Research on the Establishment of a Long-Term Care System for the Elderly with Alzheimer’s Disease Under the Background of Long-Term Care Insurance: A Literature Review

With the aging of the country’s population structure,the problem of social pensions is becoming more and more serious.As for the issue of social pension,the elderly with Alzheimer’s disease are a special group,and the issue of care services for these elderly has attracted widespread attention from society.However,judging from the current level of social security provided to the elderly with dementia in the country,there is a serious imbalance between supply and demand.Therefore,this problem needs to be solved urgently and is of great significance for further improving the country’s social pension security system.Routine care is limited to hospitals and mainly focuses on the patient’s condition.Patients fail to receive comprehensive care services and the effect is not ideal.Therefore,in order to improve patients’cognitive function and quality of life,and learn from international experience,a“community-institution-home”three-dimensional linkage care model based on long-term care insurance can be established.The application of this model can effectively solve and further improve the country’s elderly care and social security system.

Study of the Interior Design Based on Elderly People’s Psychological Behaviors and Requirements

Nowadays,the elderly have become an increasingly large group of people in China,but still many problems exist in their living space.This paper explores the physiological and psychological behavioral changes of the elderly,studies their living space requirements,and tries to put forward targeted design strategies in response.Therefore,making a better and more reasonable living space for the elderly as well as improving their living quality,finally helping the development of elderly-friendly design in China.

Ureteral Ewing’s sarcoma in an elderly woman: A case report

BACKGROUND Ewing’s sarcoma(ES)is regarded as a skeletal tumor,with few instances of extraskeletal ES.A primary ES in the ureter is extremely rare.CASE SUMMARY We report the case of a 69-year-old woman who presented with intermittent flank pain and hematuria and was found to have a mass in the left ureter.Pathology of the excised mass indicated ES.The clinical treatment and pathologic characteristics in this case,and a review of the literature describing ES in the urinary system,are presented.CONCLUSION Due to the rarity and malignancy of ES in ureter,early diagnosis and prompt surgical treatment are critical.

Trochanteric Fracture of a Congenital/Developmental Dislocation of the Hip in an Elderly Woman: A Case Report

An 87-year-old woman with a residual dislocated hip suffered a trochanteric fracture on the ipsilateral side. The fracture was treated by open reduction and internal fixation surgery with good results. To treat a proximal femoral fracture of the residual dislocated hip in an elderly patient, the patient’s overall status, pre-fracture ability, hip joint configuration, and fracture pattern should be considered.

Desmoid Tumor of the Breast as a Manifestation of Gardner’s Syndrome in an Elderly Woman: A Case Report and Review of Literature

Desmoid tumor of the breast is an extremely rare entity. Histologically, it corresponds to a benign fibroblastic proliferation of a local evolution, with a high recurrence potential. We report the first case of elderly woman presented with desmoid-tumor of the breast as a manifestation of Gardner’s syndrome. A brief literature review was provided. We report the case of a 72-year-old woman who presented with five months history of painful and an exophytic mass of her left breast. She is known to have familial polyposis and had a total colectomy with Gardner’s syndrome. She had a history of osteomas of the maxilla. On clinical examination, there was an exophytic painless mass, on the upper medial quadrant of the breast. She had also lipoma in the left leg and pigmented skin lesions in legs. Her mammograms showed a suspicious stellar image. A computed tomography scan showed an ovoid lesion. Excision of the lesion was performed. Histopathology confirms a desmoid-tumor of the breast. Evolution was marked by lesion recurrence. In conclusion, desmoid tumor of the breast is rare, non-metastatic but locally aggressive. Clinical expression is often nonspecific. Treatment remains controversial;surgical excision is the treatment of choice.

