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Background: Lumbar spinal stenosis (LSS) is prevalent among octogenarians, causing significant pain and disability. Surgical intervention is often required because of the ineffectiveness of conservative treatments. This study investigates the efficacy and safety of biportal endoscopic decompressive laminectomy (BED) in octogenarians with severe LSS, evaluating its potential as a minimally invasive surgical option. Methods: This retrospective study included 107 patients aged 80 years or older who underwent BED for LSS between March 2017 and December 2022. Data were collected from electronic medical records, including demographic information, clinical outcomes, and surgical details. Patients with fractures, infectious spondylitis, herniated discs, and follow-up less than 12 months were excluded. Clinical outcomes were assessed using the visual analog scale, Oswestry Disability Index, European Quality of Life-5 Dimensions, and painDETECT at baseline and at 3, 6, and 12 months after surgery. Results: The mean age of the 107 patients was 84.1 years, with 59% being women. Significant improvements were observed in visual analog scale scores for lower back and lower extremities pain, Oswestry Disability Index, European Quality of Life-5 Dimensions, and painDETECT scores, indicating reduced pain, decreased disability, and enhanced quality of life. There were no significant differences in outcomes between patients aged 80 to 84 and those 85 or older. Surgery-related outcomes such as operation time, blood loss, and complications were similar in both age groups. Conclusions: BED is a safe and effective treatment for LSS in octogenarians, providing significant pain relief and functional improvement. This minimally invasive technique is also viable for patients older than 85 years, without increased risk of complications, supporting its broader indications in managing LSS in the elderly. Clinical Relevance: This study highlights the efficacy and safety of BED for LSS in octogenarians, demonstrating its potential to improve quality of life and function with low risks, making it a feasible option for elderly patients. Level of Evidence: 4. [ABSTRACT FROM AUTHOR]

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Background and Purpose: Assessing appendicular skeletal muscle (ASM) mass is crucial for the diagnosis of numerous pathologies related to the decline of muscle mass in old age, such as sarcopenia, malnutrition, or cachexia. The dual-energy X-ray absorptiometer (DEXA) radiological technique, which is the gold standard for its assessment, is particularly costly and not routinely used in clinical practice. The aim of this study was to derive computationally simple equations capable of estimating the DEXA-measured ASM at zero cost in older adult populations. Methods: We used the cross-sectional data collected by the National Health and Nutrition Examination Survey (NHANES) over 7 years (1999-2006). The study sample included 16,477 individuals aged 18 years and over, of which 4401 were over 60 years old. We considered 38 nonlaboratory variables. For the derivation of the equations, we employed the Brain Project, an innovative artificial intelligence tool that combines genetic programming and neural networks. The approach searches simultaneously for the mathematical expression and the variables to use in the equation. The derived equations are useful to estimate the DEXA-measured ASM. Results and Discussion: A simple equation that includes the body weight of the patient as the sole variable can estimate the outcome of DEXA with an accuracy equivalent to previously published equations. When used to identify individuals over 60 years old with muscle mass loss, it achieved an area under the curve (AUC) value of 0.85 for both males and females. The inclusion of sex and anthropometric data (thigh and arm circumference) improved the accuracy for male individuals (AUC 0.89). The model is also suitable to be applied to the general adult population of 18 years of age or older. Using more than 3 variables does not lead to better accuracy. Conclusions: The newly proposed equations have better diagnostic accuracy than previous equations for the estimation of DEXA-measured ASM. They are readily applicable in clinical practice for the screening of muscle mass loss in the over 60-year-old population with nearly zero-cost variables. The most complex model proposed in this study requires only the inspection of a simple diagnostic chart to estimate the status of muscle mass loss. [ABSTRACT FROM AUTHOR]

Background and Purpose: Stair negotiation is crucial for functional independence and is a leading cause of fall-related injuries in older adults. The Step Test Evaluation of Performance on Stairs (STEPS) is a quick and easily administered outcome measure for assessing stair negotiation. This study investigated the reliability and concurrent content validity of the STEPS test to determine its usefulness in older adults. Methods: Eighty-two community-dwelling older adults (mean age 81.2 years, 51 females) were assessed on the STEPS test, Timed Up and Go (TUG), 5-times sit to stand (5XSTS), stair self-efficacy (SSE) questionnaire, and time to ascend and descend stairs. Participants repeated the STEPS test 7 to 14 days later for intrarater reliability by the same rater. Spearman rank and intraclass correlations were used to determine the association of measures and intrarater reliability. Results and Discussion: The mean STEPS score was 15.6 (SD = 3.7) out of 20. The STEPS total score demonstrated excellent intra- and interrater reliability. It had moderate to good and significant correlations with TUG, 5XSTS, SSE, and time to ascend and descend measures. Faster performance on the 5XSTS, TUG, and time to ascend and descend correlated with better performance on the STEPS test, indicating validity for assessing balance and mobility during stair negotiation in older adults. Lower SSE correlated with lower observer ratings of performance on stairs (STEPS scores), indicating agreement between participant reports of self-efficacy and observer ratings of performance. Step Test Evaluation of Performance on Stairs items that demonstrated the most frequent loss of points were balance (use of handrail), step continuity, foot placement, and self-propulsion (ascent only). Conclusions: Assessment of older adults' safety and performance on stairs is vital given the increased difficulty of stair navigation and the high risk for injurious falls in this population. This study demonstrates that the STEPS test is a reliable and valid outcome measure for assessing stair performance in older adults. [ABSTRACT FROM AUTHOR]

Background and Purpose: Gait speed is a robust measure that offers many advantages clinically. However, decisions concerning its utilization exist, including whether to assess usual or fast gait speed. The current study aimed to identify whether usual or fast gait speed was more strongly associated with physical performance measures and balance confidence. A secondary aim was to explore these relationships within subgroups based on fall risk status. Methods: This was an observational study with a cross-sectional design involving 57 community-dwelling older adults (77.2% female; mean age = 68.8, SD = 6.5 years, range = 60-87 years) who were assessed on the following variables: usual and fast gait speed, knee extension strength, step execution time, 6-minute walk test (6MWT), and Activities-specific Balance Confidence Scale (ABC-6). Spearman ρ correlations were computed to determine bivariate associations of usual and fast gait speed with physical performance measures and balance confidence for the whole sample and within subgroups based on fall risk [lower fall risk (n = 28) vs higher fall risk (n = 29)]. Multiple linear regression models were estimated with either usual or fast gait speed as key predictors of knee extension strength, step execution time, 6MWT, and ABC-6. Results and Discussion: Stronger correlations were observed for fast gait speed compared with usual gait speed with all physical performance measures and balance confidence for the entire sample and within the higher fall risk group. Multiple regression results indicated that models with fast rather than usual gait speed as the key predictor explained more of the variance in 6MWT (R² = 64.5% vs 45.6%), ABC-6 (R² = 28.5% vs 25.4%), step execution time (R² = 24.9% vs 19.0%), and knee extension strength (R² = 15.7% vs 7.2%). Conclusions: Fast gait speed showed stronger associations and better predictive capabilities compared with usual gait speed with physical performance measures and balance confidence in older adults. Despite being measured less often than usual gait speed, fast gait speed assessment warrants additional consideration. [ABSTRACT FROM AUTHOR]

