Factors related to successful aging among community-dwelling elderly in Wenzhou,China

Objectives:To examine the level of successful aging and the relationship between successful aging and activities of daily living(ADL),life satisfaction,social support,income,and self-efficacy among community-dwelling elderly in Wenzhou,China.Methods:A descriptive correlational design was applied.Subjects were community-dwelling elderly in 4 districts of Wenzhou,China.Simple random sampling was used to recruit 83 participants.All participants were screened using the Mini-Cog tool.Data were collected using 6 questionnaires such as a demographic questionnaire,the Successful Aging Inventory(SAI),the Barthel Index for ADL,the Satisfaction With Life Scale(SWLS),the Social Support Rating Scale(SSRS),and the General Self-Efficacy Scale(GSES).Data were analyzed using descriptive statistics and Pearson correlation analysis.Results:The results showed that 53%of the participants had a higher level of successful aging and 43.4%had a moderate level of successful aging with a mean score of 56.76(standard deviation[SD]=12.31).Factors such as elderly income(r=0.73,P<0.001)and self-efficacy(r=0.72,P<0.001)had high correlations with successful aging,whereas ADL(r=0.67,P<0.001),life satisfaction(r=0.63,P<0.001),and social support(r=0.36,P<0.001)had moderate correlations with successful aging.Conclusions:There was a significant positive correlation between successful aging and ADL,life satisfaction,social support,income,and self-efficacy among community-dwelling elderly in Wenzhou,China.The findings may guide the formulation of more effective health education and intervention measures to improve successful aging among the elderly.

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.

Population Pharmacokinetics of Propofol Administered by TCI in Chinese Elderly Patients

Aim To investigate the population pharmacokinetics of propofol administered by TCI in Chinese elderly patients. Methods Thirty-two patients with ASA Ⅰ - Ⅱ , 65 - 82 years old, undergoing selective lower abdominal operation were studied. Propofol was administered by target-controlled infusion with Marsh parameter. The target plasma concentration was 3 μg＇ mL^-1. Radial arterial blood samples were collected and analyzed by reversed phase HPLC with fluorescence detection. Population pharmacokinetic modeling was performed using NONMEM. Inter-individual variability and intra-individual variability of propofol were estimated for clearances and volumes of distribution. The effects of age, body weight, lean body mass, gender, height, hemoglobin, total protein, albumin, creatinine, alanine aminotrans ferase （ALT）, and aspartate aminotransferase （AST） were investigated. The effects of coadministered opioid drugs were also studied. Results The pharmacokinetics of propofol in the Chinese elderly patients was best described by a three-compartment open model. Lean body mass was found to be a covariate for system clearance at significant level （ P 〈 0.005）. The clearance decreased linearly with age as well （ P 〈 0. 005）. The apparent volume of distribution for deep peripheral compartment （V3） was influenced by gender. Elderly female patients showed a higher value for V3. Conclusion The pharmacokinetics of propofol administered by TCI in Chinese elderly patients can be well described by a three-compartment open model. Inclusion of age, lean body mass and gender as covariates significantly improved the model. To ensure the accuracy and precision of target-controlled infusion, the population pharmacokinetic model applied to the individual patient should be adjusted reasonably.

Survey on the Demand for Elderly Care Services of Community Residents in Beijing and Analysis of Influencing Factors

