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Elderly Population (elderly + population)
Kinds of Elderly Population Selected AbstractsCHEWING PATTERNS OF VARIOUS TEXTURE FOODS STUDIED BY ELECTROMYOGRAPHY IN YOUNG AND ELDERLY POPULATIONSJOURNAL OF TEXTURE STUDIES, Issue 4 2002KAORU KOHYAMA ABSTRACT The effects of food texture on the chewing patterns of elderly and young people, masticatory recordings using electromyography (EMG) were carried out. Fourteen French adults (mean 29.4 years) and 23 elderly (mean 67.7 years) participated. Six food products (rice, beef, cheese, crispy bread, apple and peanuts) were tested. The chewing pattern of elderly subjects was characterized by a significant increase of number of chews and chewing duration for all foods except rice. Whatever the food type, muscle activity per chew (mean amplitude × burst duration) was lower for elderly than for young subjects. Single chews appeared less effective for food reduction in elderly than in young subjects. This can be partly compensated for by increasing the chewing duration and number of chews. No significant difference was found between both groups of subject for the total amount of EMG activity required prior to swallow whatever the food chewed. [source] Ten Dimensions of Health and Their Relationships with Overall Self-Reported Health and Survival in a Predominately Religiously Active Elderly Population: The Cache County Memory StudyJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 2 2006Truls Østbye MD OBJECTIVES: To document the extent of healthy aging along 10 different dimensions in a population known for its longevity. DESIGN: A cohort study with baseline measures of overall self-reported health and health along 10 specific dimensions; analyses investigated the 10 dimensions as predictors of self-reported health and 10-year mortality. SETTING: Cache County, Utah, which is among the areas with the highest conditional life expectancy at age 65 in the United States. PARTICIPANTS: Inhabitants of Cache County aged 65 and older (January 1, 1995). MEASUREMENTS: Self-reported overall health and 10 specific dimensions of healthy aging: independent living, vision, hearing, activities of daily living, instrumental activities of daily living, absence of physical illness, cognition, healthy mood, social support and participation, and religious participation and spirituality. RESULTS: This elderly population was healthy overall. With few exceptions, 80% to 90% of persons aged 65 to 75 were healthy according to each measure used. Prevalence of excellent and good self-reported health decreased with age, to approximately 60% in those aged 85 and older. Even in the oldest old, the majority of respondents were independent in activities of daily living. Although vision, hearing, and mood were significant predictors of overall self-reported health in the final models, age, sex, and cognition were significant only in the final survival models. CONCLUSION: This population has a high prevalence of most factors representing healthy aging. The predictors of overall self-reported health are distinct from the predictors of survival in this age group and, being potentially modifiable, are amenable to clinical and public health efforts. [source] Functional and Cognitive Consequences of Silent Stroke Discovered Using Brain Magnetic Resonance Imaging in an Elderly PopulationJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 7 2004Wolf-Peter Schmidt MD Objectives: To evaluate the prevalence of silent stroke and its associated consequences on physical, cognitive, and emotional functioning in an elderly population. Design: Population-based cross-sectional survey. Setting: The Memory and Morbidity in Augsburg Elderly project in the Augsburg region of southern Germany. Participants: Two hundred sixty-seven community-dwelling persons aged 65 to 83. Measurements: The presence of silent stroke was determined using magnetic resonance imaging brain scan and a single question asking for physician-diagnosed stroke in each participant. The health effect of silent stroke was assessed using rating scales for self-perceived health status (36-item short-form health survey), activities of daily living (ADLs) and instrumental ADLs, cognitive function, and depression (Center for Epidemiologic Studies Depression scale). Results: Just fewer than 13% (12.7%) of participants were affected by silent stroke. Silent stroke was associated with a history of hypertension, heart surgery, and elevated C-reactive protein. Individuals with silent stroke showed impairments on the Mini-Mental State Examination test and in the cognitive domains of memory, procedural speed, and motor performance. Conclusion: The presence of silent stroke has a considerable effect on cognitive performance in those affected. Determining the presence of silent stroke using brain imaging may contribute to identifying individuals at risk for developing gradual neurological deficits. [source] Prevalence of Alcohol-Related Problems in an Elderly Population and Their Association With Cognitive Impairment and DementiaALCOHOLISM, Issue 4 2010Marcos A. Lopes Background:, Studies investigating the association between alcohol use and cognitive disorders in the elderly population have produced divergent results. Moreover, the role of alcohol in cognitive dysfunction is not clear. The aims of this study were to estimate the prevalence of alcohol-related problems in an elderly population from Brazil and to investigate their association with cognitive and functional impairment (CFI) and dementia. Methods:, A community-based cross-sectional study was performed. A sample of 1,145 elderly people was examined in 2 phases. Several instruments were utilized in the first phase: the CAGE questionnaire was used to identify potential cases of alcohol-related problems, and a screening test for dementia was used to estimate CFI. The CAMDEX interview (Cambridge Examination) and DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4th edition) criteria were used for the clinical diagnosis of dementia in the second phase. Results:, "Heavy alcohol use" (CAGE , 2) was found in 92 subjects (prevalence: 8.2%). It was associated with gender (males, p < 0.001), low education (only in females, p = 0.002), and low socioeconomic level (p = 0.001, in females; p = 0.002, in males). The Mini Mental State Examination exhibited a nonlinear relationship with alcohol-related problems in females; "mild,moderate alcohol use" (CAGE < 2) presented the highest score. A significant association between alcohol-related problems and cognitive dysfunction was found only in females. "Heavy alcohol use" was associated with higher CFI and dementia rates compared to "mild,moderate alcohol use" (p = 0.003 and p < 0.001, respectively). "Mild,moderate alcohol use" had a tendency of association with lower CFI and dementia rates when compared to "no alcohol use" (p = 0.063 and 0.050, respectively). Conclusion:, Our findings suggest that alcohol use does not have a linear relationship with cognitive decline. [source] Prevalence and Comorbidity of Insomnia and Effect on Functioning in Elderly PopulationsJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue S7 2005Sonia Ancoli-Israel PhD A good night's sleep is often more elusive as we age, because the prevalence of insomnia in older people is high. Insufficient sleep can have important effects on daytime function by increasing the need to nap, reducing cognitive ability including attention and memory, slowing response time, adversely affecting relationships with friends and family, and contributing to a general sense of being unwell. However, rather than aging per se, circadian rhythm shifts, primary sleep disorders, comorbid medical/psychiatric illnesses, and medication use cause sleep difficulties in older people, which psychosocial factors may also affect. Clinicians should ask elderly patients about satisfaction with sleep. Any sleep complaints warrant careful evaluation of contributing factors and appropriate treatment. [source] Incontinence in the aged: contact dermatitis and other cutaneous consequencesCONTACT DERMATITIS, Issue 4 2007Miranda A. Farage Urinary and faecal incontinence affects a significant portion of the elderly population. The increase in the incidence of incontinence is not only dependent on age but also on the onset of concomitant ageing issues such as infection, polypharmacy, and decreased cognitive function. If incontinence is left untreated, a host of dermatological complications can occur, including incontinence dermatitis, dermatological infections, intertrigo, vulvar folliculitis, and pruritus ani. The presence of chronic incontinence can produce a vicious cycle of skin damage and inflammation because of the loss of cutaneous integrity. Minimizing skin damage caused by incontinence is dependent on successful control of excess hydration, maintenance of proper pH, minimization of interaction between urine and faeces, and prevention of secondary infection. Even though incontinence is common in the aged, it is not an inevitable consequence of ageing but a disorder that can and should be treated. Appropriate clinical management of incontinence can help seniors continue to lead vital active lives as well as avoid the cutaneous sequelae of incontinence. [source] The prognosis and incidence of social phobia in an elderly population.ACTA PSYCHIATRICA SCANDINAVICA, Issue 1 2010A 5-year follow-up Karlsson B, Sigström R, Waern M, Östling S, Gustafson D, Skoog I. The prognosis and incidence of social phobia in an elderly population. A 5-year follow-up. Objective:, To examine the prognosis and incidence of social fears and phobia in an elderly population sample followed for 5 years. Method:, A general population sample (N = 612) of non-demented men (baseline age 70) and women (baseline age 70 and 78,86) was investigated in 2000,2001 and in 2005,2006 with semi-structured psychiatric examinations including the Comprehensive Psychopathological Rating Scale, and the Mini International Neuropsychiatric Interview. Social phobia was diagnosed according to the DSM-IV criteria. Results:, Among nine individuals with DSM-IV social phobia in 2000, 5 (55.6%) had no social fears in 2005, and 1 (11.1%) still met the criteria for DSM-IV social phobia. Among individuals without DSM-IV social phobia in 2000 (N = 603), 12 (2.0%) had DSM-IV social phobia in 2005. Conclusion:, These findings challenge the notion that social phobia is a chronic disorder with rare occurrence in old age. [source] Lateral Wedge Resection: A Simple Technique for Repairing Involutional Lower Eyelid EntropionDERMATOLOGIC SURGERY, Issue 9 2010IGAL LEIBOVITCH MD BACKGROUND Lower lid involutional entropion is a common eyelid pathology affecting the elderly population. Most of the reported surgical techniques are mainly based on a lateral tarsal strip anchored to the orbital rim. OBJECTIVES To report the surgical outcome using a simple single-stitch lateral wedge technique to repair involutional lower entropion. METHODS This single-surgeon, retrospective, noncomparative cases series included all patients with involutional lower eyelid entropion who were operated on using the lateral wedge technique. RESULTS Fifty-eight eyelids of 52 patients (46 unilateral, 6 bilateral; 27 men, 25 women; age, mean 67±10; range 50,85) underwent surgical repair. Immediate resolution of entropion and associated ocular symptoms was achieved in 55 eyelids (94.9%). One case had postoperative ectropion that completely resolved spontaneously after 4 weeks, and one had wound dehiscence that healed completely without any intervention. Another patient had residual entropion that resolved after an additional surgical repair. No other cases of recurrence were noted during a mean follow-up period of 16 months (range 6,24 months). CONCLUSION This minimally invasive single-stitch lateral wedge technique is a simple and effective procedure for repairing involutional lower eyelid entropion and is associated with low recurrence and complication rates. Igal Leibovitch, MD, has indicated no significant interest with commercial supporters. [source] Laparoscopic paraesophageal hernia repair: quality of life outcomes in the elderlyDISEASES OF THE ESOPHAGUS, Issue 8 2008E. J. Hazebroek SUMMARY Paraesophageal hernias (PEH) occur when there is herniation of the stomach through a dilated hiatal aperture. These hernias occur more commonly in the elderly, who are often not offered surgery despite the failure of medical treatment to address mechanical symptoms and life-threatening