Background and Purpose: Walking speed (WS) is an easily assessable and interpretable functional outcome measure with great utility for the physical therapist providing care to older adults. Since WS was proposed as the sixth vital sign, research into its interpretation and use has flourished. The purpose of this scoping review is to identify the current prognostic value of WS for the older adult. Methods: A scoping review was conducted using PubMed, CINAHL, and SPORTDiscus to find relevant articles highlighting the predictive capabilities of WS for older adults. Titles and abstracts were reviewed to identify relevant articles. Articles were excluded based on the following criteria: sample included both younger and older adults without separate analyses, sample was focused on a particular disease, if the study was published before 2017, or if the study did not report relevant cut points for interpretation of WS. The search returned 1064 results. Following removal of articles not meeting inclusion criteria and critical appraisal, relevant cut points were extracted from 47 original research publications. Results and Discussion: A preliminary review of the included articles showed that WS is a valuable prognostic tool across many health domains, including mental health, mortality, disability, pain, bone and joint health, falls, cognition, physical activity, metabolic health, risk for cardiovascular disease, socialization, and metabolic health. The fastest WS of 1.32 meters per second (m/s) served as a cutoff for decreased risk for incident development of type 2 diabetes, while the slowest WS of less than 0.2 m/s was associated with increased duration of hospitalization. Multiple studies reported on the prognostic value of WS slower than 1.0 m/s. Conclusion: Although the reported range of predictive WS values was broad, multiple studies found WS of approximately 1.0 m/s to be a useful marker for delineating risk or decline across a variety of health domains. Clinicians may find it useful to use a WS slower than 1.0 m/s as a "yellow flag" to guide evaluation and intervention for their older adult clients. [ABSTRACT FROM AUTHOR]

Background: Assistive devices (ADs) for ambulation are commonly provided to improve safety and independence in older adults. Despite the common use of these devices, there are no standard prescribing guidelines, and non-health care providers, including caregivers and family members, often make decisions about the need for ADs. Identifying factors or a single screening test associated with AD use would benefit clinicians and non-health care caregivers in making decisions to adopt an AD for patients, clients, and family members. Purpose/Objectives: The purpose of this cross-sectional study was to identify the test that best predicts ADs for ambulation and non-AD use among community-dwelling individuals. Methods: Eighty-five older adults (81.6 ± 8.2 years old) who underwent outpatient physical therapy participated in this study. They participated in a series of tests, including the Timed Up and Go, handgrip and quadriceps strength, the 30-second chair-rise test, the 5-m fast gait speed, the Functional Independence Measure, the locomotive syndrome tests (stand-up test, 2-step test [2ST], and the Locomo-5 Checklist), and numeric pain scales. Mann-Whitney U tests were used to identify differences between those who did and did not use an AD for ambulation. Logistic regression analyses were used to examine which test best predicted AD use. Results: 80% of participants (n = 68) used an AD for ambulation. There were significant differences in all test variables between users and nonusers (P = .033 to P < .001), except for quadriceps strength, age, and pain (all P > .05). Only the 2ST was a significant predictor of AD use, with a cutoff distance of the toe-to-toe stride shorter than 93% of body height (sensitivity: 72%, and specificity: 82%, P = .048). Discussion: Simple functional measures differed between those who did and did not use ADs for ambulation; however, only the 2ST predicted AD status. Individuals who cannot step 93% of their body height may be appropriate for an AD. Conclusions: If comprehensive clinical evaluations are not available to make decisions about AD use, the 2ST can be used to make clinical recommendations for an AD for ambulation. [ABSTRACT FROM AUTHOR]

The impact of ageing on the body and its association with skin harm and frailty in relation to multimorbidity, comorbidity and polypharmacy is clearly described in the literature. The ageing population globally brings with it the challenge for healthcare professionals of managing individuals with increasingly complex and inter-related needs. This article considers ageing skin and skin tears within the context of frailty as a syndrome. It discusses what frailty is understood to be, how to recognise and assess for it, and how to consider risk and prevention of harm to the skin of the ageing person with frailty. [ABSTRACT FROM AUTHOR]

Background: Supervised group exercise may have greater health benefits than no exercise or exercise alone. Purpose: The purpose of this systematic review and meta-analysis was to investigate the effectiveness of supervised group-based exercise on the risk of falls among community-dwelling older adults compared to no exercise or exercise alone. Methods: Four databases were searched up to March 1, 2024 for eligible randomized controlled trials. Results: Seventeen randomized controlled trials were eligible for this meta-analysis. Meta-analyses showed that compared with no exercise, supervised group-based exercise had a significant effect on preventing falls, injurious falls, and fall-related fractures. Compared with exercise alone, supervised group-based exercise significantly reduced falls and injurious falls. Conclusions: Moderate-quality evidence suggests that compared with no exercise or exercise alone, supervised group-based exercise is more effective at preventing falls among community-dwelling older adults. [ABSTRACT FROM AUTHOR]

Background: Adherence to antihypertension medications has been explored in previous studies; however, these studies generally focus on individuals who reside in urban areas. Improved understanding is needed regarding rural older adults who are self-managing medications for hypertension and the motivational factors that may influence adherence. Objectives: The purpose of this study was to examine medication adherence among rural older adults with hypertension and the association with motivational factors as defined in self-determination theory, including quality of motivation (autonomous vs controlled), perceived competence, perceived autonomy support, and basic psychological needs satisfaction. Rural nursing theory was also used to explore the concept of resilience. Methods: This cross-sectional study involved 80 older adults (≥65 years old) self-managing at least 1 prescribed medication for managing their hypertension. Participants ranged in age from 65 to 89 (mean [SD], 74.04 [6.18]) years from rural areas in the northwest. Participants completed a demographic questionnaire, a measure of medication adherence, and questionnaires to assess perceived autonomy support, basic needs satisfaction, autonomous and controlled motivation, perceived competence, and resilience. Results: Correlational analysis and multiple regression were used to examine associations and predict adherence. Perceived autonomy support, resilience, cost of medication, and medication regimen complexity were the only variables significantly associated with medication adherence and predicted adherence. Resilience mediated the relationship between perceived autonomy support and medication adherence. Conclusions: Overall, findings indicate high levels of adherence. Interventions that enhance perceptions of autonomy support and resilience may be useful in managing hypertension. [ABSTRACT FROM AUTHOR]