Laparoscopic vs open partial colectomy in elderly patients:Insights from the American College of Surgeons- National Surgical Quality Improvement Program database

AIM: To compare the outcomes between the laparoscopic and open approaches for partial colectomy in elderly patients aged 65 years and over using the American College of Surgeons- National Surgical Quality Improvement Program(ACS NSQIP) database. METHODS: The ACS NSQIP database for the years 2005-2011 was queried for all patients 65 years and above who underwent partial colectomy. 1:1 propensity score matching using the nearest- neighbor method was performed to ensure both groups had similar preoperative comorbidities. Outcomes including postoperative complications, length of stay and mortality were compared between the laparoscopic and open groups. χ2 and Fisher's exact test were used for discrete variables and Student's t-test for continuous variables. P < 0.05 was considered significant and odds ratios with 95%CI were reported when applicable. RESULTS: The total number of patients in the ACS NSQIP database of the years 2005-2011 was 1777035. We identified 27604 elderly patients who underwent partial colectomy with complete data sets. 12009(43%) of the cases were done laparoscopically and15595(57%) were done with open. After propensity score matching, there were 11008 patients each in the laparoscopic(LC) and open colectomy(OC) cohorts. The laparoscopic approach had lower post-operative complications(LC 15.2%, OC 23.8%, P < 0.001), shorter length of stay(LC 6.61 d, OC 9.62 d, P < 0.001) and lower mortality(LC 1.6%, OC 2.9%, P < 0.001). CONCLUSION: Even after propensity score matching, elderly patients in the ACS NSQIP database having a laparoscopic partial colectomy had better outcomes than those having open colectomies. In the absence of specific contraindications, elderly patients requiring a partial colectomy should be offered the laparoscopic approach.

Elderly patients and inflammatory bowel disease

The incidence and prevalence of inflammatory bowel disease(IBD) is increasing globally. Coupled with an ageing population, the number of older patients with IBD is set to increase. The clinical features and therapeutic options in young and elderly patients are comparable but there are some significant differences. The wide differential diagnosis of IBD in elderly patients may result in a delay in diagnosis. The relative dearth of data specific to elderly IBD patients often resulting from their exclusion from pivotal clinical trials and the lack of consensus guidelines have made clinical decisions somewhat challenging. In addition, age specific concerns such as co-morbidity; locomotor and cognitive function, poly-pharmacy and its consequences need to be taken into account. In applying modern treatment paradigms to the elderly, the clinician must consider the potential for more pronounced adverse effects in this vulnerable group and set appropriate boundaries maximising benefit and minimising harm. Meanwhile, clinicians need to make personalised decisions but as evidence based as possible in the holistic, considered and optimal management of IBD in elderly patients. In this review we will cover the clinical features and therapeutic options of IBD in the elderly; as well as addressing common questions and challenges posed by its management.

On the Creation Background and the Influence of Wei Zhuang’s Famous Poem:Lament of a Northwestern Woman

Lament of a Northwestern Woman(Qin Fu Yin),composed by Wei Zhuang after the Huangchao uprising,is a long poem that showcases the sufferings of the civilians and embodies the people’s character of the poem,which is the profound empathy and compassion of the poet towards the civilians’plight.The poem was written during the reign of Emperor Xizong of the Tang Dynasty in the year Gengmao(883 AD).2023 is also the year Gengmao,so this poem has existed for a remarkable 1140 years.For over a millennium,this long poem remained submerged in history until the opening of the Dunhuang Grottoes at the turn of the 20th century.The deep compassion and commiseration towards the underprivileged masses conveyed in this long poem are reminiscent of Du Fu’s renowned“Three Poems of Separation.”Moreover,it is widely believed that this poem foretells the decline of the Tang Dynasty.

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.

Relationship between Cognition and Activities of Daily Living in Elderly Women with Mild Cognitive Impairment in Japan

Purpose: This study aims to examine the relationship between cognition and ADL in elderly women with MIC. Methods: Cognitive function was assessed using a 4-item instrument screening for dementia. Each item was scaled from 1 to 4. The Katz Index was used to Participants (N = 680) were asked to return the completed questionnaire in the sealed envelope provided. The study received approval from the human subject’s ethics committee at Osaka University. Results and Conclusion: Participants’ mean age was 78.2 ± 6.5 years old. The age range of participants was 65 to 97 years old. Associations were not statistically significant between cognitive function and family structure. However, associations were significant for ADL items involving excretory failure (OR = 3.5, p = 0.000 in 2004, OR = 2.9, p = 0.000 in 2005;P < 0.05) using a logistic regression analysis adjusted for age. Therefore, we recommend that nurses work to educate the public about treatment-adjusted dementia in the community, teaching family members or caretakers to observe the ADL of the elderly, being watchful for unusual excretory habits, extra clothes, or the smell of elderly persons’ dirty clothing.

