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Weaver’s bottom, popularly known as ischial bursitis, is a highly unusual entity affecting adults and older populations. Ischial bursitis is an inflammation of the ischial bursa and fluid collection and associated changes in the hamstring muscle complex (HMC). The ischial bursa lies near the

Objectives Respiratory syncytial virus (RSV) causes substantial morbidity and mortality in older adults. We assessed severe clinical outcomes among hospitalized adults that were associated with RSV infections. Methods We performed a nested retrospective study in 3 New York City hospitals during 2 respiratory viral seasons, October 2017–April 2018 and October 2018–April 2019, to determine the proportion of patients with laboratory-confirmed RSV infection who experienced severe outcomes defined as intensive care unit (ICU) admission, mechanical ventilation, and/or death. We assessed factors associated with these severe outcomes and explored the effect of RSV-associated hospitalizations on changes in the living situations of surviving patients. Results Of the 403 patients studied (median age, 69 years), 119 (29.5%) were aged ≥80. Severe outcomes occurred in 19.1% of patients, including ICU admissions (16.4%), mechanical ventilation (12.4%), and/or death (6.7%). Patients admitted from residential living facilities had a 4.43 times higher likelihood of severe RSV infection compared with patients who were living in the community with or without assistance from family or home health aides. At discharge, 56 (15.1%) patients required a higher level of care than at admission. Conclusions RSV infection was associated with severe outcomes in adults. Living in a residential facility at admission was a risk factor for severe outcomes and could be a proxy for frailty rather than an independent risk factor. Our data support the development of prevention strategies for RSV infection in older populations, especially older adults living in residential living facilities.

SUMMARY Aging is a universal feature of life and a complex process at all levels from the biological to the societal. What constitutes older age is subjective and flexible, and how one defines older age is influenced by everchanging individual, generational, and cultural expectations. As the global population ages at an unprecedented rate, we are increasingly confronted with a myriad of challenges associated with aging, including increased healthcare needs and the far-reaching negative consequences of individual and structural agism. However, the shift in world demographics toward an older population is not a growing burden, but an opportunity to reshape our view of older life and proactively embrace healthy aging. Indeed, a healthy person is not defined by the absence of illness, but by the potential for meaningful work, positive relationships, and longevity. Simple preventive measures, such as improved diet and increased exercise, can enhance overall health and quality of life, and growing evidence highlights the potential of positive psychology for improving psychological well-being and overall quality of life. Now more than ever, technological innovation including artificial intelligence can be leveraged to improve our understanding of the causes and consequences of aging, as well as the most effective interventions to enhance resilience and extend healthy longevity. Good health is our greatest asset. It is the responsibility of all-individuals, society, business, science, healthcare systems, and government-to ensure that everyone is well equipped to maintain good health. Together, we can all live better, longer.

Aim: To assess the impact of blood flow restriction and retro walking in knee osteoarthritis subjects. Study Design: It was a comparative study. All the participants who meet inclusion criteria gave a written consent and were allocated to Group A or Group B randomly by chit method and the pre and post test scores were derived. The scores obtained in the two groups were compared and the results were derived. Place and Duration of the Study: This study was conducted in musculoskeletal sciences division, RNPC Sawangi, Wardha, for 12 months Methodology: A total of 150 samples were chosen. Using the chit method, they were divided into two groups at random, Group A and Group B. Blood Flow Restriction Training was given to Group A, while retro walking training was given to Group B. The training lasted 15 days. After 15 days, the pain, strength, and WOMAC score were tested again. Result: Out of 150 patients 75 were placed in each group, where p=.0001. Significant increase was seen in mean of group I and II in pre ad post-test NPRS score, Quadricep and hamstrings muscle strength and WOMAC score. Analysis showed significant improvement in both the groups. Conclusion: Both the interventions included in this study, have been shown to help individuals with osteoarthritis reduce pain, enhance strength, and improve their WOMAC score. Both the interventions are easy to practice and can be easily performed by the older population. When these two interventions were compared blood flow restriction therapy was proved to be better than retro walking.