Objective: To investigate the current situation of the demand for geriatric care services of community residents in Beijing and analyze the influencing factors to provide a reference basis for meeting the demand for diversified and professional geriatric care services. Methods: A self-made questionnaire was used to randomly survey 1558 elderly individuals at community health service centers in 8 urban districts where elderly care centers were planned to be built. The influencing factors of the different characteristics of elderly care service needs from three aspects were analyzed using a dichotomous logistic regression model: predisposing, enabling, and, need factors. Results: 69.7% of the elderly required home care services, 22.8% wanted to get care services at elderly care centers, 15.9% wanted to get care services at nursing homes, 12.3% required community care services, and 7.4% didn’t know where to access care services. 68.5% of the elderly required care services for disabilities/semi-disabilities, 58.0% for dementia, 54.7% for common diseases, 34.9% for rehabilitation training, 33.0% for plumbing care, and 7.5% for hospice care. At the same time, there were urban- rural differences in the demand for elderly care services, with suburban elderly having a higher demand for care services than those living in urban areas (P < 0.05). The elderly’s demand for care services was mainly related to age, place of residence, and gender in the causative factors, mode of residence and physical condition among able factors, and mode of care services and care needs among need factors (P < 0.05). Conclusion: The demand for elderly care services was differentiated by factors including place of residence, age, and gender. It is crucial to accurately match the demand for elderly care services, innovate the mode of elderly care services, and improve the service quality to improve the elderly health service system.

Age-specific reference ranges of prostatespecific antigen in the elderly of Amirkola: A population-based study

Objective:To determine the age-specific reference ranges of prostate-specific antigen(PSA)in the older men in the city of Amirkola.Methods:This cross-sectional study is a part of Amirkola Health and Ageing Project(AHAP)which has been conducted as a cohort study since 2011 in Amirkola,a city in northern Iran.The demographic information of all men aged 60 and older were collected through questionnaires and interviews and the PSA measurements were performed using ELISA and Diametra kit.The acquired data were analyzed afterwards.Results:A number of 837 elderly men with a mean age of 69.99±7.72 years participated in this study.The serum PSA level(95th percentile)was determined to be 0.9(0-4.89)ng/mL in the age group of 60-64 years,1.1(0-4.88)ng/mL in the age group of 65-69 years,0.93(0-9.01)ng/mL in the age group of 70-74 years,1.3(0-7.95)ng/mL in the age group of 75-79 years,1.9(0-11.98 ng/mL)in the age group of 80-84 years,and 1.45(0-33.17)ng/mL in the 85 and older group.The serum PSA level was significantly correlated with age(p=0.000).Conclusion:This study indicated that there is a direct correlation between the age and serum PSA levels.The use of age-specific reference range could guide clinicians on the incidence of prostate cancer in this population and perhaps reduce the number of unnecessary tests in this population group.

Verapamil and vasospastic angina： underuse in the elderly population

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

The Ratio of the Elderly to the Working-age Population in Japan,Singapore and Thailand

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Determination of a Cut-Off Point of a Scale for Achievement Motive in Geriatrics That Predicts the Frequency of Undertaking Instrumental Activities of Daily Living in Community-Dwelling Elderly People

Background: Among elderly people, rehabilitation is important for reducing the risk of falls and hospitalization and to maintain an independent life for longer. Motivation is a factor for elderly people to lead an active daily life and leave home more frequently. Purpose: The purposes of this study were to determine the optimal cut-off point in the Scale for Achievement Motive in Geriatrics (SAMG) that could identify individuals as inactive or active, based on the Frenchay Activities Index (FAI), and to compare characteristics between active and inactive groups classified by the cut-off point. Methods: A cross-sectional study of 285 community-dwelling elderly people measured SAMG and FAI and physical function. Receiver operating characteristic (ROC) analysis was used to calculate the area under the curve (AUC) that was the optimal cut-off point for the SAMG total score, with the associated sensitivity and 1-specificity when compared with the FAI results. Demographic parameters and physical function were compared between two groups defined by cut-off point. Results: The AUC was 0.78, the optimal cut-off for SAMG total score for indicating inactivity was ≤48, the sensitivity was 77.98% and the 1-specificity was 75.00%. The group with SAMG score >48 was characterized by a significantly higher proportion of women, fewer people sharing a house, and participation in more hobbies. Discussion: A cut-off point of 48 in the SAMG could be a predictive index of motivation toward goals for individuals with inactive daily activities. The group with score higher than the cut-off was characterized by more women, fewer people living together, and more hobbies than the group with lower scores.

