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.

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.

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.

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.

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.

Valuable Beyond Vulnerable: A Scoping Review on the Contributions of Older Forced Migrants in Post-migration Recovery

During times of crisis, including pandemics, climate change, and forced migration, much of the discourse in ageing research and intervention centers on the vulnerabilities of older adults. Unfortunately, the valuable contributions of older adults to post-disaster recovery and healing are often overlooked and undervalued. Our aim in this scoping review is to shed light on the critical contributions of older forced migrants to post-migration recovery. We set the scene by introducing the two significant global demographic changes of the twenty-first century: forced migration and ageing. We provide a discourse on older forced migrants, ageing in situations of forced migration, and some of the challenges faced by older forced migrants. We then present some of the substantial roles of older forced migrants in post-migration recovery, including building resilience, contributing to culture and language transfer, providing emotional support, offering mentorship and leadership, participating in community building, and fostering social integration. We close by highlighting some of the lessons that can be drawn from understanding the unique roles played by older adults in post-forced migration recovery and the key actions necessary to promote these roles.

Social Capital and Depressive Ill-Health——An Evaluative Approach to the Implementation of the Chronic Care Model (CCM)

Background: Social capital has been described as a person’s sense of belonging as a result of the number and type of relationships she/he has, in which trust and reciprocity are especially important. Aim: To illuminate older persons’ experiences of social capital and depressive ill-health after implementation of the CCM. Methods: Data were collected from nine participants resident in two districts of Norway by means of individual in-depth interviews. A qualitative hermeneutic analysis was performed. Results: Two overall themes, desire for a guardian and a wish for independence despite being dependent, and two themes emerging from the analysis. The first theme—searching for protection was based on three sub-themes overwhelmed by the emotional pain of other people, a sense of exclusion and worries about the future, while the second theme—the need for a relationship with trustworthy persons comprised two sub-themes, namely, emotional pain was not understood and powerlessness to change the situation. The result of this study highlights the need for greater understanding on the part of healthcare professionals of how older persons manage their social relationships. Healthcare professionals require more knowledge about how negative self-beliefs held by older persons suffering from emotional pain, which can lead to reduced ability to trust other people. Another consequence is that fear of being dependent on other people can result in unwillingness to admit the need for help. Conclusion: This study highlights the lack of social capital in older persons who suffer from depressive ill-health. The implementation of the CCM does not appear to improve the situation. Older persons need to be more aware of their social needs and productive interactions in order to protect themselves and obtain support from their social network.

Referrals to Emergency Departments—— The Processes and Factors That Influence Decision-Making among Community Nurses

The aim of the study was to describe the basis on which municipal care registered nurses (RN) make decisions and their experiences when referring older persons from nursing homes to emergency departments (EDs). RNs in the community are to ensure that older adults receive good care quality in nursing home. This study used a descriptive design with a qualitative content analysis. The analysis of the data from the 13 interviews revealed one theme “Shared responsibilities in the best interests of the older person reduce feelings of insufficiency”. The content was formulated, which revealed the RNs’ feelings, reasoning and factors influencing them and their actions in the decision-making situation, before the patients were referred to an emergency department. Complex illnesses, non-adapted organizations, considerations about what was good and right in order to meet the older person’s needs, taking account of her/his life-world, health, well-being and best interests were reported. Co-worker competencies and open dialogues in the “inner circle” were crucial for the nurses’ confidence in the decision. Hesitation to refer was associated with previous negative reactions from ED professionals. The RN sometimes express that they lacked medical knowledge and were uncertain how to judge the acute illness or changes. Access to the “outer circle”, i.e. physicians and hospital colleagues, was necessary to counteract feelings of insecurity about referrals. When difficult decisions have to be made, not only medical facts but also relationships are of importance. To strengthen the RNs’ and staff members’ competence by means of education seems to be important for avoiding unnecessary referrals. Guidelines and work routine need to be more transparent and referrals due to the lack of resources are not only wasteful but can worsen the older persons’ health.

Norwegian Nursing Home——A Care Facility or a Home?

This article focuses on the function of Norwegian nursing homes. A brief history of institutionalisation of older people in Norway is presented. An expressed task for Norwegian nursing homes is active treatment, and even though the “Guarantee of dignity” was implemented from January 2011, there are proofs that the rights of the residents are constantly violated. Another task for Norwegian nursing homes is to be home for the residents. This double function of the nursing home, being both a care facility and a home is discussed, and whether the nursing homes succeed in fulfilling these tasks or not is questioned. It is also questioned if Goffman’s descriptions of total institutions are applicable on nursing homes of today.

Examination of Experimental Method to Extract Characteristics of Lower Limb Movement in Emergency Braking Operation

The purpose of this study is to clarify the driving behavior and reaction pattern peculiar to the elderly. In this paper, we conducted a brake operation experiment with five young people, and aimed to create an evaluation index and an experimental method that can extract the characteristics of emergency brake operation from pedaling force and lower limb movement. The results showed that in order to operate the brakes strongly and quickly, the knee was firmly flection, and then the pedaling force was increased when the knee was extended. Furthermore, it was shown that if the brakes were operated without moving the ankle joint, the operation would be quicker.