Potentially inappropriate medication (PIM) is a primary health concern affecting the quality of life of patients over 65. PIM is associated with adverse drug reactions including falls, increased healthcare costs, health services utilization and hospital admissions. Various strategies, clinical guidelines and tools (explicit and implicit) have been developed to tackle this health concern. Despite these efforts, evidence still indicates a high prevalence of PIM in the older adult population. This systematic review explored the practice of using explicit tools to review PIM in hospitalized patients and examined the outcomes of PIM reduction. A literature search was conducted in several databases from their inception to 2019. Original studies that had an interventional element using explicit criteria detecting PIM in hospitalized patients over 65 were included. Descriptive narrative synthesis was used to analyze the included studies. The literature search yielded 6116 articles; 25 quantitative studies were included in this systematic literature review. Twenty were prospective studies and five were retrospective. Approximately, 15,500 patients were included in the review. Various healthcare professionals were involved in reviewing PIM including physicians and hospital pharmacists. Several tools were used to review PIM for hospitalized patients over 65, most frequently Beer’s criteria and the STOPP/START tool. The reduction of PIM ranged from 3.5% up to 87%. The most common PIM were benzodiazepines and antipsychotics. This systematic review showed promising outcomes in terms of improving patient outcomes. However, the reduction of PIM varied in the studies, raising the question of the variance between hospitals in the explicit tools used for review. Additional studies need to be conducted to further investigate the outcomes of reviewing PIM at different levels, as well as assessing the cost-effectiveness of using explicit tools in reducing PIM.

Background A recent campaign in the NHS highlighted that sitting in a chair can help to prevent deconditioning such as the loss of muscle strength, as well as helping to maintain a patient’s dignity (NHS improvement). The aim of this audit was to review whether the current seating available in our Emergency Department (ED) meets the needs of the older population who attend. Methods A prospective audit was completed over 6 days. It captured the number of patients who were seated in chairs in the morning and early afternoon, and if not, why. Results Total number of patients reviewed: 62. Total number of patients on a trolley: 50/62. Average CFS: 6. Average age: 83. Sex: 25 male, 37 female. • 54% not appropriate due to ongoing medical issues. Of the remaining 46%; • 17% lacked appropriate seating. • 47.8% who were appropriate to sit out did not for a number of reasons i.e. presentation surges in ED, demand outstripped capacity in terms of 1:1 care. • The remainder either declined to sit out, required specialise seating or no clear reason reported. • Only 10% of those who were in bed had no medic. Conclusion 54% of patients who remained on a trolley were medically unwell and not fit to sit out. However 47.8% of those medically fit to sit were not sitting out as per reasons discussed above. More education is needed for all staff about the importance of sitting patients out. Future plans should include staff education sessions and the development of a standard operating procedure to assist with identifying patients on arrival to the ED who could safely sit out. This could help in preventing patients’ cascade to dependency at the front door.

Large-scale deployment of COVID-19 vaccines will seriously affect the ongoing phases 2 and 3 randomised placebo-controlled trials assessing SARS-CoV-2 vaccine candidates. The effect will be particularly acute in high-income countries where the entire adult or older population could be vaccinated by late 2021. Regrettably, only a small proportion of the population in many low-income and middle-income countries will have access to available vaccines. Sponsors of COVID-19 vaccine candidates currently in phase 2 or initiating phase 3 trials in 2021 should consider continuing the research in countries with limited affordability and availability of COVID-19 vaccines. Several ethical principles must be implemented to ensure the equitable, non-exploitative, and respectful conduct of trials in resource-poor settings. Once sufficient knowledge on the immunogenicity response to COVID-19 vaccines is acquired, non-inferiority immunogenicity trials-comparing the immune response of a vaccine candidate to that of an authorised vaccine-would probably be the most common trial design. Until then, placebo-controlled, double-blind, crossover trials will continue to play a role in the development of new vaccine candidates. WHO or the Council for International Organizations of Medical Sciences should define an ethical framework for the requirements and benefits for trial participants and host communities in resource-poor settings that should require commitment from all vaccine candidate sponsors from high-income countries.

Purpose of Review: This review aims to provide an overview of the current evidence for prehabilitation in frail, older surgical patients and to provide a pragmatic approach for implementation into routine perioperative care. Recent Findings: There is increasing evidence for the use of prehabilitation strategies to improve postoperative outcomes. However, there is heterogeneity in the components of prehabilitation programs studied. Furthermore, they have not been robustly examined in a frail older population. Summary: Older patients are frequently frail and at increased risk of adverse postoperative outcomes. This group may benefit from prehabilitation. A consistent approach to screening, assessment, and optimization across multiple domains using an interdisciplinary approach should be used to examine this robustly.