The main goal of this study was to investigate the influence of patient age on humeral implant fixation in stemless reverse shoulder arthroplasty (RSA). The secondary goals were to investigate the influence on the occurrence of complications and on clinical outcomes. We performed a retrospective multicenter study, including a series of patients operated on for stemless RSA. All patients were reviewed at a minimum of 2 years, with clinical and radiographic evaluation. The primary endpoint was the occurrence of migration of the humeral implant at the final follow-up. Secondary endpoints were clinical scores, occurrence of postoperative complications, need for revision surgery, and radiographic changes. Each patient ≥70 year old was matched on gender and body mass index,with a patient < 70 year old on a 1:1 basis. Forty-five patients aged ≥70 years were included and matched, with 45 patients aged <70 years, giving a total of 90 patients (54.4% men) with the mean age being 68.5 ± 7.9 years. There was no difference between the 2 groups in terms of surgical modalities. There was no correlation between age and clinical outcomes. Three migrations of the humeral implant occurred, none leading to a revision, without any influence of age (P = 1.0). We found no correlation between patient age and the occurrence of a postoperative complication (P = 1.0), reoperation (P = 1.0) or any of the other radiographic parameters assessed. This study reported the stability of stemless RSA implants in elderly patients. Clinical outcomes, complication, and revision rates were not affected by age either. [ABSTRACT FROM AUTHOR]

Reverse shoulder arthroplasty (RSA) has extended its indications in recent years to include complex proximal humerus fractures (PHFs) in elderly patients. The traditional approach in cases of PHF has been to cement the stem but, as in orthopedic surgery, the current trend in PHF is to avoid cementing the humeral stem as well. We evaluated 63 patients (representing 63 shoulders) who underwent RSA with uncemented stem after acute fracture of the proximal humerus. We analyzed the clinical and radiological outcomes, as well as medium-term complications, using two different prosthesis models. The mean postoperative follow-up period was 21-23 months, and the mean age of the patients was 74.5 years. The average Constant Score was 56.94 points; there were no statistical significant differences in Constant Score depending on the prosthesis model used. No cases of aseptic loosening were observed. However, there was evidence of stress-shielding in prostheses with diaphyseal fixation, although this phenomenon did not appear to have functional or clinical consequences for the patients. Intraoperative complications occurred in 6.35% of cases, and postoperative complications were noted in 4.92%. Based on the results of this study, we can affirm that the use of RSA with cementless stems in PHF can be a safe alternative, providing satisfactory clinical, functional, and radiographic results in the short term without the need to use cement in their fixation. The choice of prosthesis model may influence the occurrence of radiographic phenomena but does not seem to affect clinical outcome. [ABSTRACT FROM AUTHOR]

Anatomic total shoulder arthroplasty (aTSA) and reverse total shoulder arthroplasty (rTSA) are proven surgical treatment options for both traumatic and degenerative conditions of the shoulder. Our objective is to report both clinical and patient-reported outcomes (PROs) of patients over the age of 75 at the time of arthroplasty. We hypothesize no functional difference in outcomes between patient groups. Patients over the age of 75 at the time of surgery who received primary aTSA or rTSA between 2009 and 2020 with a minimum of two-year follow-up were selected. A retrospective chart review was performed. Patients 60-75 were included as a control group. 2:1 propensity matching using sex, Charlson Comorbidity Index, preoperative forward elevation (FE), and external rotation (ER) was used in selecting a comparison cohort of patients 60-75. Statistical analysis included the t -test, Wilcoxon signed-rank test, and chi-squared test. For aTSA, 25 patients older than 75 years fit the inclusion criteria. The mean follow-up time was 4.2 (2.0-12.0) years. aTSA patients over the age of 75 had significant improvements in FE 111 to 141 degrees (P =.007), ER 28 to 44 degrees (P <.001), and internal rotation (IR) sacrum to L4 (P =.003). There were also improvements in FE strength (FES) 4+/5 to 5/5 (P =.0303) and IR strength (IRS) but not ER strength (ERS) from 4+/5 to 5/5 (P =.098). There was no significant difference in range of motion (ROM), strength, or PROs between age groups (>75 years vs. 60-74 years). For rTSA, 47 patients older than 75 years fit the inclusion criteria. Average clinical follow-up was 3.5 (2.0-10.6) years. Patients demonstrated ROM improvements in ER (31 to 40 degrees, P =.0413), FE (96 to 138 degrees, P <.001) but not IR (L5 to L4, P =.3509). There were significant improvements in postoperative strength in FES (4-/5 to 4+/5, P <.001), ERS (4-/5 to 4+/5, P <.001), and IRS (4/5 to 5/5, P <.001). The only significant difference between propensity-matched age groups was postoperative IR (L4 to L5, P =.013). There were no significant differences in PROs between different age groups. aTSA and rTSA provide significant improvements in ER, FE, ROM, ERS, FES, and IRS in patients over the age of 75 with no significant difference in outcomes compared to a younger cohort. [ABSTRACT FROM AUTHOR]

To explore paramedics' experiences and perspectives about attending and managing older adults who had fallen. This qualitative, exploratory study used a purposive sample of paramedics in Western Australia. Participants had at least one year of clinical experience. Semi-structured interviews were undertaken. Data were analysed via an inductive thematic approach. Fourteen paramedics were interviewed (Median age: 38 years, n = 5 females). The main theme identified that experiences were positive when attending patients with high-acuity medical problems or injuries following falls because binary decision-making (transport vs non-transport) was appropriate. Themes highlighted that decision-making for low-acuity falls attendances was a complex balance between 1) patient context, 2) risk management, 3) paramedic reactions, and 4) the lack of alternate referral pathways available. Experiences could be stressful and frustrating when attending falls call-outs for older adults with no injuries or medical problems. Participants concurred that when transport to hospital was not required there were no available, alternative pathways to refer onwards for appropriate health or social care. Attending low-acuity call-outs for falls was often frustrating and required complex decision-making, with gaps in services identified. Further exploration of alternative referral pathways for health care for pre-hospital management of adults who fall is required. [ABSTRACT FROM AUTHOR]

Registered nurses report the experience of delivering end of life care in emergency departments as challenging. The study aim was to understand what it is like to be a registered nurse providing end of life care to an older person in the emergency department. A hermeneutic phenomenological study was conducted in 2021, using semi-structured interviews with seven registered nurses across two hospital emergency departments in Queensland, Australia. Thematic analysis of participants' narratives was undertaken. Seven registered nurses were interviewed; six of whom were women. Participant's experience working in the emergency department setting ranged from 2.5–20 years. Two themes were developed through analysis: (i) Presenting the patient as a dying person; and (ii) Mentalising death in the context of the emergency department. Nurses providing end of life care in the emergency department draw upon their personal and aesthetic knowing to present the dying patient as a person. The way death is mentalised suggests the need to develop empirical knowing about ageing and supportive medical care and ethical knowing to assist with the transition from resuscitation to end of life care. Shared clinical reflection on death in the emergency department, facilitated by experts in ageing and end of life care is recommended. [ABSTRACT FROM AUTHOR]

The article examines the safety of reduced-dose edoxaban in elderly patients with atrial fibrillation, highlighting that the lower dose significantly reduces major bleeding without increasing stroke risk compared to both the higher dose and warfarin. Topics include the effectiveness of reduced-dose edoxaban for patients aged 80 and older, its impact on bleeding and stroke rates, and the implications for patients undergoing transcutaneous aortic valve replacement.