complications. The aim of this study was to assess the impact of laparoscopic repair of PEH on quality of life in an elderly population. Data were collected prospectively on 35 consecutive patients aged >70 years who had laparoscopic repair of a symptomatic PEH between December 2001 and September 2005. The change in quality of life was assessed using a validated questionnaire, the Quality of Life in Reflux and Dyspepsia questionnaire (QOLRAD), and by patient interviews. Patients were assessed preoperatively, and at 6 weeks, 6 months, 12 months, 1 year, and 2 years postoperatively. Mean patient age was 77 years (range 70,85); mean American Society of Anesthesiologists class was 2.7 (range 1,3). There were 28 women and 7 men. There was one readmission for acute reherniation, which required open revision. Total complication rate was 17.1%. All complications were treated without residual disability. There was no 30-day mortality, and median hospital stay was 3 days (range 2,14). Completed questionnaires were obtained in 30 of 35 patients (85.7%). There was a significant improvement in quality of life, as measured with QOLRAD, at all postoperative time points (P < 0.001). Laparoscopic PEH repair can be performed with acceptable morbidity in symptomatic patients refractory to conservative treatment and is associated with a significant improvement in quality of life. Our data support elective repair of symptomatic PEH in the elderly, a population who may not always be referred for a surgical opinion. [source] ,-Amyloid immunization approaches for Alzheimer's diseaseDRUG DEVELOPMENT RESEARCH, Issue 2 2002Bruno P. Imbimbo Abstract Alzheimer's disease (AD) represents the third leading cause of death in the U.S. and the leading cause of dementia in the elderly population. Until recently, there was little hope of efficiently combating this devastating disease. The deposition of ,-amyloid (A,) is the major pathological hallmark of AD brains. Genetic, biochemical, and pharmacological evidence support the hypothesis that A, plays a key role in the development of the disease. Thus, in the last 5 years a number of pharmacological strategies have been developed to interfere with the A, cascade. The most revolutionary of these approaches was proposed in 1999 by scientists at Elan Pharmaceuticals, which immunized against A, transgenic mice with spontaneously developing A, pathology. The immunization was achieved by subcutaneous injections of a preaggregated form of the synthetic human 42-amino acid A, emulsified with Freund's adjuvant, an immune stimulant. The vaccination caused a near complete inhibition of A, plaque formation in younger animals and a marked reduction of the A, burden in older animals. The effects on A, plaques were accompanied by a reduction of A,-associated astrogliosis and neuritic dystrophy. These results were later confirmed by other groups with similar vaccination protocols, which also demonstrated that the A, immunization of transgenic animals normalize or reduce the cognitive impairment associated with A, pathology. Interestingly, effective removal of brain A, plaques was also obtained by peripherally administering A, antibodies. The mechanism with which the vaccine increases A, clearance is not fully understood. Centrally, the vaccine appears to activate A, phagocytosis by microglial monocytes. Peripherally, serum A, antibodies bind and sequester A,, thus altering its equilibrium between CNS and plasma. The dramatic results obtained in animal models of AD raised unprecedented hopes for both a preventive and a curative intervention for this devastating disorder. A vaccine preparation for human use (AN-1792) composed of preaggregated human A,42 peptide and a highly purified saponin derivative (QS-21) was developed by Elan Pharmaceuticals and Wyeth Ayerst and tested in AD patients. Unfortunately, a Phase IIa study aimed at evaluating the safety and immunological activity of AN-1792 in 360 AD patients was discontinued because 15 subjects receiving the vaccine developed serious signs of CNS inflammation. Both central activation of cytotoxic T cells and autoimmune reactions were proposed as potential mechanisms of toxicity. Other therapeutic A, vaccination strategies are being pursued, including immuno-conjugates and monoclonal antibodies. The future of these and other A, immunization approaches depend on a clear understanding of the mechanism of A, clearance and additional insight into the role of inflammation in the AD brain. Drug Dev. Res. 56:150,162, 2002. © 2002 Wiley-Liss, Inc. [source] Incidence of Status Epilepticus in Adults in Germany: A Prospective, Population-Based StudyEPILEPSIA, Issue 6 2001Susanne Knake Summary: ,Purpose: To determine the incidence and case-fatality rate of status epilepticus (SE) in adults in Hessen, Germany, we performed a prospective, population-based study from July 1997 through June 1999. Methods: All adult patients residing within the zip-code area 35 (area-35) with SE were included. Area-35 had 743.285 adult inhabitants, including 123.353 adult inhabitants of the primary service area of the University Hospital Marburg (PS-area). Patients were reported by 16 hospitals in the area and were prospectively identified and carefully reviewed within 5 days by one of the authors. Based on the crude annual incidence of SE and a rate of underascertainment of 10% determined for the PS-area, the corrected, age-adjusted incidence of SE in area 35, more representative of the population of Germany, was calculated. Results: The crude annual incidence in the PS-area was 15.8/100,000 [95% confidence interval (CI), 11.2,21.6]. The calculated, corrected, age-adjusted incidence of SE in area 35 was 17.1/100,000. It was higher for men compared with women (26.1 vs. 13.7) and for those aged 60 years and older (54.5 vs. 4.2/100,000, p < 0.0001). The etiology was mainly remote symptomatic due to cerebrovascular disease. Epilepsy was previously diagnosed in only 50% of the patients. The case-fatality rate was 9.3%. Conclusions: Based on our data, at least 14,000 patients would be affected by SE in Germany, associated with ,1,300 deaths annually. The incidence of SE in Germany is similar to that found in the white United States population. Furthermore, this study confirms the higher incidence of SE in