Objective: The aim of the study was to evaluate the concordance among 10 anticholinergic scales for the measurement of anticholinergic drug ex posure in at-risk elderly complex chronic patients in primary care. Methods: An 8-month cross-sectional, multicenter study was carried out in a cohort of complex chronic patients older than 65 years in treatment with at least 1 drug with anticholinergic activity. Demographic, pharmaco logical, and clinical data were collected. Anticholinergic burden and risk were detected using the 10 scales included on the anticholinergic burden calculator (http://www.anticholinergicscales.es/). We used κ statistics to evaluated the concordance 2 to 2 (according to risk: high, medium, low or without risk) among the included scales. Results: Four hundred seventy-three patients were recruited (60.3% fe male, median age of 84 years [interquartile range = 10]). Eighty was the to tal number of anticholinergic drugs with any scale (1197 prescriptions), with a median of 2 drugs with anticholinergic activity per patient (inter quartile range = 2). The κ statistics comparing all the 10 scales ranged from −0.175 (Drug Burden Index versus Chew Scale) to 0.708 (Anticholinergic Activity Scale [AAS] versus Chew Scale). The best concordance was ob tained between AAS and Chew Scale (κ = 0.708), followed by Clinician Rated Anticholinergic Scale and Duran Scale (κ = 0.632) and AAS and Anticholinergic Cognitive Burden Scale (κ = 0.618), being considered sub stantial strengths of concordance. Conclusions: The agreement among the 10 scales in elderly patients with complex chronic conditions was highly variable. Great care should be taken when assessing anticholinergic drug exposure using existing scales because of the wide variability among them. The only scales that showed agreement were the AAS-Chew, Clinician-Rated Anticholinergic Scale– Duran, and AAS–Anticholinergic Cognitive Burden Scale pairs. In the rest of the cases, the scales are not interchangeable.

The older population has a high mortality with COVID-19 and this cohort often presents atypically with infection. This study compares presenting complaints and observations of older patients with COVID-19 against the established case definition to determine whether the case definition should be broadened to better identify SARS-CoV-2 infection in this age group. This retrospective observational study analysed the presenting complaints and observations of people aged 70 years and over who were admitted to a district general hospital with confirmed SARS-CoV-2 infection from March to May 2020. Out of 225 patients, only 11.5% presented with the trio of cough, fever and breathlessness; 30.2% did not present with any of these symptoms (p

Because of a shortage of health care providers, providing rehabilitation in health care facilities is difficult. Virtual reality–based rehabilitation is effective in older populations. There are only a few studies among patients with sarcopenia. This is a quasi-experimental, single-group, pretest–posttest design evaluating the clinical effectiveness of virtual reality–based progressive resistance training among residents aged over 60 years with sarcopenia in rural care facilities. The authors used Oculus Rift with headsets to provide the virtual reality–based progressive resistance training. The authors administered the program twice per week, 30 min per session, for 12 weeks. The primary outcomes were dominant handgrip strength, walking speed, and appendicular skeletal muscle mass index. Data from 30 participants were analyzed. Significant improvements in handgrip strength and walking speed were observed. Although an increasing trend in appendicular skeletal muscle mass index was observed, it did not reach statistical significance. The authors concluded that the virtual reality–based progressive resistance training is partially effective in older sarcopenic adults in health care facilities.

BACKGROUND: The burden of disability among the older population is increasing as older people grow with significant social and economic negative impacts. AIM: This study examines functional disability and its associated risk factors among older Saudi citizens attending primary health-care centers (PHCCs) in Riyadh city. METHODS: This descriptive cross-sectional study was carried out on 504 older Saudi citizens aged ≥60 years who attended a PHCC in Riyadh city between December 2019 and May 2020. Interviewer-administered questionnaire was used to assessing the disability in activities of daily living (ADL) and instrumental activities of daily living (IADL) using the Katz Index and Lawton scale. RESULTS: The prevalence of ADL and IADL disability among participants was 24.6% and 58.5%, respectively. Smoking (p = 0.019), dyslipidemia (p = 0.018), rheumatoid arthritis (p = 0.028), history of falls (p = 0.014), and an emergency visit (p = 0.049) were risk factors associated with ADL disability. Predictors of IADL disability were advanced age (p = 0.004), being female (p = 0.029), and the need for a caregiver (p = 0.000). The need for homecare was positively associated with ADL dependency (p = 0.008) and IADL dependency (p = 0.003). Furthermore, regular physical activity was a protective factor against ADL functional disabilities (p = 0.002) and IADL functional disabilities (p = 0.000). CONCLUSION: This study found a high prevalence of ADL and IADL disability among elderly Saudis. Disability was associated with several sociodemographic and health status factors. The findings of this study highlight the priority of effective and targeted preventive interventions for disability.