Objective: The incidence of sepsis in older adults has been increasing with the general aging of the Japanese population. However, it has been shown that age is a critical factor in determining both the risk for sepsis and subsequent vital outcomes; aggressive treatment is often discouraged in this vulnerable patient group. This study aimed to determine whether aggressive therapeutic interventions were associated with mortality in older Japanese patients experiencing septic shock. Design: Single-center retrospective cohort study. Setting: Medical Intensive Care Unit of a city hospital (Kishiwada Tokushukai Hospital) in Japan between January 2020 and September 2021. Patients: Patients diagnosed with septic shock at the time of admission and older patients over 65 years of age were included and divided into two groups: a withholding group that received only minimal peripheral infusion and antibiotic therapy and a treatment group (non-withholding group) that received intensive care, such as vas- opressor use or mechanical ventilator management. Interventions: None. Measurements and results: One hundred patients were included in this study. There were 13 and 87 patients in the withholding and non-withholding groups, respectively. There was no significant difference in 30-day mortality between the two groups (53.85% vs 39.08%, p=0.127). However, the 72-hour mortality was significantly higher in the withholding group (53.8% vs 25.3%, p=0.034). Conclusions: Among older patients with septic shock, the withholding group showed a survival rate that was not significantly different from that of the non-withholding group. On the other hand, some level of survival may be expected in patients who withhold treatment after 72 hours or more. Further studies are needed to determine the impact of withholding treatment on patients, not only in terms of mortality but also in terms of long-term prognosis and activities of daily living after discharge from the hospital. [ABSTRACT FROM AUTHOR]

Introduction: The growing aging population requires the development of new policies and programs to meet the needs and expectations of the elderly. Identifying priorities for the elderly's quality of life can be the foundation for rehabilitation services provided to the elderly. This study aims to assess the quality of life priorities in the elderly using the Turkish-adapted Mayers' Lifestyle Questionnaire (3). Method: The study included 171 elderly with a mean age of 74.72 ± 4.36 years. Participants completed a sociodemographic information form and the Turkish-Adapted Mayers' Lifestyle Questionnaire (3). Results: Quality of life priorities for elderly people were independence in reading and writing, participation in paid and/or voluntary work, spiritual, and satisfying activities, and the ability to make choices about their lives. Conclusion: The study results showed that Mayers' Lifestyle Questionnaire (3) supports setting priorities by examining the quality of life of elderly people from a multidimensional perspective. The use of Mayers' Lifestyle Questionnaire (3) can contribute to the development of effective strategies aimed at improving the quality of life for elderly individuals. A holistic approach to each factor affecting quality of life will enable occupational therapists and other professionals involved with elderly people to consider person-centered factors in their interventions. [ABSTRACT FROM AUTHOR]

Background: Enoxaparin is one of the widely used injectable anticoagulants requiring dose adjustment based on body weight and renal function. Unadjusted or inappropriately adjusted doses can lead to thromboembolic or bleeding events, particularly in patients with advanced age. Objectives: This retrospective chart review study primarily aimed to evaluate enoxaparin use, along with exploring factors associated with inappropriate use and bleeding in the elderly population. Methods: Baseline characteristics, along with bleeding and thrombotic events, of the patients receiving enoxaparin in the fiscal year 2018-2019 at a secondary care hospital were extracted from the electronic medical record. Prescribed enoxaparin regimens were evaluated against the recommended dose in the package insert, pertinent guidelines, and hospital guidance. Univariate and multivariate analyses were performed to explore factors associated with inappropriate use and bleeding. Results: Two hundred and fourteen patients were included. The majority (66.8%) were female, and 39.7% were 80 years or older, with an average age of 74.4 years and a body mass index (BMI) of 24.0 kg/m2. Most patients (82.7%) had a creatinine clearance ≥30 ml/min. Seventy-six initiations (35.5%) were inappropriate, and 83 problems were found. Underdosing was the most common problem (39.8%), followed by undocumented body weight (22.9%), and inconsistent prophylactic dose per hospital guidance (20.5%). BMI ≥25kg/m2 (odds ratio [OR] 2.04 [95% confidence interval [CI] 1.04:3.98]; p=0.04) was the only factor associated with inappropriate use. There were 48 bleedings (22.4%), 21 minor (9.8%), and 27 major (12.6%). Hemoglobin (Hb) <10g/dL was associated with bleedings across all indications (OR 4.25 [95%CI 2.03:8.91]; p<0.01). Conclusions: In the predominately middle-, and oldest-old population, inappropriate use of enoxaparin was common. Those with BMI ≥25kg/m2 and Hb<10g/dL were at increased risk of underdosing and bleedings, respectively; these patients should be closely monitored [ABSTRACT FROM AUTHOR]

Background: Idiopathic normal pressure hydrocephalus (iNPH) is a disease that is clinically characterized by gait disturbance and balance impairment. Our purpose was to evaluate the effects of cerebrospinal fluid tap test procedures on gait, turning and balance parameters in the first 24 hours following the procedure in patients. Methods: Twenty-eight patients with a median age of 78 years participated in the study. All patients underwent assessment of gait characteristics, turning and balance before and after a tap test. Gait characteristics and turning were measured using the G-walk sensor system. Balance-related issues were assessed using three standardized tests in the Biodex Balance System: postural stability and fall risk tests, and the modified clinical test of sensory integration and balance. Results: The patients' mean walking speed increased after the tap test (p < 0.05), but left stride length, right stride length, and cadence did not show statistically significant improvement (p > 0.05). In the balance assessment, significant differences between pre- and post-scores were found on all tests (p < 0.01), except for the eyes-closed firm test (p > 0.05). Regression analyses revealed that baseline walking speed (p < 0.05) was significantly associated with positive tap test response. Conclusion: The cerebrospinal fluid tap test procedure has positive effects onwalking and turning activities, balance, and the risk of falling in older patients with iNPH in the first 24 hours following the procedure. Slow walking speed may predict positive tap test response. For patients unsuitable for shunt surgery, a tap testmay be an effectivemethod to reduce the risk of falls and improve factors thatmay cause falls. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the performance of the pneumonia severity index (PSI), acute physiology and chronic health evaluation II (APACHE II), and simplified acute physiology score III (SAPS III) in predicting mortality in patients with community-acquired pneumonia (CAP) who underwent invasive mechanical ventilation (IMV) in the emergency intensive care unit (EICU). Methods: A retrospective study was performed using the clinical data of older patients with CAP (who underwent IMV in the EICU), analyzed using APACHE II, SAPS III, and PSI. Logistic regression was used to analyze independent risk factors for mortality in these patients. The predictive values of APACHE II, SAPS III, and PSI for mortality were evaluated by the receiver operating characteristic (ROC) curves. Results: In total, 101 patients were enrolled. The logistic regression analysis showed that APACHE II was an independent risk factor for mortality in the older patients with CAP who underwent IMV (OR = 1.42, 95% confidence intervals (CI): 1.23-1.63, p < 0.001). The areas under the ROC curve (AUROC) corresponding to PSI, APACHE II, and SAPS III were 0.733, 0.837, and 0.700, respectively, and the AUROC of APACHE II was significantly higher than those of PSI and SAPS III (p < 0.05). The maximum Youden index of APACHE IIwas 0.548, and the corresponding scorewas 18.5. The sensitivity and specificity of APACHE II in predicting mortality were 88.1% and 66.7%, respectively. Conclusion: Compared to PSI and SAPS III, APACHE II had an optimal effect on predicting mortality in older patients with CAP who underwent IMV. [ABSTRACT FROM AUTHOR]

