身体活动对老年认知功能的影响

如何促进老年人的认知功能,延缓认知老化,是老年心理学的关键课题之一。大量研究表明不同的身体活动类型、活动强度、活动量以及生命早期的身体活动可能对老年人认知功能的各个方面有积极的影响,包括执行功能、注意力、认知速度、记忆力等。此外,选择性提高假说、心血管功能假说以及认知-锻炼模型用来解释这一影响机制。这些发现对维护老年人认知功能,提高老年人的生命质量,有效延缓衰老有着重要的意义。

Network analysis of the relationships between depressive symptoms and social participation activities among Chinese older adults and its implications for nursing

Objective:Network analysis was used to explore the complex inter-relationships between social participation activities and depressive symptoms among the Chinese older population,and the differences in network structures among different genders,age groups,and urban-rural residency would be compared.Methods:Based on the 2018 wave of the Chinese Longitudinal Healthy Longevity Survey(CLHLS),12,043 people aged 65 to 105 were included.The 10-item Center for Epidemiologic Studies Depression(CESD)Scale was used to assess depressive symptoms and 10 types of social participation activities were collected,including housework,tai-chi,square dancing,visiting and interacting with friends,garden work,reading newspapers or books,raising domestic animals,playing cards or mahjong,watching TV or listening to radio,and organized social activities.R 4.2.1 software was used to estimate the network model and calculate strength and bridge strength.Results:21.60%(2,601/12,043)of the participants had depressive symptoms.The total social participation score was negatively associated with depressive symptoms after adjusting for sociodemographic factors.The network of social participation and depressive symptoms showed that“D9(Inability to get going)”and“S9(Watching TV and/or listening to the radio)”had the highest strength within depressive symptoms and social participation communities,respectively,and“S1(Housework)”,“S9(Watching TV and/or listening to the radio)”,and“D5(Hopelessness)”were the most prominent bridging nodes between the two communities.Most edges linking the two communities were negative.“S5(Graden work)-D5(Hopelessness)”and“S6(Reading newspapers/books)-D4(Everything was an effort)”were the top 2 strongest negative edges.Older females had significantly denser network structures than older males.Compared to older people aged 65e80,the age group 81e105 showed higher network global strength.Conclusions:This study provides novel insights into the complex relationships between social participation and depressive symptoms.Except for doing housework,other social participation activities were found to be protective for depression levels.Different nursing strategies should be taken to prevent and alleviate depressive symptoms for different genders and older people of different ages.

不同婚姻状况老年人心理抑郁程度的影响因素分析与差异分解

进入老龄社会后,我国的老龄问题日益明显。其中,心理抑郁问题作为老年人面临的一大难题亟须得到关注。国外的多项研究指出,不同婚姻状况老年人的心理抑郁程度也有所不同。基于2011年中国健康与养老追踪调查数据,通过无条件分位数回归与RIF分解方法,分别对我国不同婚姻状况老年人的CES-D抑郁程度得分进行分析。结果发现:身体健康状况及收入水平显著影响老年人的抑郁程度,且对无配偶老年人的回报率更高;近期遇到的挫折也会对无配偶老年人产生更加明显的负面影响;不同婚姻状态对抑郁程度的参数效应不同,其中对中等心理状态老年人的影响最为明显。基于研究结论与文献梳理,分别从政府、社区以及个人三个方面,提出缓解老年人心理抑郁程度的建议。

Modulatory Effect of Pollen Extract on Apoptosis of Lymphocytes in the Elderly

Aim In this study, we investigated the changes of lymphocyte subpopulationand apoptosis process of lymphocytes in the elderly, and the modulatory effect of pollen extract(PE) on apoptosis. Methods Lymphocyte phenotypes were detected using indirect immunofluorescencetechnique. The proliferation responses were determined by MTT method. Flow cytometry and automaticimage analysis were performed to evaluate the apoptosis of lymphocytes. Results The proliferationresponses of lymphocytes in the elderly were lower than that in young adults. Decreased CD_(45) RA^+cells and increased CD_(45) RO^+ cells were found in lymphocyte population of aged people, comparedwith that of young adults. The CD_(45) RO^+ cells were prone to apoptosis. There is an inhibitoryeffect of PE on apoptosis of lymphocytes in the elderly. Conclusion It is implied that thesusceptibility of lymphocyte in the elderly to apoptosis depends on activation, so called,activation-induced cell death. Present results suggest that apoptosis of lymphocytes in aged peopleplay an important role in the pathogenesis of immunosenescence. Thus, a possibility is open fordevelopment of apoptosis-modulating drugs from pollen.