male patients and in the elderly population. This may be due to a higher incidence of cerebrovascular disease in these subpopulations. [source] Frailty predicts long-term mortality in elderly subjects with chronic heart failureEUROPEAN JOURNAL OF CLINICAL INVESTIGATION, Issue 12 2005F. Cacciatore Abstract Background, The elderly are characterized by a high prevalence of chronic heart failure (CHF) and frailty, which is a complex interaction of physical, psychological and social impairment. This study aimed to examine the predictive role of frailty on long-term mortality in elderly subjects with CHF. Materials and methods, The study assessed long-term mortality after 12-year follow up in 120 subjects with CHF and 1139 subjects without CHF, selected in 1992, from a random sample of the elderly population in the Campania region of Italy. Frailty was assessed according to a ,Frailty Staging System'. Results, Subjects with CHF were prevalently female (60%) and older than 75 years (mean 75·9 ± 6·7); subjects without CHF were prevalently female (56·4%) and younger than 75 years (mean 74·0 ± 6·3). In subjects with and without CHF stratified into classes of frailty there was a statistically significant increase in age, comorbidity, disability and low social support, and a decrease in MMSE score. Moreover, death progressively increased more with frailty in subjects (70·0% to 94·4%, P < 0·03) than in those without (43·8.% to 88·3%, P < 0·0001) CHF. The Kaplan,Meier analysis shows that at 9 years the probability of survival progressively decreased as frailty increased (45·5% to 0%) in subjects with CHF and from 62·8% to 25·9% in subjects without CHF. The Cox regression analysis indicated that frailty is predictive of mortality in the multivariate model adjusted for several variables including sex and age in subjects with and without CHF. Moreover, the analysis showed that frailty is more predictive of mortality in elderly subjects with CHF when it was analyzed either as continuous (1·48 vs. 1·36) or as a dummy (3 vs. 1 = 1·62 vs. 1·24) variable. Conclusions, Thus mortality among elderly subjects with or without CHF increases with frailty. Moreover, frailty is more predictive of long-term mortality in elderly subjects with than in those without CHF. Hence, frailty represents a new independent variable for predicting long-term mortality in elderly subjects with CHF. [source] GENETIC STUDY: BclI glucocorticoid receptor polymorphism and smoking in the general populationADDICTION BIOLOGY, Issue 3 2009Satu J. Siiskonen ABSTRACT We studied the hypothesis that the BclI polymorphism of the glucocorticoid receptor gene is associated with an increased probability of being a (heavy) smoker and a decreased ability to quit smoking. The study cohort consisted of all subjects in the Rotterdam Study, a Dutch population-based cohort of people aged 55 years and older, for whom BclI genotyping and smoking status at baseline were available. In prospective analyses, the smoking status was reassessed during three additional examination rounds. Logistic regression analysis was used to study the association between BclI polymorphism and being a smoker or a heavy smoker at baseline. Furthermore, the relationship between BclI polymorphism and incident smoking cessation was tested with Cox proportional hazards analysis within those who smoked at baseline. In total, 6358 subjects were included in the study. The presence of a G-allele was not associated with current smoking at baseline [odds ratio (OR) = 0.96, 95%confidence interval (CI): 0.85,1.09] or with the incidence of smoking cessation during follow-up [hazard ratio (HR) = 0.98, 95%CI: 0.80,1.19]. Within current smokers, having a G-allele was not significantly associated with the risk of being a heavy smoker when measured by pack-years smoked (OR = 1.07, 95%CI: 0.85,1.35) or daily consumption of tobacco (OR = 1.10, 95%CI: 0.88,1.37). We were not able to replicate the earlier findings indicating that the proportion of current smokers is lower among carriers of the CC-genotype of the BclI glucocorticoid receptor. Furthermore, the BclI glucocorticoid receptor polymorphism did not predict the incidence of smoking cessation in the general elderly population. [source] Perceptions of Elderly Self-Neglect: A Look at Culture and CohortFAMILY & CONSUMER SCIENCES RESEARCH JOURNAL, Issue 3 2007Sylvia Marie San Filippo Abuse and neglect are issues of concern that face the elderly population. This study investigated differences in perception of self-neglect behaviors among four cohort and four cultural groups. Data were collected from students, staff, and faculty at a large state university, attendees at multiple senior centers, and people attending cultural fairs in Southern California. Using this convenience sample of 494 participants, age 18 years or older, researchers identified factors influencing self-neglect perceptions in the culture and cohort models. Significant variables identified in both models are: having a daily caloric intake of fewer than 1,000 calories, avoiding friends and social events, drinking three to four alcoholic drinks at social occasions, and working part-time. It is important for professionals working with self-neglecting elders to understand differences in perception by culture and cohort. Agreement on a definition of self-neglect is a step toward better addressing self-neglect in the elderly community. [source] Nutritional Risk among Elderly Rural Midwestern WomenFAMILY & CONSUMER SCIENCES RESEARCH JOURNAL, Issue 1 2000Leslee K. Pollina Nutritional risk in relation to depression and eating disorder symptoms was assessed among a sample of rural, elderly Midwestern women. Thirty-seven community-dwelling women (M age = 72.37, SD = 16.66) were recruited from senior center nutrition sites and other venues. Body mass index (BMI) was derived from bioelectric impedance measurements, and participants completed several questionnaires including the Level I Nutrition Screen, the Beck Depression Inventory, and the Eating Attitudes Test (EAT). Results indicated that 72% of participants had BMI scores outside the healthy range for older adults, but they were more likely to be overweight than underweight. Other areas of nutritional concern were identified. Several nutritional risk items were