Older age is known as a negative prognostic parameter in patients with acute myocardial infarction (AMI). In this study, we aimed to investigate age-related differences in treatment protocols, in-hospital and 1-year mortality. This retrospective observational single-center study enrolled consecutive AMI patients with an urgent percutaneous coronary intervention (PCI) as the main method of myocardial revascularization. The patients divided were divided by age into group I (≥65 years) and group II (

Background and Purpose: Polygenic risk scores (PRSs) can be used to predict ischemic stroke (IS). However, further validation of PRS performance is required in independent populations, particularly older adults in whom the majority of strokes occur. Methods: We predicted risk of incident IS events in a population of 12 792 healthy older individuals enrolled in the ASPREE trial (Aspirin in Reducing Events in the Elderly). The PRS was calculated using 3.6 million genetic variants. Participants had no previous history of cardiovascular events, dementia, or persistent physical disability at enrollment. The primary outcome was IS over 5 years, with stroke subtypes as secondary outcomes. A multivariable model including conventional risk factors was applied and reevaluated after adding PRS. Area under the curve and net reclassification were evaluated. Results: At baseline, mean population age was 75 years. In total, 173 incident IS events occurred over a median follow-up of 4.7 years. When PRS was added to the multivariable model as a continuous variable, it was independently associated with IS (hazard ratio, 1.41 [95% CI, 1.20–1.65] per SD of the PRS; P P =0.004) compared with the lowest. The area under the curve of the conventional model was 66.6% (95% CI, 62.2–71.1) and after inclusion of the PRS, improved to 68.5 ([95% CI, 64.0–73.0] P =0.095). In subgroup analysis, the continuous PRS remained an independent predictor for large vessel and cardioembolic stroke subtypes but not for small vessel stroke. Reclassification was improved, as the continuous net reclassification index after adding PRS to the conventional model was 0.25 (95% CI, 0.17–0.43). Conclusions: PRS predicts incident IS in a healthy older population but only moderately improves prediction over conventional risk factors. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01038583.

Older adults are at high risk of developing more severe consequences of substance use. Due to aging, they may also have multiple medical and psychiatric comorbidities as well as cognitive impairment. This may lead to forensic issues both in terms of civil and criminal matters. This article will review the forensic issues of substance use and their relevance to the older population in particular.

Background Whether avoidable hospitalizations in community-dwelling persons with dementia have decreased during primary care reforms is unknown. Methods We described the prevalence and trends in avoidable hos­pitalizations in population-based repeated yearly cohorts of 192,144 community-dwelling persons with incident dementia (Quebec, 2000–2015) in the context of a province-wide pri­mary care reform, using the provincial health administrative database. Results Trends in both types of Ambulatory Care Sensitive Condition (ACSC) hospitalization (general and older population) and 30-day readmission rates remained constant with average rates per 100 person-years: 20.5 (19.9–21.1), 31.7 (31.0–32.4), 20.6 (20.1–21.2), respectively. Rates of delayed hospital discharge (i.e., alternate level of care (ALC) hospitalizations) decreased from 23.8 (21.1–26.9) to 17.9 (16.1–20.1) (relative change -24.6%). Conclusions These figures shed light on the importance of the phenomenon, its lack of improvement for most outcomes over the years, and the need to develop evidence-based policies to prevent avoidable hospitalizations in this vulnerable population.

