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.

Depression and Suicidal Ideations among Older Persons Living with HIV/AIDS in Mbarara City, Southwest Uganda

Background: Due to the increase in longevity and use of antiretroviral treatment, Uganda has had a growing population of older persons living with HIV/AIDS. However, there is a paucity of information on the mental health of the elderly living with HIV/AIDS. In this cross-sectional study, we determined the prevalence of, and associated factors for depression and suicidal ideation among older persons living with HIV/AIDS in Mbarara city, southwest Uganda. Methods: Older persons (150 females, 115 males), with mean age = 64.2 (±5.1) years, accessing health services from three purposively selected HIV/AIDS care centers in Mbarara city, southwest Uganda were recruited. Data on depression and suicidal ideation were collected using a Patient Health Questionnaire (PHQ-9) validated in Uganda, and a structured questionnaire was used to collect data on clinical and socio-demographic characteristics. Data were analysed using logistic regression. Results: Approximately 8.3% and 12.1% had depression and suicidal ideation, respectively. The factors associated with lowering the likelihood of depression were: an increase in the number of family members they stayed with and having no having any problems with their ARVs. On the other hand, earning more than 100,000 Uganda shillings was associated with reducing the risk of suicidal ideations among the participants. Conclusion: Approximately 8 to 12 in 100 older persons living with HIV/AIDS in Uganda have experienced depression or suicidal ideation. Family support and financial control were instrumental factors associated with depression and suicidal ideations, respectively. We recommended strengthening family structures and creating more avenues for financial independence among older persons living with HIV/AIDS to reduce the burden of depression, and suicidal behaviours among this vulnerable population.

Social Participation of Older Persons Based on Human Rights:Conception Renewal and Action Plan

Equal participation and the promotion of social integration are essential parts of human rights protection. The theory of the right to social participation of older persons from the perspective of age stratification hardly explains the real difficulties older persons face in participating in social life. Life course theory reveals that social participation is an intermediate link between individuals and the social environment, so it is a means for individuals to achieve specific objectives as they age. In this light, there are three main interpretations for expressions of social participation of older persons throughout history, namely participation in health-oriented toward treatment of physiological aging, participation in production oriented toward human resources development of older persons, and full participation based on human rights. In the context of mainstreaming human rights and active aging, full participation based on human rights should become the main concept of relevant academic exploration and policy practice. To this end, we should establish the principle of protecting the rights of the elderly to social participation and integration, examine the participation process from the perspective of dynamic development, and construct the participation protection mechanism in light of China’s conditions.

The Formulation of Convention on the Rights of Older Persons:The Process and Prospects

Since its establishment,the United nations open-ended Working group on aging has shouldered the historical mission of exploring the“possibilities”and even laying the“foundation”for a Convention on the Rights of older Persons.Although the formulation of a convention on the protection of the rights of older persons has been widely supported by the general public and many countries,it still faces many problems.China should adhere to the combination of“human rights”and“development”and adjust its policies to adapt to the new changes in related fields.With successful case studies,concise expression of rights,and regional contracting practice,China could participate more fully in the reform of the international mechanism for the protection of the rights of older persons to improve the voice in future international human rights governance and make greater contributions to the protection of the rights of older persons worldwide.

Psychosocial and Sociodemographic Predictors of Depression among Older Persons in Jordan

The average annual growth rate for the ageing population is increasing considerably. The purpose of this study is to examine the psychosocial predictors of depression among older persons in Jordan. Methods: A quantitative approach using cross-sectional, descriptive-correlational design was used to carry out on a nationally representative, stratified multistage clustered area probability sample of non-institutionalized adults (aged ≥ 60 years). Data collected using self-report (structured format) of data collection. Data collected in regards to depression, social support, life satisfaction, and psychological distress. Results: About 55.5% of the participants have none to slight depressive symptoms, 22% of them have mild depressive symptoms, 17.3% of them have moderate depressive symptoms, and only 5.2% of them have severed depressive symptoms. Older persons have moderate levels of life satisfaction, perceived social support and psychological distress. Type of diagnosis was not a significant predictor of depressive symptoms as it was in model 1 while working status and marital status remained significant predictors. In addition, perceived social support total (β = -1.98, 0.016), psychological distress (β = 0.465, β = -0.284, <0.001) were significant predictors of depressive symptoms. Conclusion: Effective, community-level primary mental health care for older people is crucial, and its recommended to equally focus on the long-term care of older adults suffering from mental health problems, as well as to provide caregivers with education, training and support.