associated with eating disorder symptoms and with higher depression scores. However, in an elderly population, EAT items may reflect health-related as well as eating disorder symptoms. The need for comprehensive nutritional evaluations involving psychosocial and environmental factors is discussed. [source] Interleukin-6 (G-174C) and tumour necrosis factor-alpha (G-308A) gene polymorphisms in geriatric patients with chronic periodontitisGERODONTOLOGY, Issue 1 2010A. M. Costa doi:10.1111/j.1741-2358.2009.00291.x Interleukin-6 (G-174C) and tumour necrosis factor-alpha (G-308A) gene polymorphisms in geriatric patients with chronic periodontitis Background and objective:, Periodontitis is a chronic inflammatory disease, and genetic factors may have an important role in its severity. Polymorphisms in the promoter regions of the interleukin-6 (IL-6) and tumour necrosis factor-, (TNF-,) genes have been reported to cause changes in the production of these cytokines. The aim of this study was to evaluate the possible role of IL-6 (G,174C) and tumour necrosis factor (G,308A) polymorphisms, in the severity of chronic periodontitis in an elderly population. Materials and methods:, In this study, a group of 65 elderly women, comprising 17 patients with moderate chronic periodontitis, 21 with severe chronic periodontitis and 27 healthy patients were selected. DNA was isolated from all subjects, and polymerase chain reaction was used to study the IL-6 and TNF-, gene polymorphisms. Results:, The results of this study showed a significant difference in the allele and genotype frequencies of IL-6 gene polymorphism between patients with periodontal disease and controls. Subjects carrying the G/G genotype of IL-6 were most severely affected by periodontitis. The TNF-, gene polymorphism showed no association with chronic periodontitis between patients and controls. Conclusion:, The results suggest that the IL-6 gene polymorphism may be associated with chronic periodontitis, and that TNF-, gene polymorphism may not be involved in the progression of chronic periodontitis in the population of elderly Brazilian women. [source] A review of the effectiveness of oral health promotion activities among elderly peopleGERODONTOLOGY, Issue 2 2009Colman McGrath Objectives:, This study aimed to review the effectiveness of oral health promotion studies conducted among elderly people between 1997 and 2007. Methods:, Four electronic databases were searched and papers were rated for level of evidence and scientific quality. Key findings of the papers were summarised. Results:, Thirteen thousand nine hundred and four papers were retrieved and 17 studies (18 papers) met the criteria for the review: 13 were randomised controlled studies, three were quasi-experimental studies and one was a pre-/post-single group intervention study. According to the Levels of Evidence, 11 studies could be categorised as 1b and six studies could be categorised as 2b. The quality of the evidence of the 17 studies ranged from 12 to 19; 13 of the studies had a score of 15 or above; four of the studies ranged from 12 to 14. Evidence from oral health promotion activities aimed at preventing caries, improving periodontal health and altering oral health behaviours were reviewed. The use of fluoride, antimicrobial agents and health-care provider education has important roles within oral health promotion activities for elderly people. Studies have tended to be of short-term duration and rely on surrogate outcome measures of oral health. Conclusion:, In the last 10 years, increasing attention has been paid to oral health promotion activities among the elderly population and high quality evidence has emerged. However, there is a need for even higher-quality research to provide more definitive guidelines on oral health promotion practices for elderly people. [source] Meeting the Need for Personal Care among the Elderly: Does Medicaid Home Care Spending Matter?HEALTH SERVICES RESEARCH, Issue 1p2 2008Peter Kemper Objective. To determine whether Medicaid home care spending reduces the proportion of the disabled elderly population who do not get help with personal care. Data Sources. Data on Medicaid home care spending per poor elderly person in each state is merged with data from the Medicare Current Beneficiary Survey for 1992, 1996, and 2000. The sample (n=6,067) includes elderly persons living in the community who have at least one limitation in activities of daily living (ADLs). Study Design. Using a repeated cross-section analysis, the probability of not getting help with an ADL is estimated as a function of Medicaid home care spending, individual income, interactions between income and spending, and a set of individual characteristics. Because Medicaid home care spending is targeted at the low-income population, it is not expected to affect the population with higher incomes. We exploit this difference by using higher-income groups as comparison groups to assess whether unobserved state characteristics bias the estimates. Principal Findings. Among the low-income disabled elderly, the probability of not receiving help with an ADL limitation is about 10 percentage points lower in states in the top quartile of per capita Medicaid home care spending than in other states. No such association is observed in higher-income groups. These results are robust to a set of sensitivity analyses of the methods. Conclusion. These findings should reassure state and federal policymakers considering expanding Medicaid home care programs that they do deliver services to low-income people with long-term care needs and reduce the percent of those who are not getting help. [source] Systematic review of cholecystostomy as a treatment option in acute cholecystitisHPB, Issue 3 2009Anders Winbladh Abstract Objectives:, Percutaneous cholecystostomy (PC) is an established low-mortality treatment option for elderly and critically ill patients with acute cholecystitis. The primary aim of this review is to find out if there is any evidence in the literature to recommend PC rather than cholecystectomy for acute cholecystitis in the elderly population. Methods:, In April 2007, a systematic electronic database search was performed on the subject of PC and cholecystectomy in the elderly population. After exclusions, 