Prophylactic use of implantable cardioverter-defibrillators in the elderly population

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

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

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

Association of Oral Diadochokinesis, Physical Function and Swallowing Function in Community-Dwelling Elderly People

Objective: Oral diadochokinesis (ODK) has been shown to be associated with oral frailty. In this study, we investigate the relationship between physical function, swallowing function, nutritional evaluation, and each syllable of ODK. Methods: The subjects are 26 elderly people living in an area where they can walk. ODK, tongue pressure, modified water swallowing test, EAT-10, grip strength, MNA-SF, skeletal muscle index, height, weight, and BMI were evaluated. For statistical analysis based on ODK values, the subjects were divided into two groups on the basis of the number of times the syllables /pa/, /ta/, and /ka/ were repeated: 1) The first group with >6 repetitions exceeded six; 2) the second group with ≤5 repetitions. Both groups were compared using the Mann-Whitney U test (Model 1). In addition, the syllables /pa/, /ta/, and /ka/ were also divided among the groups and a comparison was performed (Model 2). Results: In Model 1, the tongue pressure value was significantly higher in the good group (p < 0.01). In Model 2, the good group showed significantly higher values for the syllables /pa/ (p < 0.01) and /ta/ (p < 0.05). There was no significant difference in the values for the syllable /ka/. Conclusion: In community-dwelling elderly people, tongue pressure was positively associated with ODK values for the syllables /pa/ and /ta/, suggesting that tongue pressure may be associated with strength of the lip and tongue tip muscles. Furthermore, it was suggested that the ODK values may even be lower than normal values in the elderly who maintain skeletal muscle mass and thus have adequate tongue pressure;therefore, these indicators may be used as a guideline to assess oral frailty.

Developed Fall Detection of Elderly Patients in Internet of Healthcare Things

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

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

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

Problems and Countermeasures of Intelligent Elderly Care Service in the Context of Fewer Children in China

With the intensification of population aging and the implementation of the three-child policy,the elderly care pressure of Chinese families continues to rise.Therefore,accelerating the construction of a new intelligent elderly care service model is an important measure to actively respond to population aging,ease the burden of family elderly care and promote high-quality economic development.In view of this,this study analyzed the intelligent elderly care service to explore the relevant countermeasures of the intelligent elderly care service in the context of fewer children.

The increased severity of acute pancreatitis in the elderly is mainly related to intestinal barrier dysfunction

To the Editor:Severeacutepancreatitisintheelderlyischaracterizedby significantmorbidityandmortalityrates,withahigherfinancial impact when compared to the same disease in younger patients [1]. There are some obvious differences between these two populations. The most glaring one is the presence of multiple co-

Prevalence and control of hypertension in the elderly:results from China hypertension survey,2012-2015

Objective To evaluate the prevalence,awareness,treatment and control rate of hypertension among elder population in China.Methods Data form a cross-sectional stratified multistage random sampling survey conducted from 2012 to 2015 were used to analyzed.Finally,a total of 134,397 participants aged≥60 years were enrolled in our study.Hypertension was defined as systolic BP≥140 mmHg,and/or diastolic BP≥90 mmHg,and/or use of antihypertensive medicine within 2 weeks.Among participants with hypertension,control rate of hypertension was defined as the participant presenting as hypertensive,but with a systolic BP measure less than 140 mm Hg and diastolic BP measure less than 90 mm Hg.