Background: Depopulated and aging areas in Japan, the proportion of older people who die at home tends to be lower than the national average. We investigated the trend regarding their preference for dying at home and associated factors among older residents living in a village. Methods: We conducted a questionnaire-based cross-sectional study in February and June 2020, targeting residents of Mitsuse Village aged ≥ 65 years. We compared two groups for each factor, residents who preferred to die at home (Group H) and the remainder (Group O). Results: In total, 223 (62%) residents responded to the survey. Participants' median age was 77 years, and 44% were men. Group H accounted for 47% of the total. Univariate analysis showed that Group H was older (p = 0.010) and included a smaller proportion who used a private vehicle (p = 0.036), compared with Group O. Multivariate analysis showed that male sex and not having a primary care physician were associated with a preference for dying at home (p = 0.031 and p = 0.041). Availability of transportation, social isolation, family economic status, or knowledge of long-term care were not independent associations with a preference for dying at home. Conclusions: To fulfill the wishes of older people who prefer to die at home in depopulated areas of Japan, establishing better home medical, nursing, or long-term care systems with improved human and financial resources is essential. Further research on how to support individuals' preference for dying at home is needed. [ABSTRACT FROM AUTHOR]

Background and Purpose: The literature has associated bone mineral density (BMD) and Alzheimer's disease (AD). The aim of the present systematic review was to investigate BMD in older adults with AD compared with older adults with no dementia. Methods: Searches were performed in the MEDLINE, EMBASE, CINAHL, and Web of Science databases from inception to May 2022. Observational studies that compared BMD in the populations of interest were included. Methodical quality (risk of bias) was appraised using the Newcastle-Otta-wa Scale. Quality of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation approach. Standardized mean differences (SMD) were calculated for meta-analyses. Results and Discussion: Five studies were included, involving a total of 1772 older adults (373 with AD and 1399 with no dementia). A first meta-analysis compared 207 older adults with AD and 1243 with no dementia for BMD in the femoral neck. The results showed lower BMD in the AD groups (SMD = -1.52; 95% CI, -2.61 to -0.42; P = .007, low quality of evidence). A second meta-analysis considering different sites of the body (whole body, trunk, femur, and lumbar spine) also showed lower BMD in older adults with AD compared with the group with no dementia (SMD = -0.98; 95% CI, -1.91 to -0.05; P = .04, low quality of evidence). Newcastle-Ottawa Scale scores ranged from 7 to 9, indicating low risk of bias. Conclusions: Bone mineral density is lower in older adults with AD than in older adults with no dementia, especially in the femoral neck. These results suggest that older adults with AD may be at greater risk of developing osteopenia and osteoporosis. Current clinical practice guidelines should be amended for screening frequency and methodology for this particular cohort. Further studies are needed to confirm whether older people with AD have lower BMD in other sites of the body. [ABSTRACT FROM AUTHOR]

Background and Purpose: Falls are the leading reason for Injury-related emergency department (ED) visits for older adults. The Geriatric Acute and Post-acute Fall Prevention Intervention (GAPcare), an in-ED intervention combining a medication therapy management session delivered by a pharmacist and a fall risk assessment and plan by a physical therapist, reduced ED revisits at 6 months among older adults presenting after a fall. Our objective was to evaluate the relationship between measures of function obtained in the ED and clinical outcomes. Methods: This was a secondary analysis of data from GAPcare, a randomized controlled trial conducted from January 2018 to October 2019 at 2 urban academic EDs. Standardized measures of function (Timed Up and Go [TUG] test, Barthel Activity of Daily Living Index [ADL], Activity Measure for Post Acute Care [AM-PAC] 6 clicks) were collected at the ED index visit. We performed a descriptive analysis and hypothesis testing (chi square test and analysis of variance) to assess the relationship of functional measures with outcomes (ED disposition, ED revisits for falls, and place of residence at 6 months). Emergency department disposition status refers to dis- charge location immediately after the ED evaluation is complete (eg, hospital admission, original residence, skilled nursing facility). Results and Discussion: Among 110 participants, 55 were randomized to the GAPcare intervention and 55 received usual care. Of those randomized to the intervention, 46 received physical therapy consultation. Median age was 81 years; participants were predominantly women (67%) and White (94%). Seventy-three (66%) were discharged to their original residence, 14 (13%) were discharged to a skilled nursing facility and 22 (20%) were admitted. There was no difference in ED disposition status by index visit Barthel ADLs (P = .371); however, TUG times were faster (P = .016), and AM-PAC 6 clicks score was higher among participants dis-charged to their original residence (P ≤ .001). Participants with slower TUG times at the index ED visit were more likely to reside in nursing homes by six months (P = .002), while Barthel ADL and AM-PAC 6 clicks did not differ between those residing at home and other settings. Conclusions: Measures of function collected at the index ED visit, such as the AM-PAC 6 clicks and TUG time, may be helpful at predicting clinical outcomes for older adults presenting for a fall. Based on our study findings, we suggest a novel workflow to guide the use of these clinical measures for ED patients with falls. [ABSTRACT FROM AUTHOR]

Background and Purpose: Sarcopenia is a common muscle disease among the older population, posing an increased risk for functional decline and loss of independence in daily living. Early detection of sarcopenia among older people before functional decline would be beneficial in enhancing their quality of life. The Asian Working Group for Sarcopenia (AWGS) 2019 recommends the use of 3 screening methods for community-based sarcopenia detection: calf circumference (CC), or the Strength, Assistance in walking, Rise from a chair, Climb stairs, and Falls (SARC-F) questionnaire, or the SARC-F in combination with CC (SARC-CalF) questionnaire. This study aims to compare the relative performance of these 3 methods as screening tools for sarcopenia within a community-dwelling older population. Methods: A total of 700 community-dwelling older adults participated in the current study. Muscle mass, muscle strength, and physical performance were measured with bioelectrical impedance analysis, handgrip strength, and gait speed, respectively. The AWGS 2019 criteria were considered the criterion standard The sensitivity/specificity, receiver operating characteristic (ROC) curve, and area under the receiver operating characteristic curve (AUROC) analyses were determined for CC, SARC-F, and SARC-CalF to determine their relative diagnostic performance. Results: Sarcopenia was identified in 21.4% of participants according to the AWGS2019 criteria. The overall prevalence of sarcopenia was 56.6%, 14.7%, and 22.9% according to CC, SARC-F, and SARC-CalF, respectively. Calf circumference showed the highest sensitivity but lowest specificity based on AWGS 2019 as the criterion standard regardless of age, gender, and body mass index. The SARC-CalF showed better sensitivity but similar specificity than the SARC-F. The AUROC of CC was significantly better than that of SARC-F and SARC-CalF. The AUROCs of CC, SARC-F, and SARC-CalF were statistically significant in all populations, as well as in the categories of age, gender, and body mass index (P < .05). Conclusions: Calf circumference is useful in ruling out the presence of sarcopenia while the SARC-F is more effec-tive in ruling in sarcopenia, especially in the context of population-based screening. Future studies should be carried out to investigate the value of population-based sarcopenia detection using these screening tools. [ABSTRACT FROM AUTHOR]