53 studies remained, comprising 1918 patients. Three papers described randomized controlled trials (RCTs), but none compared the outcomes of PC and cholecystectomy. A total of 19 papers on mortality after cholecystectomy in patients aged >65 years were identified. Results:, Successful intervention was seen in 85.6% of patients with acute cholecystitis. A total of 40% of patients treated with PC were later cholecystectomized, with a mortality rate of 1.96%. Procedure mortality was 0.36%, but 30-day mortality rates were 15.4 % in patients treated with PC and 4.5% in those treated with acute cholecystectomy (P < 0.001). Conclusions:, There are no controlled studies evaluating the outcome of PC vs. cholecystectomy and the papers reviewed are of evidence grade C. It is not possible to make definitive recommendations regarding treatment by PC or cholecystectomy in elderly or critically ill patients with acute cholecystitis. Low mortality rates after cholecystectomy in elderly patients with acute cholecystitis have been reported in recent years and therefore we believe it is time to launch an RCT to address this issue. [source] Consumer receptiveness to universal design featuresINTERNATIONAL JOURNAL OF CONSUMER STUDIES, Issue 1 2009Teresa L. Nunn Abstract As homeowners age and struggle to adapt to the built environment, the addition of universal design features could allow added mobility and independence within their homes. Universal design means building residences in such a way that they are usable to the greatest extent possible, by all ages and abilities. The research used a descriptive analysis of survey data from 444 randomly selected US households to determine which characteristics of universal design were currently used in homes. In addition, the research examined the desire for future universal design elements. The findings indicate that the particular design features desired in the future varied depending on age. These findings are especially relevant as the desire to age in place continues to grow among our ever-increasing elderly population. [source] Validation of the Arabic version of the 5-item WHO well being index in elderly populationINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 1 2009Abla Mehio Sibai No abstract is available for this article. [source] Dementia and depression among nursing home residents in Lebanon: a pilot studyINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 4 2007L. M. Chahine Abstract Background The proportion of elderly in the Lebanese population is 7.1% and this is expected to increase to 10.2% by the year 2025. The nursing home (NH) population in Lebanon has not been studied. The aim of this study was to investigate the prevalence of dementia and depression among a portion of nursing home residents (NHR) in Lebanon and describe the characteristics of NHR afflicted with dementia and depression. Method Of 200 NHR from three NH in Lebanon, 117 were selected by random sampling. Data on demographics and medical history were collected. An Arabic version of the Mini-Mental Status Examination and Geriatric Depression Scale (GDS) were administered. Results Our final sample consisted of 102 NHR. Sixty-one (59.8%) had dementia of some kind. Seventeen (27.9%) had mild dementia, 14 (22.9%) had moderate dementia, and 30 (49.2%) had severe dementia. Forty-five (57.7%) of the NHR tested had depression as measured by a GDS score of more than 10. Conclusions Dementia and depression were present in more than half of the NHR in our sample. Our results have important implications, being the first to be collected in the Lebanese community. Screening NHR for dementia and depression on admission and at regular time intervals is a must. More studies targeting all aspects of the elderly population in Lebanon are needed. Copyright © 2006 John Wiley & Sons, Ltd. [source] The Nutrition, Aging, and Memory in Elders (NAME) study: design and methods for a study of micronutrients and cognitive function in a homebound elderly populationINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 6 2006Tammy M. Scott Abstract Background Micronutrient status can affect cognitive function in the elderly; however, there is much to learn about the precise effects. Understanding mediating factors by which micronutrient status affects cognitive function would contribute to elders' quality of life and their ability to remain in the home. Objectives The Nutrition, Aging, and Memory in Elders (NAME) Study is designed to advance the current level of knowledge by investigating potential mediating factors by which micronutrient status contributes to cognitive impairment and central nervous system abnormalities in the elderly. NAME targets homebound elders because they are understudied and particularly at risk for poor nutritional status. Methods Subjects are community-based elders aged 60 and older, recruited through area Aging Services Access Points. The NAME core data include demographics; neuropsychological testing and activities of daily living measures; food frequency, health and behavioral questionnaires; anthropometrics; gene status; plasma micronutrients, homocysteine, and other blood determinants. A neurological examination, psychiatric examination, and brain MRI and volumetric measurements are obtained from a sub-sample. Results Preliminary data from first 300 subjects are reported. These data show that the NAME protocol is feasible and that the enrolled subjects are racially diverse, at-risk, and had similar basic demographics to the population from which they were drawn. Conclusion The goal of the NAME study is to evaluate novel relationships between nutritional factors and cognitive impairment. These data may provide important information on potential new therapeutic strategies and supplementation standards for the elderly to maintain cognitive function and potentially reduce the public health costs of dementia. Copyright © 2006 John Wiley & Sons, Ltd. [source] Quality of life in Chinese elderly people with depressionINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 4 2006Sally W. C. Chan Abstract Background Depression is the most prevalent functional mental disorder of later life. It is estimated that about 5% of the elderly population of Hong Kong are suffering from depression. Aim To