guaranteeing the livelihood and protection of the rights of the elderly while taking into account childbirth,employment and other issues.the laws should not only safeguard the social participation and labor rights of the elderly,but also effectively respond to the social challenges brought about by the aging of the population.It is also necessary to optimize the family planning policy to ease the burden of child-raising,improve the population structure and promote the long-term balanced development of the population,thus fundamentally solving the problem of population aging.the effort to improve the legal system to deal with the issue of elderly care in the context of population aging will better advance Chinese modernization.

Effects of the 23-Valent Pneumococcal Polysaccharide Vaccine on the Mortality of Pneumonia among Elderly over 70 Years Old after the Great East Japan Earthquake—PPV Vaccination Program in Iwate Prefecture, Japan

Objective: To estimate the efficacy of 23-valent pneumococcal polysaccharide vaccine (PPSV23) among the elderly, we analyzed the relationship between the mortality of the elderly for pneumonia and the vaccination rate of PPSV23 from 2008 to 2016 in Iwate Prefecture, Japan. Study Design: The present study was a retrospective, observational, database study adopting an ecological design. The mortality for pneumonia among the elderly over 70 years old from 2006 to 2016 in Iwate Prefecture was calculated based on the data from the Japanese Vital Statistics. We compared the mortality rate (MR) of pneumonia among the elderly over 70 years old between the low-vaccinated period (LVP) (2006-2010) and high-vaccinated period (HVP) (2012-2016) using a Poisson regression model. Results: While the vaccination rate of PPSV23 among the elderly over 65 years old was 3.3% in 2010, it increased rapidly up to 40.7% in 2012 and reached 66.4% in 2016. The MR ratio of the total population during HVP to the average MR during LVP was 0.749. The MR of the total population during HVP was significantly lower than that during LVP (p Conclusion: The increase in vaccination rate of PPSV23 during HVP (2012-2016) may contribute to the decrease in mortality for pneumonia among the elderly over 70 years old in Iwate Prefecture.

Metabolic Disorders Increase the Risk to Incident Cardiovascular Disease in Middle-aged and Elderly Chinese

Objective The association of metabolic syndrome （MetS） with cardiovascular diseases （CVD） has not been adequately explored in middle-aged and elderly Chinese. This study aimed to investigate MetS＇ prevalence and its impact on the CVD incidence in this specific population group. Methods A data set of a community-based prospective cohort study was analyzed. A total of 2300 subjects aged 40-94 years were followed up for the CVD events. MetS defined according to the JCDCG criteria was assessed at baseline, and the middle-aged and elderly groups were classified by the WHO definition. Results As compared with the middle-aged group, the prevalence of MetS increased by 0.6 times （34.6% vs. 21.3%） and the incidence density of CVD increased by 4.9 times in the elderly group （52.3/1000 person-year vs. 8.9/1000 person-year）. Furthermore, the multivariate Cox regression revealed that the risk to CVD incidence was independently related to increased waist circumference in the middle-aged group （HR=2.23, P〈0.01） and to elevated blood glucose in the elderly group （HR=1.39, P〈O.01）. Conclusion MetS was highly prevalent in middle-aged and elderly Chinese. MetS significantly increased the risk to OdD incidence in the elderly. All individuals with metabolic disorders should receive active clinical care to reduce the incidence of CVD.

Is dual therapy the correct strategy in frail elderly patients with atrial fibrillation and acute coronary syndrome?