Metabolic syndrome vs. its components for prediction of cardiovascular mortality： A cohort study in Chinese elderly adults

Objective The predictive value of the metabolic syndrome （MetS） for mortality from all-cause and cardiovascular disease （CVD） in the Chinese population is unclear. The aim of this present study was to compare MetS with its individual components as predictors of mortality in Chinese elderly adults. Methods A cohort of 1,535 subjects （994 men and 541 women） aged 50 years or older was selected from employees of a machinery factory in 1994 and followed until 2009. Cox models were used to estimate the hazard ratios （HRs） predicted by MetS according to the harmonized defmition and by its individual components. Results The baseline prevalence of MetS was 28.0% in men and 48.4% in women. During a median follow-up of 15 years, 414 deaths occurred, of these, 153 participants died from CVD. Adjusted for age and gender, the HRs of mortality from all-cause and CVD in participants with MetS were 1.47 （95% confidence interval （CI）： 1.20-1.80） and 1.96 （95%CI： 1.42-2.72）, respectively, compared with those without MetS. Non-significant higher risk of CVD mortality was seen in those with one or two individual components （HR = 1.22, 95%CI： 0.59-2.50; fir = 1.82, 95%CI： 0.91-3.64, respectively）, while a substantially higher risk of CVD mortality only appeared in those with 3, 4, or 5 components （H_R = 2.81-3.72）, compared with those with no components. On evaluating the MetS components individually, we found that, independent of MetS, only hypertension and impaired glucose predicted higher mortality. Conclusions The number of positive MetS components seems no more informative than classifying （dichotomous） MetS for CVD risks assessment in this Chinese cohort.

Antithrombotic treatment tailoring and risk score evaluation in elderly patients diagnosed with an acute coronary syndrome

Age is an important prognostic factor in the outcome of acute coronary syndromes （ACS）. A substantial percentage of patients who ex- perience ACS is more than 75 years old, and they represent the fastest-growing segment of the population treated in this setting. These pa- tients present different patterns of responses to pharmacotherapy, namely, a higher ischemic and bleeding risk than do patients under 75 years of age. Our aim was to identify whether the currently available ACS ischemic and bleeding risk scores, which has been validated for the general population, may also apply to the elderly population. The second aim was to determine whether the elderly benefit more from a spe- cific pharmacological regimen, keeping in mind the numerous molecules of antiplatelet and antithrombotic drugs, all validated in the general population. We concluded that the GRACE （Global Registry of Acute Coronary Events） risk score has been extensively validated in the elderly. However, the CRUSADE （Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early imple- mentation of the ACC/AHA Guidelines） bleeding score has a moderate correlation with outcomes in the elderly. Until now, there have not been head-to-head scores that quantify the ischemic versus hemorrhagic risk or scores that use the same end point and timeline （e.g., ischemic death rate versus bleeding death rate at one month）. We also recommend that the frailty score be considered or integrated into the current existing scores to better quantify the overall patient risk. With regard to medical treatment, based on the subgroup analysis, we identified the drugs that have the least adverse effects in the elderly while maintaining optimal efficacy.