investigate the self-rated quality of life of community-dwelling elderly people diagnosed with depression, and to examine the relationships between quality of life and mental, physical health, functional status and social support. Methods and results A cross-sectional descriptive survey was conducted in psychiatric outpatient clinics. A convenience sample of 80 Chinese elderly people with a diagnosis of depressive disorder was recruited. Perception of quality of life was measured by the Hong Kong Chinese World Health Organization Quality of Life Scale,Brief Version. Participants' mental status, functional abilities, physical health condition, and social support status were assessed. Sixty-one (76.3%) participants were female. They were least satisfied with ,meaningfulness of life', ,life enjoyment', ,concentration and thinking', ,energy' and ,work capacity'. Functional abilities had a positive association with participants' perceived quality of life, level of depression and number of physical health conditions had a negative association. Participants had low ratings of quality of life when compared with healthy persons and persons with chronic physical problems. Findings are discussed in light of the socio-cultural environment in Hong Kong. Conclusion Comprehensive treatment and better control of depression, including different modes of medical and psychosocial intervention, could help to improve participants' perception of quality of life. A longitudinal study with a larger sample with various levels of depression and socio-demographic characteristics is recommended. Copyright © 2006 John Wiley & Sons, Ltd. [source] Life-time history of suicide attempts and coronary artery disease in a community-dwelling elderly populationINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 2 2006S. Artero Abstract Background Numerous studies have observed a strong relationship between coronary artery disease (CAD) and psychiatric disorder; notably depression, anxiety and panic attacks. No study has, however, explored the question of whether persons suffering from CAD might also be at high risk of suicide attempts. Objective The aim of the present study is to examine the relationship between CAD within a general population cohort and life-time history of psychiatric disorder and suicidal behaviour. Method A representative sample of 1843 non-institutionalized persons over 65, drawn at random from the electoral roll, was given a standardized neurological and psychiatric examination based on DSM-IV criteria. The clinical examination also included an electrocardiogram (ECG) and a questionnaire relating to life-time medical history. Cardiac events were validated by the general practitioner. Results Within this general population sample the prevalence of suicide attempts was 3.9%. A significant positive association was observed between life-time prevalence of CAD and suicide attempts (p,<,0.04). Suicide attempts were associated with major depression (p,<,0.001) co-morbid anxiety and depression (p,<,0.001) but not anxiety alone (p,=,0.16). A logistic regression analysis showed that the relationship between suicide attempts and CAD persists after adjustment for depression and anxiety. Conclusion CAD is associated with suicidal behaviour independently of depression, however, longitudinal studies are required to clarify the direction of causality and to integrate genetic, biological, environmental and psychological factors into an aetiological model. Copyright © 2006 John Wiley & Sons, Ltd. [source] Review of assessment and treatment of PTSD among elderly American armed forces veteransINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 12 2005Gina P. Owens Abstract Background The number of elderly combat veterans is steadily increasing in the US and estimates project that a notable percentage of these veterans experience symptoms of posttraumatic stress disorder (PTSD). Limited data exist specifically related to prevalence, assessment, and treatment of PTSD among the elderly veteran population. Objective This review summarizes the available research related to difficulties in assessment with the elderly American Armed Forces veteran population. In addition, both psychotherapeutic and pharmacological treatment interventions for PTSD are discussed. Methods A literature search was conducted using PsycINFO, Medline, and the National Center for PTSD's PILOTS database. Results Evidence suggests that elderly veterans generally present more somatic symptoms of PTSD. Medical and psychological comorbodities, such as depression, substance abuse, or cognitive deficits can further complicate the assessment process. Cut-scores for existing instruments need to be further established with elderly veterans. Use of exposure therapies with the elderly has not been adequately researched and mixed results have been obtained for supportive therapy for treatment of PTSD. Controlled research investigating pharmacological interventions for PTSD with the elderly is also limited. Conclusion Evidence suggests that some psychotherapeutic and pharmacological interventions already utilized with younger individuals may be useful with the elderly veteran population. However, research indicates that modifications may be required for working with the elderly population and further research in the areas of assessment and treatment are necessary. Copyright © 2005 John Wiley & Sons, Ltd. [source] Prevalence and patterns of executive impairment in community dwelling Mexican Americans: results from the Hispanic EPESE StudyINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 10 2004Donald R. Royall Abstract Introduction Little is known about the prevalence of impaired executive control function (ECF) in community dwelling elderly or minority populations. We have determined the prevalence of cognitive impairment and impaired ECF in a community dwelling Mexican American elderly population, and their associations with functional status. Subjects Subjects were 1165 Mexican Americans age 65 and over who were administered CLOX as part of the third wave of the Hispanic Established Population for Epidemiological Study (HEPESE) conducted from 1998 to 1999. Methods ECF was measured by an executive clock-drawing task (CDT) (i.e. CLOX1). Non-executive cognitive function was assessed by the Mini-Mental State Examination (MMSE) and a non-executive CDT (CLOX2). CLOX scores were combined to estimate the prevalence of global CLOX failure (i.e. ,Type 1' cognitive impairment) vs isolated CLOX1 failure (i.e. Type 2 cognitive impairment). Results 59.3% of subjects failed CLOX1. 