Low selenium and reduced cognitive function in a cohort elderly study

Cognitive function in the elderly is affected by various environmental,social,and individual factors.Studies show that chemical trace elements are closely related to cognitive function.As a protective factor,selenium promotes cognition in the elderly.However,study results into the effects of selenium on cognition have varied.By eliminating unstable environmental and other related factors,the present study selected elderly individuals from rural areas of the Shandong province to verify whether low selenium exposure is a risk factor for decreased cognitive function.Results demonstrated that age,sex,education,occupation,hypertension,stroke,and body selenium levels were factors affecting cognitive function in the elderly,and that selenium was an important protective factor.Moreover,results supported the hypothesis that a lifelong low selenium level is associated with low cognitive function.

Effect of St. John＇s wort extract on depressive disorder in elderly patients with unstable angina

The elderly patients with coronary heart disease （CHD） are often accompanied with depression. This study aimed to assess the effect of St. John＇s wort extract （SWE） on depressive disorder in elderly patients with unstable angina pectoris. Altogether 170 patients who met the set criteria were enrolled in this prospective study. They were randomly divided into SWE group （44 patients）, Deanxit group （44）, psychotherapy group （42）, and control group （40）. The effectiveness of SWE was evaluated by reduced percentage of Hamilton depression （HAMD） scale and reduced frequency of angina pectoris attack, which were measured before and at 12 weeks after the treatment with SWE. The reduced percentages of HAMD scale were 79.5%, 56.8% and 57.1% in the SWE, Deanxit and psychotherapy groups, respectively. Compared with the control, the three groups had significant differences in the percentages （P〈0.001）. The improvement after the treatment was more significant in the SWE group than in the Deanxit or psychotherapy group （P〈0,05）. The improvement of angina pectoris evaluated by the Canadian Cardiac Society Classification was significantly better in the treatment groups （88.7%, 65.9%, 57.1%） than in the control group, and it was marked in the SWE group （P〈0.001）. Angina pectoris attack, its frequencies, durations and electrocardiographic changes were significantly improved in the treatment groups than in the control group （F=6.05, 4.58, 5.12, P〈0.01）. They are markedly improved in the SWE group （P〈0.05）. SWE can improve depressive symptoms more significantly in elderly patients with unstable angina pectoris than Deanxit or psychotherapy, proving that SWE contributes to better treatment of angina attack as well.

The Experiences of the Elderly and Caregivers in Respect of Caring for the Elderly in Windhoek and Rehoboth Namibia: An Exploratory and Descriptive Study

In many instances, care for the elderly, especially in long-term care institutions, is provided under minimal supervision by caregivers who are lay people. This can lead to poor quality care or neglect of the elderly. The research question was: “How competent are lay caregivers for the elderly in old age homes, who often lack the opportunity for training to improve their knowledge and skills, in delivering care to the elderly? The aims of the study were to explore and describe the experiences of both the caregivers and the elderly in respect of caring for the elderly in old age homes. The objectives of the study were to explore and describe the experiences of the caregivers and the elderly with respect to caring for the elderly and in respect of nursing care they received. A qualitative, explorative, descriptive, contextual and phenomenology design was used to perform this study. In the situational analysis, the experiences and needs of the caregivers were described. Themes in terms of interpersonal relationships that could be positive or negative regarding the elderly were identified. These included lack of regular in-service training sessions for caregivers. Likewise, sub-themes like communication, support and caring for elderly people were revealed. Inadequate knowledge of caregivers in caring procedures, a shortage of staff, equipment and absence of policies which should support and guide the work of caregivers impacts negatively on the care of the elderly. From the experiences of the elderly and caregivers, the competencies under scrutiny emerged and were measured qualitatively by the perceptions of the elderly, in respect of the caring they were exposed to.

Evaluation of Montreal cognitive assessment for the differential diagnosis of mild cognitive impairment and Alzheimer’s disease in elderly patients with more than 5 years of schooling: Data from a Brazilian sample