Living Arrangements and Conditions of Older Persons in Namibia

In Africa, ageing is a phenomenon that is just beginning to reveal its shape. Most governments, including the Namibian government, recognize the fact that the number of older persons is on the increase, however, discussing it is still a distant phenomenon and family matter. This paper examines the living arrangements of older adults in Namibia, identifying the existing structure of living arrangements and the nature of family relationships of older people, as well as provides some basic descriptive information on the housing conditions in which older persons live and how they are associated with their socioeconomic and demographic factors. The analysis is based on 1991, 2001 and 2011 Namibia Population and Housing Censuses. The study concluded that living arrangements is constantly changing from extended family pattern to western nuclear family, mainly due to urbanization and decreased fertility rate. Housing conditions had notably improved in rural areas while in urban areas the conditions are affected by the mushrooming of informal settlements. There is need to encourage or conduct focused research on ageing to help coin policies based on evidence and make communities sensitive towards ageing. The study further recommends Government to encourage old people to form organizations that would in turn focus on sensitizing and help championing issues of ageing and aged persons.

A description of resilience for Norwegian home-living chronically ill oldest older persons

Background: Despite worsening health the chronically ill oldest older persons have expressed feelings of inner strength, which can be understood as resilience. The objective was to describe and compare the characteristics of resilience in two different age groups of chronically ill oldest older persons living at home and who needed help from home nursing care. Design: Cross-sectional design was used to describe and compare the resilience qualities between the two age groups. Methods: The inclusion criteria were 80 years or older, living at home with chronic disease, receiving help from home nursing care, and with the capacity to be interviewed. A sample of 120 oldest older women (n = 79) and men (n = 41) separated in two age groups, aged 80- 89 and 90+ years, participated in the study. Resilience characteristics were measured by Resilience Scale. Results: The whole group of oldest older people was vulnerable in relation to the characteristics of perseverance, self-reliance, and existential aloneness. Despite reduced physical health they reported a meaningful life, and equanimity. Even if there were no significant differences between the age groups among the oldest older persons in the characteristics of Resilience Scale (RS), in the characteristic of meaning there was a tendency of interaction between age and how much help from home nursing care the participants received. Conclusions: It is important to focus on the individual aging and the risk of developing illness and disabilities rather than focusing on chronologic age. Possessing meaning in life and equanimity may be strengths to meet challenges through illness and growing older.

Caring for Older Persons in a Technologically Advanced Nursing Future

As people live longer, a larger percentage will live with multiple chronic conditions and functional impairments such as difficulties with activities of daily living, mobility, and the management of one’s household. The purpose of this paper is to examine the care of older persons in a technologically advanced nursing future by discussing roles and responsibilities of nurses who practice gerontological nursing, and explaining how a technologically advanced future would change the delivery of home health care for older persons in the community. The theory of Technological Competency as Caring in Nursing grounds 3 processes of nursing as knowing persons as caring, wholeness is oneness, and caring as a multi-dimensional process. Harnessing technology for the health of older persons would enable them to live independently, socially engaged, and safely. A technologically advanced nursing future leads to concomitant sustainable disruptive and frugal innovations in healthcare. Nurses in practice must take advantage of these disruptions and consider frugal innovations as the futures of nursing education, practice, and research are here.

Shareholding Networks for Care in Rural Thailand: Experiences of Older Persons and Their Family Members

Most members of the older population in Thailand live in rural areas while their children live in cities. With the joint family system separated, elderly Thai persons often have to care for themselves, and opportunities for them to get involved in community care remain limited. In response, the aim of this study was to describe older persons’ and their family members’ experiences with shareholding networks for the care of older people in rural Thailand. Paired interviews with five older persons and five of their family members were conducted, and collected data were subjected to content analysis, which yielded results organized around two themes: older persons’ outsider status and disregard for older persons’ individuality. Whereas the theme of outsider status describes shortcomings in healthcare encounters, the theme of disregard for individuality describes the lack of engagement of authorities and caregivers in older persons’ care. In that sense, the concept of participation emerged as a framework for understanding interviewees’ experiences. Given findings from local authorities, older individuals and their family members should engage in dialogue in order to support healthcare based on shared understanding.

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. .

