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.

Metabolic Disorders Increase the Risk to Incident Cardiovascular Disease in Middle-aged and Elderly Chinese

Objective The association of metabolic syndrome （MetS） with cardiovascular diseases （CVD） has not been adequately explored in middle-aged and elderly Chinese. This study aimed to investigate MetS＇ prevalence and its impact on the CVD incidence in this specific population group. Methods A data set of a community-based prospective cohort study was analyzed. A total of 2300 subjects aged 40-94 years were followed up for the CVD events. MetS defined according to the JCDCG criteria was assessed at baseline, and the middle-aged and elderly groups were classified by the WHO definition. Results As compared with the middle-aged group, the prevalence of MetS increased by 0.6 times （34.6% vs. 21.3%） and the incidence density of CVD increased by 4.9 times in the elderly group （52.3/1000 person-year vs. 8.9/1000 person-year）. Furthermore, the multivariate Cox regression revealed that the risk to CVD incidence was independently related to increased waist circumference in the middle-aged group （HR=2.23, P〈0.01） and to elevated blood glucose in the elderly group （HR=1.39, P〈O.01）. Conclusion MetS was highly prevalent in middle-aged and elderly Chinese. MetS significantly increased the risk to OdD incidence in the elderly. All individuals with metabolic disorders should receive active clinical care to reduce the incidence of CVD.

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.

Public Square Dancing Intervention on Subjective Well-Being of Middle-Aged and Elderly People:A Meta-Analysis

Objective:To understand the influence of public square dancing on the subjective well-being of middle-aged and elderly people.Methods:According to the principle of Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA)guidelines,we search Chinese databases,such as CNKI,Wanfang Data,and VIP,and English databases,such as Proquest,Web of Science,Pubmed,Cochrane,and ScienceDirect,and collect relevant articles at home and abroad from 2006 to December 2019 for meta-analysis in January 2020.Result:A total of 10 articles were included.The meta-analysis results showed that the well-being of middle-aged and elderly people in the public square dancing intervention group was significantly higher than that of the other exercise group and control group(both P<0.01).The results of the subgroup analysis showed the following:Different durations of intervention significantly influence the intervention effect(P<0.01).No difference was found between the effect of the mixed-gender intervention and the individual female intervention(P>0.05).No significant difference was found between the groups with weekly intervention frequency(P>0.05).Conclusion:Public square dancing intervention is effective for middle-aged and elderly people’s subjective well-being.Neither mixed intervention nor the times of weekly intervention have an impact on the intervention effect.However,the length of duration of intervention influences the intervention effect.

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

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Relationship between platelet-lymphocyte ratio and carotid atherosclerosis in middle-aged and elderly patients with type 2 diabetes mellitus

Objective:To investigate the relationship between platelet-lymphocyte ratio(PLR)and carotid atherosclerosis(CAS)in middle-aged and elderly patients with T2DM.Methods:A total of 420 middle-aged and elderly patients with T2DM who were hospitalized in the Endocrinology Department of our hospital from September 2018 to September 2020 and were examined by ultrasound were selected as the subjects.The carotid artery intima-media thickness(CIMT)was examined by color Doppler ultrasonography,including normal CIMT group(n=111),CIMT thickening group(n=103)and CAS plaque group(n=206).The differences of serum PLR levels among the three groups were compared.Multivariate Logistic regression was used to analyze the relationship between PLR and CAS plaque formation.The receiver operating curve(ROC)was used to evaluate the value of multivariate Logistic regression model(Logit P)in the diagnosis of CAS lesions.Results:The mean value of PLR in CAS plaque group(127.86±48.54)was significantly higher than that in CIMT normal group(109.15±48.35).Multivariate Logistic regression analysis showed that after adjusting for other confounding factors,the increase of PLR was an independent risk factor for the occurrence of CAS plaque.ROC showed that the efficacy of multivariate Logit P model in the diagnosis of CAS plaque was(AUC=0.807,95%CI=0.759-0.858).Conclusions:PLR is one of the important risk factors for the occurrence of CAS lesions.At the same time,the multivariate Logistic regression model established in this study has clinical reference value in predicting CAS lesions in middle-aged and elderly patients with T2DM.

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.

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.

Digital literacy and financial market participation of middle-aged and elderly adults in China

Digital literacy has become increasingly important for individuals to participate in regular economic activities,including employment,consumption,and investment.This paper quantitatively defines digital literacy with recently released household survey data in China and describes the digital divide across regions and ages.We further show that digital literacy increases risky asset ownership in the financial market among the middle-aged and elderly population.In this sense,this paper identifies a novel factor that affects financial investment.These findings imply that the digital divide may lead to the asset divide and wealth inequality.Family and social assistance to improve the digital literacy of disadvantaged population groups may increase financial inclusion as well.

Associations of short-term ambient temperature exposure with lung function in middle-aged and elderly people:A longitudinal study in China

The short-term associations of ambient temperature exposure with lung function in middle-aged and elderly Chinese remain obscure.The study included 19,128 participants from the Dongfeng-Tongji cohort's first(2013)and second(2018)follow-ups.The lung function for each subject was determined between April and December 2013 and re-assessed in 2018,with three parameters(forced vital capacity[FVC],forced expiratory volume in 1 s[FEV1],and peak expiratory flow[PEF])selected.The China Meteorological Data Sharing Service Center provided temperature data during the study period.In the two follow-ups,a total of 25,511 records(average age:first,64.57;second,65.80)were evaluated,including 10,604 males(41.57%).The inversely J-shaped associations between moving average temperatures(lag01–lag07)and FVC,FEV1,and PEF were observed,and the optimum temperatures at lag04 were 16.5
C,18.7
C,and 16.2
C,respectively.At lag04,every 1
C increase in temperature was associated with 14.07 mL,9.78 mL,and 62.72 mL/s increase in FVC,FEV1,and PEF in the lowtemperature zone(<the optimum temperatures),whereas 5.72 mL,2.01 mL,and 11.64 mL/s decrease in the high-temperature zone(the optimum temperatures),respectively(all P<0.05).We observed significant effect modifications of gender,age,body mass index,body surface area,smoking status,drinking status,and physical activity on the associations(all Pmodification<0.05).Non-optimal temperatures may cause lung function decline.Several individual characters and lifestyles have effect modification on the temperature effects.

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.