There has been lack of studies that investigate the causal impact of alcohol consumption on health and mortality in middle-aged and older populations in China. This cohort study aims to investigate whether alcohol use increases poor health and mortality risk in middle-aged and older Chinese population. The study is a cohort study design that was based on the China Health and Retired Longitudinal study (CHARLS). Measures of poor health and alcohol use are self-rated poor/very poor and alcohol use. Competing Cox proportional hazard regression model (CPHM) was used to model the data and the hazards ratio (HR) of poor health, mortality for current and former drinkers versus nondrinkers and current drinkers versus former drinkers was estimated using CPHM after adjusting for deign-effects and covariates. This study found significantly increased risk of all-cause mortality among current (adjusted HR = 1.54 and P = 0.0423) and former drinkers (Adjusted HR = 1.52 and P = 0.0096) compared to lifetime nondrinkers among middle-aged and senior Chinese people; significantly increased hazard of poor health among current drinkers (Adjusted HR = 1.26 and P = 0.0443) compared with lifetime nondrinkers. The hazards of all-cause mortality and self-rated poor health increased with the amount and frequency of alcohol drinking, and drinking years. This study found that either former or current drinkers self-rated having a poor health and had a significantly increased risk of all-cause mortality compared with nondrinkers. Heavy drinkers had poor health status and higher risk of mortality compared with those who drank light or moderate amount of alcohol in middle-aged and senior Chinese population.

Background Biological and epidemiological evidence suggest that herpes simplex virus type 2 (HSV-2) elevates HIV acquisition and transmission risks. We improved previous estimates of the contribution of HSV-2 to HIV infections by using a dynamic transmission model. Setting World Health Organization regions. Methods We developed a mathematical model of HSV-2/HIV transmission among 15- to 49-year-old heterosexual, non-drug-injecting populations, calibrated using region-specific demographic and HSV-2/HIV epidemiological data. We derived global and regional estimates of the contribution of HSV-2 to HIV infection over 10 years [the transmission population-attributable fraction (tPAF)] under 3 additive scenarios, assuming: (1) HSV-2 increases only HIV acquisition risk (conservative); (2) HSV-2 also increases HIV transmission risk (liberal); and (3) HIV or antiretroviral therapy (ART) also modifies HSV-2 transmission risk, and HSV-2 decreases ART effect on HIV transmission risk (fully liberal). Results Under the conservative scenario, the predicted tPAF was 37.3% (95% uncertainty interval: 33.4%-43.2%), and an estimated 5.6 (4.5-7.0) million incident heterosexual HIV infections were due to HSV-2 globally over 2009-2018. The contribution of HSV-2 to HIV infections was largest for the African region [tPAF = 42.6% (38.0%-51.2%)] and lowest for the European region [tPAF = 11.2% (7.9%-13.8%)]. The tPAF was higher among female sex workers, their clients, and older populations, reflecting their higher HSV-2 prevalence. The tPAF was approximately 50% and 1.3- to 2.4-fold higher for the liberal or fully liberal scenario than the conservative scenario across regions. Conclusion HSV-2 may have contributed to at least 37% of incident HIV infections in the past decade worldwide, and even more in Africa, and may continue to do so despite increased ART access unless future improved HSV-2 control measures, such as vaccines, become available.

Background Associations between multiple forms of discrimination and blood pressure control in older populations remain unestablished. Methods Participants were 14 582 noninstitutionalized individuals (59% women) in the Health and Retirement Study aged at least 51 years (76% non-Hispanic White, 15% non-Hispanic Black, 9% Hispanic/Latino). Primary exposures included the mean frequency of discrimination in everyday life, intersectional discrimination (defined as marginalization ascribed to more than one reason), and the sum of discrimination over the life span. We assessed whether discrimination was associated with a change in measured hypertension status (N = 14 582) and concurrent medication use among reported hypertensives (N = 9 086) over 4 years (2008–2014). Results There was no association between the frequency of everyday discrimination and change in measured hypertension. Lifetime discrimination was associated with higher odds of hypertension 4 years later among men (odds ratio [OR]: 1.21, 95% confidence interval [CI]: 1.08–1.36) but not women (OR: 0.98, 95% CI: 0.86–1.13). Only among men, everyday discrimination due to at least 2 reasons was associated with a 1.44-fold (95% CI: 1.03–2.01) odds of hypertension than reporting no everyday discrimination, reporting intersectional discrimination was not associated with developing hypertension among women (OR: 0.91, 95% CI: 0.70–1.20). All 3 discriminatory measures were inversely related to time-averaged antihypertensive medication use, without apparent gender differences (eg, OR for everyday discrimination–antihypertensive use associations: 0.85, 95% CI: 0.77–0.94). Conclusions Gender differences in marginalization may more acutely elevate hypertensive risk among older men than similarly aged women. Experiences of discrimination appear to decrease the likelihood of antihypertensive medication use among older adults overall.