The impact of COVID-19 on health of the older persons in Bangladesh

The COVID-19 is impacting the health of the population,including older persons.Available evidence shows that older people are highly vulnerable and more likely to have adverse health outcomes.In Bangladesh,the older population is rapidly increasing,living with various disadvantaged socio-economic conditions,including inadequate access and healthcare services.These disparities are likely to increase during the COVID-19,resulting in high morbidity and mortality among them.Thus,we have examined the health vulnerabilities of older persons due to the COVID-19 pandemic using content analysis.We have analyzed 102 content collected from vari-ous online and printed articles published in newspapers,journals,and other relevant sources.The study has found increased health risks,deteriorated mental health,and poor health system functioning during the pandemic and its impact on older per-sons in Bangladesh.Strengthening health systems through an integrated model with capacity development of existing health care providers to deal with elderly health problems,including mental health and psychosocial wellbeing;promoting preven-tive measures,facilitating access to healthcare is required.Bangladesh can learn the Chinese experience to adopt innovative,specialized,and advanced systems to effi-ciently fight against the COVID-19.

Relationship between Respiratory Muscle Strength and Static Balance in Older People Requiring Support and Care

Purpose: This study aimed to clarify the relationship between respiratory muscle strength and balance in older people requiring support or nursing care. Methods: Thirty-seven older subjects aged 65 years or older who were certified as requiring nursing care or support were included in the study. Maximal inspiratory pressure (PIMAX), maximal expiratory pressure (PEMAX), and one-leg standing time were measured. Additionally, the Functional Reach Test (FRT) was performed. Pearson correlation coefficient and multiple regression analyses were performed. Results: One-leg standing time was positively correlated with PEMAX, and was particularly correlated with PIMAX, while FRT score was not correlated with respiratory muscle strength. Multiple regression analysis with one-leg standing time as the dependent variable and PIMAX and PEMAX as independent variables showed that only PIMAX was significantly correlated with one-leg standing time. Conclusion: Focusing on expiratory and inspiratory muscle strength is important for improving one-leg standing ability and thus preventing falls in older people.

Does Exercise in Older Adults Predict Problem Solving? The Role of Personality

Research suggests that physical fitness is positively associated with cognitive functioning in older adults, and that executive functions may be associated in particular. This study explored whether personality supplemented the relationship between physical activity and problem-solving. A computerized version of the Tower of London provided number of errors and time to completion as dependent variables using a sample of 65 community-dwelling older people. The NEO-FFI assessed the Big 5 dimensions of personality. Choice reaction time was used to control for changes in speed of processing with increased age. Age remained a significant predictor of both dependent variables, with neuroticism and agreeableness also showing predictive ability. Aerobic fitness was not associated with either outcome measure, suggesting that there might be differential effects of exercise on measures of different executive functions. Personality factors appear to have a stronger association with the cognitive function that has been reported previously.

基于跨理论模型的老年人运动认知风险综合征分层健康管理方案的构建

目的:以跨理论模型为指导,构建老年人运动认知风险综合征分层健康管理方案。方法:基于跨理论模型,采用文献分析法和危险因素分析制定方案初稿,通过2轮德尔菲专家函询形成最终干预方案。结果:共纳入专家15名,2轮问卷回收率均为100%;专家权威系数均为0.90;2轮专家意见的肯德尔和谐系数分别为0.130,0.131(均P<0.05)。干预方案包括4个干预模块,分别为运动认知风险综合征科普宣教、饮食管理、认知训练和身体管理。结论:构建的运动认知风险综合征老年人分层健康管理方案科学可靠,可为有效预防或延缓痴呆发生提供借鉴。

回应生活需求的居家适老化改造设计研究 以北京市某住宅改造实践为例

文章基于"个人-环境"匹配理论辨析了居家适老化改造的目标和特征,结合实践案例阐述了如何通过物理环境和情感两个层面的适老化设计回应老年人多样化的生活需求,并在此基础上从关注老年群体的多样性、老化过程的阶段性、适老改造的复杂性等维度对现有实践提出优化建议.

《老年人潜在不适当处方筛查工具/处方遗漏筛查工具(STOPP/START)标准》第3版解读

老年人潜在不适当处方筛查工具(STOPP)/处方遗漏筛查工具(START)由2008年爱尔兰Cork大学附属医院专家组首次发表并于2015年进行第2次更新。自发表以来,该标准在发现老年人潜在不适当用药、加强对老年人滥用药物的监管、减少老年人药品不良事件等方面发挥了积极作用。2023年第3版STOPP/START标准发布,在第2版基础上增加、修订和删减了一些标准,最终形成190条潜在不适当用药标准。新标准根据最新的老年人合理用药研究结果和临床证据,提供了更新、更实用的循证医学依据。本文对STOPP/START标准(第3版)进行了详细的解读,为我国潜在不适当用药标准更新和完善提供参考,并对未来该领域的研究方向提出思考和建议。

Experiences of being old and receiving home nursing care. Older South Sami narrations of their experiences—An interview study