Hepatocellular carcinoma in Egypt: A single center study over a decade

AIM： To identify the trend, possible risk factors and any pattern change of hepatocellular carcinoma （HCC） in Egypt over a decade. METHODS： All HCC patients attending Cairo Liver Center between January 1993 and December 2002, were enrolled in the study. Diagnosis of HCC was based on histopathological examination and/or detection of hepatic focal lesions by two imaging techniques plus α-fetoprotein level above 200 ng/mL. The duration of the study was divided into two periods of 5 years each; period Ⅰ （1993-1997） and period Ⅱ （1998-2002）. Trend, demographic features of patients （age, gender, and residence）, risk factors （HBsAg, HCV-Ab, schistosomiasis and others） and pattern of the focal lesions were compared between the two periods. Logistic regression model was fitted to calculate the adjusted odds ratios for the potential risk factors. The population attributable risk percentage was calculated to estimate the proportion of HCC attributed to hepatitis B and C viral infections. RESULTS： Over a decade, 1 328 HCC patients out of 22 450 chronic liver disease （CLD） patients were diagnosed with an overall proportion of 5.9%. The annual proportion of HCC showed a significant rising trend from 4.0% in 1993 to 7.2% in 2002 （P = 0.000）. A significant increase in male proportion from 82.5% to 87.6% （P = 0.009）; M/F from 5：1 to 7：1 and a slight increase of the predominant age group （40-59 years） from 62.6% to 66.8% （P = 0.387）in periods Ⅰ and Ⅱ respectively, reflecting a shift to younger age group. In the bivariate analysis, HCC was significantly higher in rural residents, patients with history of schistosomiasis and/or blood transfusion. Yet, after adjustment, these variables did not have a significant risk for development of HCC. There was a significant decline of HBsAg from 38.6% to 20.5% （P = 0.000）, and a slight increase of HCV-Ab from 85.6% to 87.9% in periods I and II respectively. HBV conferred a higher risk to develop HCC more than HCV in period Ⅰ （OR 1.9 vsl.6） and period Ⅱ （OR 2.7 vs 2.0）, but the relative contribution of HBV for development of HCC declined in period Ⅱ compared to period Ⅰ （PAR% 4.2%, 21.32%）. At presentation, diagnostic α-fetoprotein level （≥200 ng/mL） was demonstrated in 15.6% vs28.9% and small HCC （≤3 cm） represented 14,9% vs 22,7% （P = 0,0002） in periods Ⅰ and Ⅱ respectively. CONCLUSION： Over a decade, there was neady a twofold increase of the proportion of HCC among CLD patients in Egypt with a significant decline of HBV and slight increase of HCV as risk factors. α-Fetoprotein played a limited role in diagnosis of HCC, compared to imaging techniques. Increased detection of small lesions at presentation reflects increased awareness of the condition.

Submaximal oxygen uptake kinetics, functional mobility, and physical activity in older adults with heart failure and reduced ejection fraction

Background Submaximal oxygen uptake measures are more feasible and may better predict clinical cardiac outcomes than maximal tests in older adults with heart failure （HF）. We examined relationships between maximal oxygen uptake, submaximal oxygen kinetics, fianctional mobility, and physical activity in older adults with HF and reduced ejection fraction. Methods Older adults with HF and reduced ejection fraction （n = 25, age 75 ：i： 7 years） were compared to 25 healthy ageand gender-matched controls. Assessments included a maximal treadmill test for peak oxygen uptake （VO2p^ak）, oxygen uptake kinetics at onset of and on recovery from a submaximal treadmill test, functional mobility testing [Get Up and Go （GUG）, Comfortable Gait Speed （CGS）, Unipedal Stance （US）], and self-reported physical activity （PA）. Results Compared to controls, HF had worse performance on GUG, CGS, and US, greater delays in submaximal oxygen uptake kinetics, and lower PA. In controls, VO2peak was more strongly associated with functional mobility and PA than submaximal oxygen uptake kinetics. In HF patients, submaximal oxygen uptake kinetics were similarly associated with GUG and CGS as VO2peak, but weakly associated with PA. Conclusions Based on their mobility performance, older HF patients with reduced ejection fraction are at risk for adverse functional outcomes. In this population, submaximal oxygen uptake measures may be equivalent to VO2 peak in predicting functional mobility, and in addition to being more feasible, may provide better insight into how aerobic function relates to mobility in older adults with HF.