Background: Older adult patients with COVID-19 and delirium experience higher rates of adverse outcomes. Early recognition of at-risk patients and implementation of management strategies improve outcomes, though understanding barriers to acute care nurses implementing these strategies is limited. Purpose: This study's purpose was to understand the experiences of acute care nurses providing care to older adults with COVID-19 and delirium. Experiences explored included assessment, nursing management interventions, and barriers to care. Methods: Purposive sampling to recruit nurses for semistructured focus groups was performed, and thematic analysis was generated by 4 members of the research team. Results: Twenty-one nurses participated in focus groups. Thematic analysis revealed themes of increased patient social isolation, barriers to delirium assessment and prevention, increased staff demands, and stressful work environments. Conclusion: Rich findings reveal the profound impact of the pandemic on assessment for delirium and implementation of strategies for prevention and management in older adult patients. [ABSTRACT FROM AUTHOR]

Background: Falls are a frequent occurrence in older adults in long-term care facilities. Local Problem: At our long-term care facility, the percentage of patients who fell increased from 45% in 2021 to 68% in 2022, indicating a need for an evidence-based solution. Methods: We used an evidence-based quality improvement framework to pilot a tai chi exercise program. Interventions: Residents were invited to participate in the Tai Ji Quan: Moving for Better Balance program for 12 weeks. Classes were 30 minutes long and included a 5-minute warm-up and 5-minute cooldown. Results: Seventy-five residents participated in the tai chi program. There was a significant 32.3% reduction in falls (P =.001). Residents' fall risk scores decreased 14% (P <.001). Conclusions: Implementing a tai chi exercise project may affect falls and decrease the overall fall risk. [ABSTRACT FROM AUTHOR]

• This study aims to assess the epidemiological characteristics of social isolation among the elderly, considering the study area, sample size, and assessment tools. • The aim is to provide insights for the early identification and prevention of social isolation development. • A total of 35 articles were included in this study, comprising 30 cross-sectional studies and 5 cohort studies comprising a total sample size of 89,288 cases, with 17,597 involving socially isolated patients. Social isolation has become a global issue among the elderly, posing serious challenges to both social and public health. We assessed the prevalence of elderly social isolation and its related factors. Eight electronic databases were searched up to June 28th, 2023. A meta-analysis of the included literature was performed using Stata 16.0. The results showed that the incidence of social isolation in the elderly was 33 % [95 % CI (0.28, 0.38)]. The subgroup analysis revealed that people over 80, with a sample size under 500, assessed using the Lubben Social Network scale and Social Network Index scale, experienced higher social isolation, especially if they were living alone and lacked higher education. It is suggested to pay attention to the psychological well-being of elderly individuals living alone and lacking a high level of education. Early screening could help reduce the incidence of social isolation, and hence its implications, among the elderly. [ABSTRACT FROM AUTHOR]

This study compared handheld dynamometry (HHD) at the weakest point of the strength curve for hip extensors, hip abductors, and knee extensors in older adults and onerepetition maximum (1RM) of that same muscle groups with cuff weights. Fifty participants (62-94 years) were tested. Paired t tests indicated no significant differences between the 2 measures. Reliability testing for absolute agreement between 1RM and HHD yielded intraclass correlations of good to excellent. This demonstrates HHD at or near the weakest point of a muscle group provides an accurate measure of older individual's 1RM for knee extension, hip extension, and hip abduction. [ABSTRACT FROM AUTHOR]

Introduction: Stroke commonly causes low aerobic fitness and walking speed. Objective: To compare the estimated aerobic fitness of the community and non-community elderly individuals after chronic stroke. Investigate the association between walking speed and aerobic fitness. Methods: Elderly people after stroke classified as community walkers or limited community walkers, according to their walking speed (10-m walk test), in m/s, were assessed with The Human Activity Profile (HAP). The Lifestyle Energy Consumption (LEC) score of the HAP was used to estimate aerobic fitness through the peak oxygen uptake (Vo2peak). Results: Aerobic fitness of elderly individuals after stroke classified as community walkers was on average 17.3 (6.0) mL kg-1 min-1, while for non-community walkers, it was on average 10.2 (5.6) mL kg-1 min-1. There was a significant difference between groups (-7.05, 95% CI -10.98 to -3.12; P < .001). A statistically significant (P < .001) association with moderate magnitude (r = 0.587) was observed between the LEC and the habitual walking speed. Conclusions: Individuals with lower walking speed have lower aerobic fitness. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to examine the effects of frailty, balance, and depression on the performance of activities of daily living (ADL) in older adults. Methods: Eighty-five older adults registered at a community health center in Amasya-Türkiye volunteered to participate in this one-time data collected observational study. All participants were assessed using the Mini Mental State Test (MMST), simple FRAIL scale, Geriatric Depression Scale-Short Form, and Lawton Instrumental Activities of Daily Living (L-IADL) Scale. Results: According to FRAIL scale scores, 38.8% (n = 33) of the participants were evaluated as frail, 37.6% (n = 32) as pre-frail, and 23.5% (n = 20) as normal. There were statistically significant correlations between all parameters analyzed (p < 0.05). According to the regression analysis performed to determine which factors are associated with L-IADL, it was determined that a 1-unit increase in the Berg Balance Scale score was associated with a 0.639-unit increase in the L-IADL score. Mean L-IADL score differed significantly between the frailty groups, with frail participants having a significantly lower mean L-IADL score compared to pre-frail and normal participants (p < 0.05). Conclusions: Our results demonstrated that frailty, balance, and depression are associated with performance of activities of daily living, with balance being the strongest determinant. Frail older adults showed greater dependence in activities of daily living than those who were pre-frail or normal. [ABSTRACT FROM AUTHOR]

Older adults living in a community are looking for alternative and complementary methods to improve their healthy longevity and quality of life. This study aimed to examine the effects of the Qigong therapy on psychological well-being, physical health state, sleep state, and life satisfaction of older adults living in community. This study used a quasi-experimental pretest-posttest control group design. The study samples were 69 older adults (intervention, n = 34; control, n = 35) over 65 years old in community in South Korea. Qigong therapy was performed 50 minutes per session, twice a week for a total of 20 times over a 10-week period in a comfortable and quiet environment without external noise. Measures were the study participant's general characteristics survey, psychological well-being scale, Cornell Medical Index—Korean version, sleep scale, and life satisfaction scale standardized for the elderly. Effects of Qigong therapy according to interaction effect over time and the group showed statistically significant differences in psychological well-being, physical health state, sleep state, and life satisfaction. This study suggests that Qigong therapy was an effective nursing intervention for improving the psychological well-being, physical health state, sleep state, and life satisfaction of older adults living in community. [ABSTRACT FROM AUTHOR]