Background: Diagnostic investigation of dementia is based on a series of tests which lie the neuropsychological evaluations. The Montreal Cognitive Assessment (MoCA) was developed as an instrument to recognize Mild Cognitive Impairment (MCI) and initial cases of Alzheimer’s disease. The present study aims to evaluate the predictive value of Brazilian MoCA test version in a sample of elderly above 5 years of education. Methods: Cross-sectional study with 136 elderly, above 60 years old at least 5 years of education. Diagnostic criteria is based on clinical and neuropsychological data classified Alzheimer’s disease n = 52, MCI n = 45 e normal controls n = 39. MoCA test was compared with Cambridge Cognitive Examination, Mini-Mental State Exam, Verbal Fluency, Clock Drawing Test, Geriatric Depression Scale and Pfeffer Functional Activities Questionnaire. Accuracy was evaluated by receiver operating characteristic (ROC) curve analyses. Pearson correlation coefficient was used to compare the MoCA with the other tests. It was also used logistic regression analysis to identify the main risk factors for the diagnostic groups. Results: MoCA was the best test to differentiate Alzheimer’s disease cases from MCI with 86.5% sensitivity and 75.6% specificity. Furthermore, analyzes of correlation test showed that MoCA correlates robust way of already validated with other tests and wide application inBrazil. Conclusions: It can be concluded that MoCA is a good screening tool for investigation of MCI among the elderly in Brazil with over 5 years of schooling. Studies with larger numbers of participants are needed to further validate the test also for elderly people with low education.

The Association between Activity of Daily Living and the Combination of Alzheimer’s Disease and Cataract in Elderly Requiring Nursing Care

Some clinical and epidemiological studies have suggested that Alzheimer’s Disease (AD) and cataract, may share common pathogenetic mechanisms, subsequently a positive association between the prevalence of AD and cataract, although other studies found no significant relationship between dementia and visual impairment including cataract in the elderly. Little is known about the association between Activity of Daily Living (ADL) and the combination of AD and cataract. To examine the association between ADL and the combination of AD and cataract, we performed a national survey in nursing care institutions in Japan, examining the decreased ADL in elderly with and without AD and cataract for 453 elderly aged 85.0 ± 8.13 years. The proportion, 43.5% of AD in subjects without cataract was significantly higher than that, 23.5% with cataract. Almost all ADL in AD with cataract was significantly lower than that without cataract, although all ADL in cataract patients receiving surgery in AD was significantly (all p < 0.002) higher than that in cataract patients without surgery in AD, as was confirmed by the multiple regression analysis incorporating into the relevant factors as independent variables. These results showed that ADL scores including cognitive functions decreased by cataract were increased by the surgery in the patients with AD. A significantly negative association between AD and cataract seen in our data, which was inconsistent with the previous result, might lead to the necessities of the clinical diagnosis for slight severity of cataract for patients with AD.

Musical and Photographic Stimulations on the Symptomatology of Alzheimer’s Disease in Elderly

Background: Alzheimer’s disease is a progressive and neurodegenerative disorder characterized by deterioration of brain functions. Psychosocial interventions such as music and photographic stimuli may contribute to cognitive and sensory exercise or rehabilitation. Objective: Evaluate musical and photographic stimuli in elderly people with Alzheimer’s disease. Methods: It is an uncontrolled clinical trial, before-after type, eleven subjects composing the sample. Participants were submitted to Katz Index, Autobiographical Memory Test, GDS-15, Mini-Mental State Examination. The collection instruments were used on the first and last day of intervention, individually. There were 2 sessions in the week with duration of 50 minutes totaling 20 sessions. Data were analyzed by descriptive and inferential statistics and as variables expressed as mean standard deviation. Results: There was a significant effect of cognitive activity (P < 0.01), it was observed that a small advance (P = 0.05) of the daily life activities. With the analysis of GDS-15, it is verified that they are more effective for the increase of the previous self-estimation of the therapy (P = 0.94). In the application of the AMT, it is observed that there was a better recruitment of the memory for the neutral words. Conclusion: Musical and photographic stimuli had a positive effect on the cognitive level, daily life activities and autobiographical memory in seniors with Alzheimer’s disease.