Appropriate prescribing in the elderly: Current perspectives

Advances in medical therapeutics have undoubtedly contributed to health gains and increases in life expectancy over the last century. However, there is growing evidence to suggest that therapeutic decisions in older patients are frequently suboptimal or potentially inappropriate and often result in negative outcomes such as adverse drug events, hospitalisation and increased healthcare resource utilisation. Several factors influence the appropriateness of medication selectionin older patients including age-related changes in pharmacokinetics and pharmacodynamics, high numbers of concurrent medications, functional status and burden of co-morbid illness. With ever-increasing therapeutic options, escalating proportions of older patients worldwide, and varying degrees of prescriber education in geriatric pharmacotherapy, strategies to assist physicians in choosing appropriate pharmacotherapy for older patients may be helpful. In this paper, we describe important age-related pharmacological changes as well as the principal domains of prescribing appropriateness in older people. We highlight common examples of drugdrug and drug-disease interactions in older people. We present a clinical case in which the appropriateness of prescription medications is reviewed and corrective strategies suggested. We also discuss various approaches to optimising prescribing appropriateness in this population including the use of explicit and implicit prescribing appropriateness criteria, comprehensive geriatric assessment, clinical pharmacist review, prescriber education and computerized decision support tools.

Hierarchical Linear Model Approach to the Determinants of Activities of Daily Living of Chinese Oldest Old at Both Individual and Regional levels

Based on the Chinese longitudinal healthy longevity survey conducted in 2002, this paper uses hierarchical linear model (HLM) to make an approach to the possible determinants of activities of daily living (ADL) of Chinese oldest old (aged 80 and above) by combining both individual and provincial level factors. The descriptive analysis shows that there is a great differ- ential in ADL by province among Chinese oldest old. The findings turn out that there does exist a significant differential in ADL between oldest old and young old, and that there is also a great differential in ADL by province among Chinese oldest old. The HLM demonstrates that comorbidity, age, cognitive impairment, visual impairment, and emotion could be the most important indi- vidual factors while natural environment, medical facilities, type of staple food and poverty rate in urban areas are the most sig- nificantly regional determinants of ADL of oldest old. The find- ings imply that future actions should not only be taken at individ- ual level, but also at regional level in order to achieve the goal of a healthy aging society in China.

Living alone, health and preventive care use among the elderly in Shanghai, China

Objective:The purpose of the study was to compare the preventive care use and health between the elderly living alone and living with other individuals and identify strategies to improve the preventive care use among the elderly living alone.Methods:A questionnaire including socioeconomic characteristics,preventive care use,health status and Social Support Rate Scale was administered to 240 elderly living alone and 244 elderly living with other individuals in Shanghai,China.Logistic regression analysis was used to examine the predictors of preventive care use.Results:The elderly living alone were more likely to be single(never married,divorced,separated and widowed),have lower social support and income,utilize less routine physical check-up and blood glucose screenings,have worse self-reported health and have limitations in IADL compared to the elderly living with other individuals.Women,old age,high education,income and social support and close to medical institutions were positively associated with routine physical check-up among the elderly.Conclusion:Living alone was associated with less preventive care use and worse health.It was important to provide more social support and economic support for the elderly living alone to increase their preventive health care service utilization and improve their health status.

Study on Body Form and Garment Size Series of the Middle Age and Aged People

This paper was designed to analyze on the data, which was obtained from 'National Physique Fitness Investigation Report (2000)'. In order to get the typical body form and figure type of the middle age and aged people, it was focused on the body form data of this group (age 40 - 60). After calculation and analyzing, the distinguishing feature of body form and the distribution of figure type were deduced. Finally, the re-classification of body form for Chinese middle age and aged people was suggested. It as also suggested that a new garment size series especially for the middle age and aged should be built to fit for these people. This conclusion would be useful and significant to design and production for clothing company, especially that who take the aged people as their target consumer.

Research Progress on elderly quality of life and influencing factors

While the rising number of elderly population has caused widespread concern in society, the quality of life of elderly has become a hot research topic too. According to the current study, theoretical research still needs to be strengthened.Compared with the theoretical research, emperical research is significantly increased.Scholars have taken a full disscussion to the quality of life of the elderly, in addition, the influential factors also be analysed from different angle. From the perspective of quality of life, this paper reviewed the different kind way ofthe definition,the research of the elderly＇ quality of life as well as the influencing factors.