Approach to Helicobacter pylori infection in geriatric population

The prevalence of Helicobacter pylori(H. pylori) infection and its complications increase with age. The majority of infected individuals remain asymptomatic throughout the life but 10%-20% develops peptic ulcer disease and 1% gastric malignancies. The incidence of ulcers and their complications are more common in the older population resulting in higher hospitalization and mortality rates. The increased use of medications causing gastric mucosal damage and the decreased secretion of protective prostaglandins in elderly are major factors increasing gastric mucosal sensitivity to the destructive effects of H. pylori. Due to higher prevalence of gastrointestinal(GI) malignancies,upper GI endoscopy is mostly preferred in elderly for the diagnosis of infection. Therefore,"endoscopy and treat" strategy may be more appropriate instead of "test and treat" strategy for dyspeptic patients in older age. Urea breath test and stool antigen test can be used for control of eradication,except for special cases requiring follow-up with endoscopy. The indications for treatment and suggested eradication regimens are similar with other age groups; however,the eradication failure may be a more significant problem due to high antibiotic resistance and low compliance rate in elderly. Multidrug usage and drug interactions should always be consid-ered before starting the treatment. This paper reviews briefly the epidemiology,diagnosis,disease manifesta-tions,and treatment options of H. pylori in the geriatric population.

Heart failure mortality compared between elderly and non-elderly Thai patients

Objective To investigate heart failure mortality compared between elderly and non-elderly Thai patients.Methods This study included patients at least 18 years of age who were admitted to the hospital with a primary diagnosis of heart failure(ICD-10-TM code:150.9)during 2008-2012 according to three major Thailand reimbursement systems(civil servant,social security,and universal coverage systems).Patients were categorized into either the elderly group(age>65 years)or the non-elderly group(age<65 years).Mortality rate and survival analysis were compared between groups.Demographic,underlying disease and comorbid condition data were collected.Cardiovascular and non-cardiovascular death was also analyzed.Results A total of 201,709 patients were included.The average age of patients was 64.9±14.8 years,and the gender proportion breakdown was 84,155(41.7%)males and 117,554(58.3%)females.Just over half of patients(107,325 patients;53.2%)were elderly.Overall mortality rate was 50.8%.The mortality rate at one month,six months,one year,and three years was 11.0%,24.5%,32.5%,and 46.3%,respectively.Elderly patients had a higher rate of mortality compared to non-elderly patients with an adjusted odds ratio(OR)of 1.47(95%CI:1.46-1.49)for all-cause mortality,an OR of 1.25(95%CI:1.23-1.27)for cardiovascular death,and an OR of 1.72(95%CI:1.68-1.75)for non-cardiovascular death(all P<0.001).After adjusting for potential confounders,elderly status remained the second strongest factor associated with increased risk of mortality after heart failure hospitalization following chronic kidney disease.Conclusions The overall mortality rate after heart failure hospitalization was a very high 50.8%.Multivariate analysis revealed elderly status to be an independent predictor of mortality after hospitalization.This finding suggests that improvements are needed related to the quality of care and follow-up given to elderly Thai heart failure patients.

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

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

Exploration on China's Institution-oriented Elderly Care Service System Based on Human Factors Engineering

Objective Aging process in China has brought more and more challenges to traditional home-based care for the aged and more attentions to the mode of institution-oriented elderly care.This work,by analyzing the problems and defects of institution engaging in elderly care based on the human factors engineering theory,discusses the people-centered institution-oriented elderly care service system,in terms of the problems that the pattern of institution-oriented elderly care focuses more on the facilities and environment construction than the principal role of people in the elderly care service system.Methods Sampled the institutions engaging in elderly care in Hefei City,Anhui Province,P.R.China(a medium-sized city in China);surveyed 45 institutions engaging in elderly care and 828 registered elders in Hefei City by hierarchical and systematic sampling method.Results(1)institutions engaging in elderly care shared the occupancy rate of 49.6%and low total service efficiency;(2)institutions engaging in elderly care offered 100%life-oriented service items,but only 6.1%personalized service items provided;(3)100%simple housing facilities in elderly care institutions,but extremely less personalized service facility(3.2%),with poorer quality and less satisfaction;(4)insufficient professional service staff could be available;48.1%institutions have 5 or less professional service staffs.Conclusion A countermeasure to improve the elderly care service system was raised here by aiming at improving the institution-oriented elderly care service:(1)to transfer service toward the people-oriented concept,formulating preferential policy for endowment insurance;(2)to pay attention to personalized design of service facility,offer personalized and featured service items,and improve service management level;(3)to build professional team for elderly care.