31.1% failed both CLOX1 and CLOX2 (Type 1 cognitive impairment). 33.3% failed CLOX1 only (Type 2 cognitive impairment). 35.6% passed both measures [no cognitive impairment (NCI)]. Many subjects with CLOX1 impairment at Wave 3 had normal MMSE scores. This was more likely to occur in the context of Type 2 cognitive impairment. Both CLOX defined cognitive impairment groups were associated with functional impairment. Conclusions A large percentage of community dwelling Mexican American elderly suffer cognitive impairment that can be demonstrated through a CDT. Isolated executive impairments appear to be most common. The ability of a CDT to demonstrate ECF impairments potentially offers a rapid, culturally unbiased and cost-effective means of assessing this domain. In contrast, the MMSE is relatively insensitive to ECF assessed by CLOX1. Copyright © 2004 John Wiley & Sons, Ltd. [source] Presentations and management of Post Traumatic Stress Disorder and the elderly: a need for investigationINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 5 2004Walter Busuttil Abstract Background With an aging population increasing presentations of cases of Post Traumatic Stress Disorder (PTSD) can be expected to old age services. While progress has been made in recent years in relation to the understanding and development of aetiological theories, classification, assessment and management strategies and protocols in the adult population, similar advances have lagged behind for the elderly. Aims To review the adult literature regarding PTSD and discuss how this might apply to an elderly population. An attempt is made to highlight a better awareness of the field of psychological trauma in the elderly in the hope of stimulating debate and research. Method A review of the adult literature is conducted relating to classification, aetiology, demographic features, vulnerability, assessment, clinical management including psychotherapy and medications and how these may apply to the elderly. Results Little has been published in this field that directly relates to the elderly. The adult literature allows insight into understanding how PTSD may present in the elderly, and how they may be managed. Conclusions Further specific research is needed in the elderly in order to facilitate a better understanding of PTSD that present in this unique population. This will lead to better clinical assessment, management and treatment provision. Copyright © 2004 John Wiley & Sons, Ltd. [source] Nursing home suicides,a psychological autopsy studyINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 12 2003Kirsi Suominen Abstract Objective Older adults comprise a fifth of all suicides. Elders are the fastest growing part of the population, thus the number of persons needing nursing home care will increase dramatically in the near future. Little information has been available about suicides in nursing homes. The present study described all suicides among older adults in nursing homes in Finland during a 12-month period emphasizing the factors that have been found to be associated with suicide in the general elderly population. Methods Drawing on data from a psychological autopsy study of all suicides (n=1397) in Finland during one year, all suicides committed by patients in nursing homes were identified. Retrospective DSM-IV consensus diagnoses were assigned. Results Twelve elderly (aged 60 years or more) nursing home residents who died by suicide, 0.9% of all suicides, were identified. The primary finding of the present study was that nursing home residents who died by suicide had suffered from highly comorbid somatopsychiatric disorders. One or more diagnoses on Axis I were made for all who died by suicide in nursing home. Depressive syndrome was diagnosed in three-quarters of subjects. Only a third of these were identified to have suffered from depressive symptoms before their death. Conclusions Early recognition and adequate treatment of both somatic diseases and mental disorders, particularly depression, as well as early recognition of suicide risk among nursing home residents, are needed in order to prevent suicide. Copyright © 2003 John Wiley & Sons, Ltd. [source] A prevalence study of suicide ideation among older adults in Hong Kong SARINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 11 2003Paul S. F. Yip Abstract Objective The objective of this paper is to ascertain estimates of the prevalence, and associated risk factors for, suicidal ideation among community-dwelling older adults in Hong Kong. Method The study was conducted as part of the General Household Survey (GHS), using face to face interviews of ethnic Chinese people aged 60 or above living in the community. Elders living in institutions or elderly homes were excluded from the study. Results Six percent of the sample was found to have ever had suicide ideation. The results showed that poor physical health, including poor vision, hearing problems, and a greater number of diseases; and poor mental health, especially in the form of depression, are predictors of suicidal ideation in the elderly population. Also, statistical analysis by linking individual factors to depression showed that financial and relationship problems are significant risk factors as well. Older adults who engaged in active coping, that is, those who actively seek to manage or control the negative events in their lives, fare better with lower levels of suicidal ideation than those who use passive coping styles. Conclusions The prevalence of suicidal ideation is similar among elders in Hong Kong and western countries. Factors that contribute to risk for suicidal ideation span physical and mental health, social, and psychological domains. Although the association of suicidal ideation to self-destructive acts remains to be determined, these findings indicate a variety of potential foci for late life suicide prevention efforts. Copyright © 2003 John Wiley & Sons, Ltd. [source] | |||||||||||||||||||||||||||||||||||||||||||