Association of upper gastrointestinal symptoms with functional and clinical characteristics in the elderly

AIM： To evaluate the prevalence of upper gastrointestinal symptoms and their association with clinical and functional characteristics in elderly outpatients. METHODS： The study involved 3238 outpatients ≥ 60 years consecutively enrolled by 107 general practitioners. Information on social, behavioral and de- mographic characteristics, function in the activities of daily living （ADL）, co-morbidities and drug use were collected by a structured interview. Upper gastroin- testinal symptom data were collected by the 15-items upper gastro-intestinal symptom questionnaire for the elderly, a validated diagnostic tool which includes the following five symptom clusters： （1） abdominal pain syndrome; （2） reflux syndrome; （3） indigestion syn- drome; （4） bleeding, and （5） non-specific symptoms. Presence and severity of gastrointestinal symptoms were analyzed through a logistic regression model. RESULTS： 3100 subjects were included in the final analysis. The overall prevalence of upper gastrointes- tinal symptoms was 43.0%, i.e. cluster （1） 13.9%, （2） 21.9%, （3） 30.2%, （4） 1.2%, and （5） 4.5%. Upper gastrointestinal symptoms were more frequently re- ported by females （P 〈 0.0001）, with high number of co-morbidities （P 〈 0.0001）, who were taking higher number of drugs （P 〈 0.0001） and needed assistance in the ADL. Logistic regression analysis demonstrated that female sex （OR = 1.39, 95% CI： 1.17-1.64）, dis- ability in the ADL （OR = 1.47, 95% CI： 1.12-1.93）, smoking habit （OR = 1.29, 95% C]： 1.00-1.65）, and body mass index （OR = 1.06, 95% CI： 1.04-1.08）, as well as the presence of upper （OR = 3.01, 95% C]： 2.52-3.60） and lower gastroenterological diseases （OR = 2.25, 95%CI： 1.70-2.97）, psychiatric （OR = 1.60, 95% CI： 1.28-2.01） and respiratory diseases （OR = 1.25, 95% C]： 1.01-1.54） were significantly associated with the presence of upper gastrointestinal symptoms. CONCLUSION： Functional and clinical characteristics are associated with upper gastrointestinal symptoms. A multidimensional comprehensive evaluation may be useful when approaching upper gastrointestinal symp- toms in older subjects.

EFFECTS OF ELECTRO-ACUPUNCTURE ON SOMATOSTATIN AND PANCREATIC POLYPEPTIDE IN ISCHEMIC CEREBROVASCULAR DISEASES

The levels of somatostatin(SS)in CSF and blood and pancreatic polypeptide(PP)inplasma were measured by radioimmunoassay in 64 patients with acute ischemiccerebrovascular diseases(ICVD),randomly divided into two groups:group 1(n=31,bothelectro-acupuncture and routine treatments given)and group 2(n=33,routine treatment)and 26 non-ICVD patients were used as controls.The points of electro-acupuncture wereQuchi(LI 12),Waiguan(SJ 5)and Huantiao(GB 30)and Zusanli(St 36).After a courseof treatment,the SS levels in plasma and CSF were significantly increased in the patientsof group 1 with good result and their plasma PP level had no significant change.In thepatients with poor result,however,the PP level was significantly decreased.The resultssuggested that electro-acupuncture might play an active role in alleviating the SSmetabolic disturbance in CNS of ICVD patients.

Analysis of Electrogastrograms of Elderly Gastrectomized Subjects by Using Maximum Lyapunov Exponent

Not much data are available regarding the electrical activity in the stomachs and intestines of elderly gastrectomized patients The purpose of this study was to determine the feasibility of using a complex dynamic method to analyze the electrogastrograms （EGGs） of healthy young, healthy elderly, and gastrectomized elderly male individuals. The authors analyzed the EGGs by using the maximum Lyapunov exponent （MLE）, which is one of the indices of the chaotic characteristics of time series. Significant differences were observed between the MLEs estimated from the, EGGs of the young and elderly individuals for most of the temporal intervals. The authors＇ data indicate that the EGGs of elderly gastrectomized subjects might be distinguished from the EGGs of healthy elderly individuals on the basis of the MLE distribution.