Atrial fibrillation(AF)is a very common arrhythmia in clinical practice.Its incidence and prevalence are age-related and are growing in the last years.Age is a risk factor also for coronary artery disease(CAD),and with the evolution of preventive care,the first event(acute coronary syndrome(ACS)or percutaneous coronary intervention(PCI))takes place at a later age.If elderly patients with AF and CAD undergo ACS or PCI,they have indication to assume triple therapy.Triple therapy(oral anticoagulation(OAC)plus dual antiplatelet therapy(DAPT))exposes patients to high bleeding risk.In the last 10 years,several clinical trials have tested dual therapy(OAC plus single antiplatelet therapy)in AF patients who undergo ACS or elective PCI.WOEST trial has tested warfarin+clopidogrel against triple therapy.PIONEER AF-PCI trial has tested low-dose rivaroxaban+P2Y12 inhibitor or very low-dose rivaroxaban+DAPT against standard triple therapy with warfarin.RE-DUAL PCI trial has tested two doses of dabigatran+P2Y12 inhibitor against standard triple therapy with Warfarin.AUGUSTUS trial has tested apixaban against warfarin both in dual therapy with P2Y12 inhibitor and in triple therapy with a P2Y12 inhibitor and aspirin.ENTRUST-AF PCI,last published study,has tested edoxaban+P2Y12 inhibitor against triple therapy.All these trials show dual therapy reduces significantly bleeding risk than triple therapy.In this paper,we analyze these clinical trials to understand if dual therapy results can be applied to elderly patients and what is probably the better approach in elderly AF patients undergo to ACS or PCI.

BMI and BMI Changes to All-cause Mortality among the Elderly in Beijing： a 20-year Cohort Study

Objective To explore the association between body mass index （BMI） and all-cause mortality among the elderly in Beijing. Methods This analysis was based on the Beijing multidimensional longitudinal study of aging （BLSA）, which included 2,090 subjects over 55 years old and was followed-up from 1992 to 2012. BMI-mortality curves were drawn to find the optimal BMI range with the lowest mortality. Cox proportional hazard models were used to obtain the hazard ratios （HRs） for BMI and BMI changes in the overall population and in specific stratified populations. Results During follow-up, 2,264 deaths were recorded; BMI-mortality curve was U-shaped, with the lowest mortality at a BMI of approximately 25 kg/m2. After adjusting for gender, age, smoking, drinking and some pre-existing diseases, HRs for underweight, overweight and obesity compared with normal weight were 2.372 （95% C/： 2.254-2.632）, 0.767 （95% CI： 0.666-0.884） and 0.872 （95% CI： 0.830-1.246）, respectively. HR for BMI drop was 3.245 （95% CI： 0.824-22.772） in the underweight group and 1.892 （95% C/： 0.830-1.246） in the normal weight group, HR for BMI rise was 1.795 （95% CI： 1.243-2.591） in normal weight group and 2.962 （95% CI： 2.202-3.203） in the overweight group. Conclusion Keeping BMI in an overweight status and stable is related to a reduced mortality

Catheter ablation for atrial fibrillation is associated with reduced risk of mortality in the elderly:a prospective cohort study and propensity score analysis

Background It is unclear whether catheter ablation(CA)for atrial fibrillation(AF)affects the long-term prognosis in the elderly.This study aims to evaluate the relationship between CA and long-term outcomes in elderly patients with AF.Methods Patients more than 75 years old with non-valvular AF were prospectively enrolled between August 2011 and December 2017 in the Chinese Atrial Fibrillation Registry Study.Participants who underwent CA at baseline were propensity score matched(1:1)with those who did not receive CA.The outcome events included all-cause mortality,cardiovascular mortality,stroke/transient ischemic attack(TIA),and cardiovascular hospitalization.Results Overall,this cohort included 571 ablated patients and 571 non-ablated patients with similar characteristics on 18 dimensions.During a mean follow-up of 39.75±19.98 months(minimum six months),24 patients died in the ablation group,compared with 60 deaths in the non-ablation group[hazard ratio(HR)=0.49,95%confidence interval(CI):0.30-0.79,P=0.0024].Besides,6 ablated and 29 non-ablated subjects died of cardiovascular disease(HR=0.25,95%CI:0.11-0.61,P=0.0022).A total of 27 ablated and 40 non-ablated patients suffered stroke/TIA(HR=0.79,95%CI:0.48-1.28,P=0.3431).In addition,140 ablated and 194 non-ablated participants suffered cardiovascular hospitalization(HR=0.84,95%CI:0.67-1.04,P=0.1084).Subgroup analyses according to gender,type of AF,time since onset of AF,and anticoagulants exposure in initiation did not show significant heterogeneity.Conclusions In elderly patients with AF,CA may be associated with a lower incidence of all-cause and cardiovascular mortality.