The Sami people who are the natives of Scandinavia are not a homogeneous group. They consist of different groups of Sami populations of which the South Sami population are one small group. For the South Sami this means a problem;they have to struggle against a general ignorance about the Sami people and culture, which also may affect received home nursing care. The aim of this study is to describe individual South Sami experiences of being old and receiving home nursing care. A sample of 10 older persons with South Sami background was chosen for this study. Narrative interviews were conducted and qualitative content analysis was used to identify and categorize primary patterns in data. The experience of being an old person with South Sami background who receives home nursing care was understood through the use of the following four themes developed from the informants’ own narratives: “Experience of losses in life”;“Feelings of being less valued”;“Feelings of gratitude”;and “Experience of meaning in daily life as old”. The main finding is that the South Sami population still is exposed to an ongoing subtle colonisation. Therefore, it is important to prepare and teach nurses who work in the South Sami area in cultural care, traditional values and beliefs specific to the South Sami population.

积极老龄化视角下老年人力资源开发优化路径研究——以广西柳州市为例

贯彻和践行积极老龄化理念,是系统推进应对人口老龄化国家战略的重要依托。我国人口老龄化问题日趋严峻,给社会经济发展带来了重大影响。其中,部分低龄老年人具有较好的身体素质。因此,促进低龄老年人力资源再开发,是实现积极老龄化的关键步骤。

中国老年人志愿服务参与类型对老化态度的影响研究

老年志愿服务契合健康老龄化、积极老龄化与生产性老龄化的内在要求,已成为实施积极应对人口老龄化国家战略的重要策略之一。然而,当前研究聚焦机构或组织开展的正式志愿服务参与,对在中国情境中具有深厚历史积淀的非正式志愿服务参与却缺乏足够关注,中国老年人志愿服务参与的类型与群体异质性有待梳理。同时,老化态度是影响老年人生活质量的重要因素之一,而老年人不同的志愿服务参与类型对老化态度的影响与作用机制尚待厘清。本研究采用中国老年社会追踪调查数据,基于正式与非正式的角度,将老年志愿服务参与分类为“正式型”“非正式型”“双重参与型”及“非参与型”,并引入“身体-认知-社会”分析框架,探讨中国老年人志愿服务参与类型对老化态度的影响机制。研究结果发现:相对于非参与型,正式型志愿服务参与对老化态度有显著的积极影响。尤其是健康状况越差的老年人,参与正式型志愿服务对其老化态度的积极作用越突出,验证了志愿服务参与对老年弱势群体的“社会补偿效应”;而健康状况好的老年人参与正式型志愿服务则主要是通过提升个人价值感来获得更积极的老化态度。参与非正式型志愿服务对老化态度影响不显著,主要是因为其对心理获得维度显著的消极影响抵消了对心理社会丧失与身体变化体验维度的正向影响。参与非正式型志愿服务会显著降低老年人的个人价值感,从而降低其心理获得感。双重参与型的志愿服务参与虽然能够在身体变化体验维度与心理获得维度起到积极作用,但在老化态度的心理社会丧失维度呈现负向效应,因而总效应也不显著。一方面,双重参与既可以通过提升个人价值感来帮助老年人提高心理获得感,也可以直接促进对身体变化的积极感知。特别是对于健康状况较差的老年人,两种类型都参加有助于提高对身体变化的积极体验。另一方面,双重参与直接和间接的作用导致心理社会丧失感,尤其是在尊老敬老氛围较好的社区,参与两种类型反而更容易导致心理社会丧失感和对身体变化的消极体验。建议加强老年志愿服务的品牌化建设,推动志愿服务参与的均衡化;加大对非正式志愿服务的宣传力度,提升社会认知度;营造年龄友好的社会环境,树立科学、积极的老龄观。

社区自理老年人生活空间受限状况及影响因素分析

目的 调查社区自理老年人生活空间受限状况并分析其影响因素,为针对性干预提供参考。方法 采用方便抽样法选取268名合肥市社区自理老年人作为研究对象,采用一般资料调查表、生活空间测评量表、简易精神状态检查量表、艾森克人格问卷简式中文版进行调查。结果 社区自理老年人生活空间受限发生率为42.2%。年龄、性别、婚姻状况、受教育程度、人格类型、是否使用辅助工具、认知功能是社区自理老年人生活空间受限的影响因素(均P<0.05)。结论 社区自理老年人的生活空间受限发生率较高。医护人员应加强对社区自理老年人生活空间受限的早期筛查与识别,采取针对性干预措施以改善自理老年人的生活空间状况,提升其晚年生活幸福感,促进健康老龄化。