Resistin might not be a risk factor for carotid artery atherosclerosis in elderly Chinese males

Objective To investigate the correlation between the serum resistin level and carotid artery atherosclerosis in elderly Chinese males. Methods The study enrolled 235 elderly Chinese males [median age 76 （range 60-97） years] scheduled for ultrasound examination of carotid artery plaque and determination of carotid artery intima-media thickness （CIMT）. They were divided into carotid atherosclerotic plaque （CAP） and carotid atherosclerotic plaque-free （CAP-free） groups according to the ultrasound results. Their clinical profiles were col-lected, and the serum resistin and other blood biochemistry levels were determined.Results The CAP group was older and had a thicker mean CIMT than the CAP-free group. However, there was no difference in the serum resistin level between the groups. CIMT was positively correlated with age （r = 0.299,P〈 0.001）. The serum resistin level was not correlated with CIMT, even after controlling for age. Multiple linear regression analysis revealed that age （β = 0.001,P〈 0.001） and body mass index （β = 0.002,P= 0.015） were significantly and posi-tively correlated with the mean CIMT. Only age [odds ratio （OR）： 1.159; 95% confidence interval （CI）： 1.078-1.183,P〈 0.001] was associ-ated with the presence of carotid artery atherosclerotic plaque. The serum resistin level was not correlated with the mean CIMT or associated with the presence of carotid artery atherosclerotic plaque.Conclusion The results suggest that resistin might not be a risk factor for atherosclerosis in elderly Chinese males.

Validation of a FFQ （Food Frequency Questionnaire） for Older People

Nutrition data for older adults is an area that has few studies mainly in Brazil. Due to the importance to know the behavior of this age group, the aim of this study was to develop and validate a frequency food questionnaire （FFQ） for older people in Brazil. It was considered a sample of 73 subjects from the city of Avar6, Sao Paulo, Brazil, and it was applied three 24-hour recalls and a FFQ developed for adults. Data from the three 24-hour recalls were transformed in nutrient intake as well as the data from FFQ. Statistical analysis was performed in order to get correlations between data from the mean of three 24-hour recalls and FFQ for some nutrients. It was found high correlations among them, concluding that the FFQ is valid to get nutrient intakes for older people.

A Literature Survey of Disaggregating General Well-Being： Empirical Capability Approach Assessments of Young and Old Generations in Affluent Countries

This paper explores how empirical capability approach studies assess well-being for young and old generations in affluent countries, defined as high-income OECD countries. After a brief overview on the theoretical capability background and empirical core decisons, the authors discuss empirical capability studies on the well-being of children, adolescents and the elderly. The authors find that the issues of child and youth well-being have been increasing interested by capability researchers while despite of the importance of demographic change, few researchers deal with old-age issues. The authors conclude that for young as well as old generations, capability approach studies confirm that income assessment is not sufficient to capture well-being for the young and the old but has to be enriched by a more comprehensive perspective on capabilities and functionings. Moreover, it is recommendable and issues that have already entered the agenda of studies on for research on elderly to adopt research methods, questions capabilities of children and young adults. As capability sets for both, young and old generations are in general characterized by changes, i.e., expansions in the case of children, declines in the case of older people, both may benefit from a more dynamic perspective on life cycles on their way to potential dynamic capability theories and empirics.

Research on The Elderly Spiritual Demand in China

Spiritual demand as one of the basic requirements of human, has more important significance for the elderly group. Descriptive statistic analysis shows that in the CLHLS, the elderly spiritual demand and supply is in a state of disequilibrium in our country, supply is far less than demand. The main factors of restricting the old people＇s spiritual need are not being met, including economic factors, intergenerational relations factors, emotional factors and the particularity of spiritual demand, etc. So we need to change our ideas, with the demand of the old structure and strength, by constructing a complete supply system of family, society and government to strengthen for the supply of the spiritual needs of old people, so that the elderly would be happy during his or her later lives.