Effect of serum γ-glutamyltranferase and albumin levels on the response to cardiac resynchronization therapy in the elderly

Background Several liver function tests have been identified as predictors of hospitalization for heart failure(HF) and death in patients with chronic HF. The relationship between serum γ-glutamyltranferase(GGT) and albumin(SA) levels with the response to cardiac resynchronization therapy(CRT) has not been reliably determined. The aim of the study was to evaluate the impact of liver function tests on the results of CRT in the elderly. Methods Baseline GGT and SA were assessed before CRT device implantation in the elderly(> 70-year-old) patients. The endpoints were:(1) CRT response defined as > 5% left ventricular ejection fraction improvement and no hospitalization for HF or cardiovascular death;(2) hospitalizations;and(3) mortality. Results Eighty of 138(58%) included patients were responders at nine months. Compared to responders, the SA levels were not significantly different(35.1 ± 5.4 vs. 33.6 ± 5.5 g/L, P = 0.103);but the GGT levels, higher(81.6 ± 69.3 vs. 54.7 ± 49.6 U/L, P = 0.013) in non-responders to CRT. GGT level was independently associated with non-response to CRT(P < 0.001, OR = 0.17;95% CI: 0.08–0.38, P < 0.001). GGT cut-off value ≥ 55 U/L was highly predictive of non-response [AUC = 0.65, 64% Sensitivity, 69% Specificity(95% CI: 0.56–0.74)]. GGT ≥ 55 U/L was also associated with higher risk of hospitalization for atrial fibrillation(AF)(95% vs. 83%, P = 0.024). Both SA and GGT had no impact on overall(P = 0.220, P = 0.723) mortality. Conclusions Higher level of GGT is an independent predictor of non-response to CRT in patients over age 70 years and is associated with higher risk of hospitalization for AF. Baseline serum levels of albumin and GGT and have no impact on mortality in elderly patients undergoing CRT.

Non-ST elevation acute coronary syndrome in the elderly

1 Introduction Societies are ageing at an accelerated pace.This scenario is a well-known challenge for health care systems,as chronic diseases,multiple comorbidities and dependency are all entities that often converge in the elderly.Besides,there is an issue regarding a reduction in the general incidence of acute coronary syndrome(ACS)together with a delayed in the age of presentation,which,in sum,lead to an increase in both incidence and prevalence of ACS with age,especially non-ST elevation myocardial infarction(NSTEMI).

Pacemaker therapy in very elderly patients: survival and prognostic parameters of single center experience

Background Permanent pacing is the therapy of choice for treating severe and/or symptomatic bradyarrhythmias. The number of very elderly patients receiving pacemakers is increasing and little is known about survival in this specific subgroup. This study is aimed at assessing the actual survival of patients requiring pacing therapy at age > 85 years and investigating variables associated with death. Methods Between 2010 and 2017, 572 patients aged ≥ 85 years underwent pacemaker implantation for conventional bradycardia indications in Department of Cardiology, S. Chiara Hospital, Italy. Results Thirty percent of patients were ≥ 90-year-old and comorbidities were frequent. Fifty-seven percent of patients required pacing for prognostic reasons(acquired atrioventricular block), and the remaining for relief of bradycardia symptoms. A dual-chamber pacemaker was implanted in 34% of patients. The 5-year survival was 45%(standard error: 3%), and the 8-year survival was 26%(standard error: 4%). The risk of death was similar in patients who received pacemaker for symptom relief and for prognostic reasons in the overall population(HR = 1.19, 95% CI: 0.93–1.52, P = 0.156), as well as in the ≥ 90-year-old group(HR = 1.39, 95% CI: 0.92–2.11, P = 0.102). At multivariate analysis, following variables were associated with death: higher age, lower ejection fraction, dementia/dysautonomia and diagnosis of cancer. The pacing indication and the implantation of a single chamber pacemaker were not associated with worse prognosis. Conclusions This study showed a good life expectancy in patients aged ≥ 85 years who received a pacemaker. Strong risk factors for all-cause death were non-cardiac. Pacemaker therapy seems a clinically effective therapeutic option to improve survival and to control bradyarrhythmia-related symptoms in very elderly patients.