There are several treatment options available to restore function and appearance in patients with combined mid-facial defects. Owing to the size of the defect and the associated size and weight of the prostheses, adequate retention can be challenging to achieve. Retention of a facial prosthesis can be improved using several techniques, such as medical grade adhesives, attachments, or osseo-integrated implants. For patients with a history of radiotherapy, surgical rehabilitation may be less favourable than non-surgical approaches owing to the risk of osteoradionecrosis and a reduced blood supply in the surgical fields. This clinical case report highlights the conservative rehabilitation of a combined mid-facial defect using a magnet-retained intra-oral and extra-oral prosthesis. CPD/Clinical Relevance: A thorough medical and clinical assessment will highlight factors that will influence the treatment planning process when managing a combined mid-facial defect. [ABSTRACT FROM AUTHOR]

Background: Regular exercise is advised for individuals given a diagnosis of cardiovascular disease. COVID-19 presented challenges to exercise adherence. Objective: The objective of this study was to determine long-term exercise adherence and whether individuals with cardiovascular disease adhered to American Heart Association/American College of Cardiology Foundation guidelines before and during the COVID-19 pandemic. Methods: This is an observational cross-sectional study in which men (73%) and women discharged from a multiwide hospital system after an acute coronary event were enrolled. Participants completed 3 questionnaires, including the Exercise Adherence Rating Scale. Results: Five hundred eighty-two individuals (mean [SD] age, 67 [9.8] years) completed the survey. Fifty-three percent of participants met minimum exercise guidelines during COVID-19. Exercise days per week decreased significantly during COVID-19 in women (P =.013) but not significant for men (P =.301). Categorized by age, the decrease was significant for middle-aged women (P =.002), not older women (P =.336). Men exercised more minutes per session (P =.034), and had greater exercise adherence (P =.003) and greater exercise intensity (P <.001). Overall, women participated less in cardiac rehabilitation (P =.046) and reported the greatest disparity in exercise adherence and intensity. Conclusion: Exercise after an acute event is beneficial, and the percentage of individuals meeting recommended guidelines should be higher considering the relationship between exercise and the possibility of future cardiac events. On the basis of the many physical and mental benefits of maintaining exercise, healthcare practitioners are encouraged to screen all patients for exercise adherence with a major emphasis on educating women and older adults. [ABSTRACT FROM AUTHOR]

Background: Recruiting participants with cardiovascular disease into research during the COVID-19 pandemic was challenging, particularly those at risk of health disparities. Objective: During the pandemic, 12 cohorts of older women with cardiovascular disease were recruited from cardiology clinics into a lifestyle intervention trial to prevent cognitive decline. Objectives were to (a) describe the results of modified recruitment/screening strategies to overcome pandemic-related challenges and (b) evaluate differences in age, race, and ethnicity between patients recruited/randomized, recruited/not randomized (entered recruitment but not randomized because of being ineligible or not interested), and not recruited (clinic patients who met preliminary criteria but did not enter recruitment). Methods: This was a cross-sectional descriptive analysis. In-person study strategies proposed before the COVID-19 pandemic were modified before study onset (September 2020). Women 65 years or older with cardiovascular disease were recruited from cardiology clinics by clinicians, posted flyers, and letters mailed to patients randomly selected from electronic health record data extractions. Patients were classified as recruited/randomized, recruited/not randomized, and not recruited. Results: Of 5719 patients potentially eligible, 1689 patients entered recruitment via referral (49.1%), posted flyers (0.5%), or mailed letters (50.3%), and 253 patients were successfully recruited/randomized. Recruited/randomized participants were, on average, 72.4 years old (range, 65–90 years old), non-Hispanic White (54.2%), non-Hispanic Black (38.3%), Hispanic/Latinx (1.6%), and other/not reported (5.1%). The recruited/randomized group was significantly younger with fewer patients of Hispanic/Latinx ethnicity compared with those not recruited. Conclusions: During the pandemic, all recruitment/screening goals were met using modified strategies. Differences in sociodemographic representation indicate a need for tailored strategies. [ABSTRACT FROM AUTHOR]

The causes and risk factors of vitamin B12 deficiency are many and varied. Importantly, they vary considerably across the lifespan, from infancy to old age. The complexity of the physiology of vitamin B12 bespeaks the myriad of possible causes of deficiency and possible disruptions of its functional integrity. These lead ultimately to the pathobiological effects witnessed in deficiency of this fascinating micronutrient. This brief overview of the multiplicity of mechanisms that can result in vitamin B12 deficiency, and the panoply of its manifestations explores the underlying reasons for the protean presentations of the disease. As the human organism progresses through the chronology and milestones of age, various susceptibility factors arise resulting from the interplay of environmental and genetic factors. Acting independently and in concert, these factors produce the common denominator of vitamin B12 deficiency. However, the rate at which such deficiency develops and the way in which it presents clinically vary widely, subject to such influences as genetic variability, end-organ susceptibility, and concomitant micronutrient status. Some examples of unusual cases of vitamin B12 deficiency are described. Much has been learned about the last of the numbered vitamins in almost a century. Much yet remains to be discovered. [ABSTRACT FROM AUTHOR]

Objectives: This study investigated the impacts of exercise on irisin and fibroblast growth factor 21 (FGF-21) expression, as well as triiodothyronine (T3) and free fatty acid (FFA) levels in elderly women. Methods: Thirty women aged 65 to 70 years (10 per group) were randomly assigned to aquatic exercise, land exercise, and control groups. The aquatic and land groups engaged in 3 exercise sessions per week (60 min/session) for 16 weeks. The intensity was progressively increased every 4 weeks. Results: Irisin and FGF-21 levels significantly increased in the aquatic exercise group. In the posttest, the aquatic exercise group had the highest irisin levels. Significant findings were observed for irisin and FGF-21 for the main effect between aquatic and band exercise groups (p<0.05 for both), the main effect between measurement times (p<0.01 and p<0.001, respectively), and the interaction effect (p<0.05 and p<0.001, respectively). The irisin level was significantly higher in the aquatic than in the land group 30 minutes after the last session (p<0.05). In both exercise groups, T3 levels were significantly higher 30 minutes after the final session (p<0.05) than before the program. The FFA level was significantly higher in the aquatic exercise group than the others. In the aquatic group, FFA levels were significantly higher 30 minutes after both the first (p<0.01) and the last (p<0.001) session compared to pre-program values. Conclusion: Differences in exercise type and environment can promote fat metabolism by stimulating hormonal changes that induce brown fat activity and browning. [ABSTRACT FROM AUTHOR]