The independent role of muscular strength in the prevention of chronic disease is increasingly being recognized. However, no cohort study has assessed the relationship between handgrip strength and the incidence of hypertension among the middle-aged and older population. The aim of this prospective cohort study was to investigate whether handgrip strength is related to incident hypertension among people aged 40 years and over.This prospective cohort study (n = 8,480) was performed between 2013 and 2019 as part of the Tianjin Chronic Low-grade Systemic Inflammation and Health (TCLSIH) Cohort Study, Tianjin, China.Participants without baseline hypertension were followed up for ~6 years (median 4.0 years). Hypertension was defined according to the JNC7 criteria. Handgrip strength was measured using a hydraulic handheld dynamometer. Adjusted Cox proportional hazards regression models were used to assess the relationships between weight-adjusted handgrip strength and the risk of incident hypertension.The incidence rate of hypertension per 1000 person-years was 70. The fully adjusted hazards ratios (95% confidence interval) of the incidence of hypertension for increasing quartiles of weight-adjusted handgrip strength were: 1.00(reference), 0.84 (0.75-0.95), 0.78 (0.69-0.88), and 0.66 (0.58-0.75) (P for trend0.0001). Moreover, the adjusted hazards ratio (95% confidence interval) of incident hypertension for per unit increase in weight-adjusted handgrip strength was 0.17 (0.10-0.27) (P0.0001). Similar results were observed in males and females.The present cohort study is the first to find that high weight-adjusted handgrip strength, but not absolute handgrip strength, is significantly and independently related to low risk of incident hypertension among the middle-aged and older population.

Older adults historically have been excluded from biomedical research, especially in low-and middle-income countries (LMICs). This study aims to assess the scientific production of older adults-related publications (OARPs) in Ecuador and uncover research gaps to inform health and aging policy. A Scopus search was performed to retrieve OARPs published from 2008 to 2018. Bibliometric indicators studied included the number of publications per year, study design, research focus, and research lines. A total of 121 OARPs were retrieved. Sixty-four articles (~ 53%) were excluded. Overall, the most common study designs were cross-sectional and case–control studies, 84.2% (n = 48) and 8.8% (n = 5), respectively. The primary research focus was in the clinical-surgical area (~ 51%), and the most prevalent research lines were in the epidemiology of older-related diseases (35%) and causes of older-related diseases (26.3%). Across the analyzed period, we were not able to find studies related with aging policy, and we found only one OARP dedicated to diagnosis/treatment and provision of geriatric services, respectively. Ecuadorian OARPs were scarce during the last decade, providing limited evidence to address health priorities of the local older population and to inform health policy making. Improving research on the older population would provide valuable inputs to key stakeholders to perform evidence-based policy development that ultimately will improve quality of life and long-term health outcomes in Ecuador and other LMICs.

BACKGROUND: With the accelerated development of aging, the health problems of rural elderly are becoming increasingly severe. OBJECTIVE: The study aims to understand the mental health issues of the rural older population. METHODS: The risk factor analysis and the disease risk assessment are utilized to analyze the impacts of depression on older adults. First, the prevalence of depression in China’s rural older population is counted and analyzed. Next, both single and multi-factor analyses are employed to analyze the degree of depression among rural older adults quantitatively, and the existing risk factors are determined. The multiple risk factors and multi-source logistic regression algorithm establish the risk assessment model of depression in the rural older population. Finally, the risk factors of depression in older adults are calculated by analyzing and processing the above statistical data. A risk assessment model of depression is built, whose sensitivity and specificity are tested. RESULTS: Single-factor analysis and multi-factor analysis reveal 20 vital influencing factors of depression in older adults, such as cognitive ability, emotional state, and memory. The sensitivity and specificity of the risk assessment model based on multi-factor logistic regression are 87.3%80.2%, respectively, capable of effectively assessing and screening the potential population of depression among older adults. CONCLUSIONS: This model provides a scientific basis for screening out and preventing older adults’ mental health issues with depression and improving older adults’ quality of life.