The power of informal institutions:The impact of clan culture on the depression of the elderly in rural China

Exploration of ways to improve the subjective welfare of residents is an important area of current academic research.Using data from the China Family Panel Studies survey conducted in 2010,this paper investigated the impact of clan culture on the mental health of elderly people in rural China.The results demonstrated that clan culture can significantly decrease the depression score of the rural elderly.Further,there was no gender difference with respect to the impact of clan culture on the depression score of the elderly.At the same time,the positive effects of clan culture on the depression score of the elderly have gradually weakened with economic development.Exploration of the mechanisms involved indicated that in areas with stronger clan culture,older people receive more social support.This study enriches our understanding of the impact of informal institutions on the welfare of rural residents.At the same time,it can also provide a certain decisionmaking reference for the government to formulate relative poverty relief strategies in a new stage of poverty alleviation.

A Survey of Social Nutrition Status of the Elderly in theUrban Area of Chengdu, Sichuan Province

The social nutrition status was investigated among 246 subjects aged 60-90 living at three urban communities in Chengdu of Sichuan Province. The questionnaire was designed to evaluate socirydeweraphic background, the subjects' nutrition knowledge, and the support systerns for geriatric nutrition. Fasting venous blcod was colected for the analysis of biochemical parameters. Blood pressure, bene mineral contents (BMC), body weight (BW) and they height (BH) were measured at the same time. Only 49. 7% of the subjects correctly an swered four basic questions on nutrition. Food patterns for the elder1y were simple and modest. Several nutrition-related disorders for the elderly were including high systolic bbo pressure (44. 6 % ), hyPertriglyceridemia (25. 9 % ), high diasto1ic blood pressure (25. 1% ),obesity (24. 5% ), high PBG (20. 6% ), emaciation (19. 9%), high FBG (17.9%) and osteoporosis (16. 8%). These data indicate that the support systems for the geriatric nutrition will have to be improved.

Study on Influence Factors of Pressure Injury Risk in the Elderly Inpatients with Kidney Disease Based on LASSO Regression

Objective: This paper aims to explore clinical status and related influence factors of pressure injury (PI) in the elderly inpatients with kidney disease, so as to provide reference for the prevention and treatment of PI in the elderly inpatients with kidney disease. Methods: Retrospective collection method is adopted to collect 158 clinical cases of the elderly inpatients with kidney disease aged ≥ 60 in the Nephrology Department, the First Affiliated Hospital of Jinan University from January 2017 to December 2019, and then least absolute shrinkage and selection Operator (LASSO) regression analysis is used to analyze 17 possible influence factors;finally Logistic regression model is established to analyze and screen influence factors of risk. Results: 1) Among 158 elderly inpatients with medium and high risk of PI, the incidence of PI is 20.25%;the most common stage of injury is stage I (42.5%);sacrococcygeal (60%) is the high-risk site of pressure injury. 2) LASSO regression analysis shows that history of present respiratory infection/respiratory failure (β = 1.2714. P < 0.05) and hospitalization time (β = 0.4177. P < 0.05) are independent factors influencing PI risk in the elderly inpatients with kidney disease. Conclusion: The elderly patients with kidney disease and PI risk are the high incidence population of hospital acquired PI;for the elderly inpatients with kidney disease and having respiratory infection history or respiratory failure, prolonged hospitalization will significantly increase the risk of PI. Therefore, targeted preventive and control measures should be taken to reduce the incidence of PI.