Fournier’s Gangrene: 13-Year Experience in a Tertiary Center, North Eastern Nigeria

Background: Fournier’s gangrene is a fulminant infection of the genitourinary tract characterized by progressive necrosis of the skin and subcutaneous tissue of the external genitalia. Initially mainly seen involving the scrotum of elderly men with different moods of occurrence each unpleasantly lethal. With varying types of presentation only one thing has remained constant;the poor prognosis of this condition. Purpose/Aim: Thus, it’s important to study the trends of the presentation of this condition laying emphasis on the challenges in the management of these patients;both the negative and positive prognostic factors. Materials and Methods: Urology ward record books, clinic record books and operating theater records were used to identify patients managed for Fournier gangrene in ATBUTH Bauchi. A retrospective study of the medical files of all the patients managed from January 2011 to January 2024 was done. Data was analyzed using SPSS version 29. Results: Data from 47 patients seen during the period of study were carefully collected and analyzed. The age range is 2 weeks to 97 years. There were two neonates, one at 2nd week of life and the other at 3rd week. Mortality rate is 36%. The average time duration before presentation for patients that died was two weeks, a minimum of 9 days prior to presentation and a maximum of 21 days, about 10 of which came in septic shock and the remaining presented with fever and very extensive necrotizing fasciitis of the perineum. All the patients that died had diabetes mellitus as a comorbidity except the neonate. All the patients that survived were much younger, all were below 60 years of age (2 weeks - 53 years). Conclusion: Here, we share our experience managing patients with Fournier’s gangrene in our facility in the past 13-year period from January 2011 to January 2024. .

Connective Tissue Diseases on the Elderly Population in Dakar Hospital Setting

Introduction: Immunosenescence contributes to the development of auto-antibodies. However, while the prevalence of some autoantibodies increases with age, the incidence of connective tissue diseases decreases with age. This study aims to determine the clinical and paraclinical characteristics of connective tissue diseases in the elderly population. Materials and Methods: We conducted a retrospective and descriptive study, from March 2010 to March 2021, in the Internal Medicine Department of Aristide Le Dantec Hospital, including all the medical records of patients followed up for connective tissue disease and whose symptomatology began at an age greater than or equal to 65 years. Epidemiological, clinical, paraclinical, therapeutic and evolutionary data were collected from a pre-established survey form and then processed using SPSS software. Results: Overall, 22 cases were collected out of 275 seen on consultation. They involved 16 women and 6 men, aged between 65 and 85 years with a median of 70 years. The mean duration of the clinical picture was 15.7 months with extremes of 1 and 96 months. The clinical symptoms were joint pain in 21 patients associated with dry eye and mouth syndrome in seven cases and one patient underwent isolated dry eye and mouth syndrome. Joint involvement was deforming in 13 patients. Poor general condition was noted in 20 patients. Biology showed anemia in 14 patients, hyperleukocytosis (2 patients) and thrombocytosis (5 patients). The sedimentation rate (SR) was accelerated in 9 patients and the C-reactive protein (CRP) was positive in 12 patients. Immunology showed a positive Latex test (3 patients/6), Waaler-Rose reaction (8 patients/13), anti-cyclic citrullinated peptides (anti-CCP) antibodies (11 patients/11), anti-nuclear antibodies (2 patients/4). Anti-extractable nuclear antigens (anti-ENA) antibody testing in 4 patients showed positive anti-U1RNP (1 case), anti-SSA and anti-SSB (1 case). Plain X-Rays of the hands, wrists and feet showed destructive lesions in 16 patients. The diagnosis of rheumatoid arthritis (RA) was set in 21 patients, one of which was associated with Sjogren’s syndrome (SS) and one with primary Sjogren’s syndrome. Treatment was based on prednisone (21 cases), methotrexate (17 patients), and hydroxychloroquine (9 patients). The evolution was remarkable in 10 patients. Conclusion: Autoimmune diseases in the elderly are uncommon compared to the young adult population. In our study, we only found cases of rheumatoid arthritis and Sjogren’s syndrome. As the population ages, connective tissue diseases may be increasingly diagnosed.

Sera Monastery's Home for the Elderly

Xirao Jiangcan, a 78-year- old lama, is sunbathing in front of a scripture-chanting hall in Sera Monastery in Lhasa, Tibet. He feels comfortable in the native of Deqin warmth of the sun. A County in Diqing Tibetan Autonomous Prefecture, Yunnan, Xirao came to Lhasa at the age of 26. He has lived in Sera Monastery for 52 years. Currently he resides in the monastery＇s Old People＇s Home. Many other old lamas also live in the old people＇s home.

The Shaping of Woman's Language and Its Therapeutic Function through Images in "The Yellow Wallpaper"

In Perkins' "The Yellow Wallpaper",the wallpaper acts as woman's language.Through this interaction between the wallpaper and the heroine in in this story,Gilman displays to us women's embarrassing status in family and society,and leaves the reader to think of woman's future.