Objectives: This study investigated the association between living arrangements and healthrelated quality of life (HRQoL) in older people. Methods: A secondary analysis was conducted of 6,153 participants (aged ≥60 years) from the seventh Korean National Health and Nutrition Examination Survey (2016 to 2018). HRQoL was measured using the 3-level version of the EuroQol 5-dimensional questionnaire. The chi-square test, t-test, and multiple regression were used, applying sampling weights for the analysis. Results: The proportion of respondents living alone was 18.0%, with a higher prevalence among women and older age groups (p <0.001). The overall HRQoL was lower in groups living alone than in groups living with others (p <0.001). Older people living alone showed higher impairments in all dimensions of the 3-level version of the European Quality of Life 5-Dimensional Questionnaire (EQ-5D-3L) than those living with others, including mobility (p <0.001), self-care (p <0.001), usual activities (p <0.001), pain/discomfort (p <0.001), and depression/anxiety (p<0.001). Problems with mobility were most prevalent (42.8%), followed by pain/ discomfort (41.9%) in respondents living alone. Living alone was significantly associated with a lower HRQoL index score (b=-0.048, p<0.001) after adjusting for age, gender, education, exercise, perceived stress, and perceived health status. Conclusion: Living alone was negatively associated with HRQoL. Based on this study, future care planning for older people should consider their living arrangements. The need to strengthen and expand care programs targeting those living alone should also be addressed. [ABSTRACT FROM AUTHOR]

The secular stagnation hypothesis suggests that population aging (65+) places a drag on long-run growth, but this assertion remains a matter of debate. To address this issue, we use a panel of OECD countries for the years 1975–2014 to estimate the relationship between the old-age dependency ratio (population 65+/population 15–64) and secular growth (10- and 20-year intervals). Our empirical evidence clearly shows that the old-age dependency ratio has a negative effect on growth, confirming the demographic implications of the secular stagnation hypothesis. We also propose an overlapping generations model that explains this pattern in the data. Within this framework, optimizing households invest in their children's human capital and save for retirement. We show that an increase in the old-age dependency ratio reduces productivity through a reduction in human and physical capital as more resources are transferred to the elderly. This reduction in productivity results in slower growth and secular stagnation. [ABSTRACT FROM AUTHOR]

Tooth wear is a significant problem in the ageing population and has increased in prevalence over the last century owing to the increase in life expectancy. Further, with the advances in dentistry, people tend to retain more of their natural dentition until the seventh or eighth decade of their lives and leading to an increased number of people with tooth wear. A certain degree of physiological tooth wear is inevitable over a lifetime as a result of the continuous function of the dentition. CPD/Clinical Relevance: A removable prosthesis, used in patients with severely worn teeth, is cost-effective compared to other prosthetic options and can be easily maintained hygienically. [ABSTRACT FROM AUTHOR]

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The incidence of cancer is closely correlated with age, as 75% of non-small cell lung cancer (NSCLC) patients are aged at least 65 years. The availability of immune checkpoint inhibitors (ICIs) has altered the available NSCLC therapeutic pattern. Limited studies on elderly patients have demonstrated that ICIs as monotherapy provide substantial benefits for patients aged 65-75 years, showing no significant difference compared to younger patients. This benefit is also observed in combination with immune-combined chemotherapy or radiotherapy. For individuals older than 75 years, the survival effect was not evident, though. Immune-related adverse events (irAEs) with ICIs alone were similar in incidence across age categories. Immune-combination chemotherapy resulted in a higher incidence of irAEs than chemotherapy alone, and patients ≥75 years of age were more likely to experience higher-grade irAEs. Besides the fact that immunosenescence in older patients influences the immune milieu in a multifaceted manner, which in turn impacts the effectiveness of immunotherapy, the prognosis is also influenced by the Eastern Cooperative Oncology Group performance status (ECOG PS) score, among other factors. For certain individuals aged ≥75 years or in poor physical health, immunotherapy combined with low-intensity chemotherapy has emerged as a viable treatment option. However, there are fewer related studies, so there should be a conscious effort to increase the number of elderly patients enrolled in the trial and a comprehensive assessment to explore individualized treatment options. To provide additional references and guidance for immunotherapy in elderly NSCLC patients and to propose new therapeutic perspectives in combination with their characteristics, this review aims to summarize and analyze the pertinent studies on the application of programmed cell death protein 1 (PD-1)/programmed cell death ligand 1 (PD-L1) inhibitors in these patients. [ABSTRACT FROM AUTHOR]

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Introduction: Early diagnosis of dementia is partly based on the evaluation of the basic (b-), instrumental (i-) and advanced (a-) activities of daily living (ADL). Adapting the item content of assessment tools to maintain relevance, understanding, and equivalence of the items and scales across other groups is pertinent. However, there are limited assessment tools developed on or adapted for use on the growing older Sub-Saharan African (SSA) migrant population in Europe. Focusing on the item content, we evaluated the relevance of the advanced activities of daily living (a-ADL) tool to the older SSA migrant population in Belgium. Method: Two focus group discussions were organized with participants from the SSA community in Gent, Belgium. Relevant, irrelevant, unclear, and new items were identified. The data was analyzed through the inductive method while consensus agreements were used to arrive at refined themes. Results: Out of the 49 items on the tool, both groups unanimously agreed that 15 items were relevant and 23 irrelevant. Thirteen new items were identified, whereas 15 items were considered unclear. Conclusion: Participants agreed the tool was relevant but should be adapted. Verification and validation of these results in a larger SSA older migrant population in Belgium is strongly recommended. [ABSTRACT FROM AUTHOR]

Background: Predicting discharge in older people from general medicine wards is challenging. It requires consideration of function, mobility, and cognitive levels, which vary within the cohort and may fluctuate over a short period. A previous systematic review identified 23 assessment tools associated with discharge destination in this cohort; however, the psychometric properties of these tools have not been explored. Purpose: To evaluate, synthesize, and compare the psychometric properties of 23 assessment tools used to predict discharge destination from acute general medical wards. Methods: Four databases were systematically searched: Medline (Ovid), Embase (Ovid), Cumulative Index of Nursing and Allied Health Literature (CINAHL), and Evidence-Based Medicine Review databases. Studies were included if participants were from general medicine or acute geriatric wards and investigated at least one psychometric property (reliability, internal consistency, measurement error, responsiveness, hypothesis testing, and structural or criterion validity) in 23 previously identified assessment tools. Data were extracted and methodological quality were assessed independently by 2 assessors using the COnsensus-based Standards for selection of health Measure INstruments (COSMIN) checklist. As per the COSMIN checklist, results were rated against "sufficient," "insufficient," or "indeterminate." Results: Forty-one studies were included. The de Morton Mobility Index (DEMMI) was the most rigorously evaluated assessment tool; it scored "sufficient" psychometric properties in 5 of 7 psychometric categories. The Alpha Functional Independence Measure (AlphaFIM), Barthel Index, and Mini-Mental State Examination (MMSE) demonstrated "sufficient" psychometric properties in at least 3 psychometric categories. The remainder of the tools (n = 19, 83%) had "sufficient" psychometric properties in 2 or fewer psychometric categories. Discussion and Conclusion: Based on current evidence, out of 23 assessment tools associated with discharge destination in acute general medicine, the DEMMI has the strongest psychometric properties. Other tools with substantial evidence in this cohort include the AlphaFIM, MMSE, and Barthel Index. Research is required to thoroughly evaluate the psychometric properties of the remaining tools, which have been insufficiently researched to date. Results can be used by physical therapists to guide selection of appropriate tools to assess mobility and predict discharge destination. Trial Registration: A priori, PROSPERO (CRD 42017064209). [ABSTRACT FROM AUTHOR]