Hyperkyphosis is identified when kyphosis angle exceeds the normal ranges. In overall, hyperkyphosis upsurges with age, particularly after the age of 40. It arises as a consequence of multifactorial causes and is associated with increased health susceptibility. Separately from the penalties of typical aging, as declining muscle power and degenerative vicissitudes of the spine, additional influences lead to the growth of the kyphosis angle. Besides fractures, other adverse health outcomes associated with hyperkyphosis include worsening physical function, falls and earlier mortality. Given the growing older population and the high prevalence of age-related hyperkyphosis, better delineation of associated ill-health outcomes will help inform the development and testing of effective kyphosis managements. The sequence of handling with kyphosis start conventional and rolling to surgical interference as a previous option if the patient’s symptoms do not recover with conventional treatment or if the curving is too significant.

BACKGROUND Recent research has shown that knee arthroscopy does not provide a meaningful clinical benefit for degenerative knee changes in the older population. The 2016 Australian Orthopaedic Association (AOA) Annual Scientific Meeting held a plenary session on this topic to educate surgeons about these research findings and communicate their clinical practice statement on this issue. This paper set out to find if there has been a change in clinical practice since this meeting. METHODS The analysis consisted of all knee arthroscopies performed in a single city of Far North Queensland, Australia, over an 8-year period. The number and type of arthroscopies performed in patients

Background The UK older population is higher than the global average. Over the next 20 years, England will see an increase in the number of older people who have higher levels of dependency, dementia and comorbidity, many of whom will require 24-hour residential care. It is estimated that 70% of residents in nursing and residential care homes either have dementia on admission or develop it while residing in the care home, many of who will have complex needs with high levels of multimorbidity. However, there is a lack of consistency in the provision of primary care and specialist services to this population and a known gap in knowledge and skills of dementia care in care home staff and primary care teams. Methods This article considers the current health policy drivers to enhance integrated health and social care provision to care homes and proposes a model of care that would support the aims of the NHS Long Term Plan for care to be delivered closer to home and improve out of hospital care which includes people who live in care homes by introducing Enhanced Health in Care Homes. It is crucial that such a model includes the correct skill mix to meet the needs of the care home population. Conclusions There are currently gaps in service provision to many care homes. Admiral nurse case managers and specialists in dementia care, are well placed to support the delivery of Enhanced Health in Care Homes and improve access to specialist support to care home residents, their families, care home staff and the wider health and social care system.

Subclinical atrial fibrillation (SCAF) is associated with an increased risk of clinical AF, major cardiovascular events and death. Short-term evidence on SCAF in older populations is scarce, especially in the hospital setting. We performed a cross-sectional study on 60 multimorbid older consecutive patients (aged 80+) admitted to an Internal Medicine and Geriatrics Unit for acute medical diseases with no history of AF, in order to investigate prevalence and predictors of SCAF. Portable ECG monitoring was placed on admission and ECG recording lasted for 5 days. Mean age: 85.7±4.9 years. Female prevalence: 58.3%. High burden of comorbidities: 87.9%. All enrolled patients had CHA2DS2-VASc score ≥3. SCAF was detected in 16 patients (26.7%) and 11 patients (18.4%) had at least a SCAF episode lasting 6 minutes or longer. No clinical, laboratory and echocardiographic parameters predicted SCAF. Patients with ≥2004 supraventricular ectopic beats/24h (SVEBs/24h) had a 6-fold higher prevalence of SCAF than patients with

Objective: To assess prevalence, risk factors, and cost burden of fall-related hospital admissions among older people in India. Previous studies conducted in India have not focused on the number of fall-related hospital admissions. Design: A prospective observational study was carried out over 12 months. Socio-demographic, medical and medication details were collected from the patients, medical records, and treating physicians. Setting: The study was conducted in internal medicine, orthopedics, and emergency departments of a tertiary care teaching hospital in Mysuru, Southern India. participants: Patients 60 years of age or older, of any gender, admitted to hospital were included in this study. Main Outcome Measure: Prevalence of fall-related hospital admission, fall-related hospital admission associated with medication use, and direct cost incurred due to fall-related hospital admission. Results: A total of 1,036 patients [Males 53.6%] with a mean (SD) age of 69.3 (8.1) years were included in the study. A total of 188 patients were admitted due to falling with the prevalence of 18.1%. The majority of patients fell due to environmental factors [105 (55.8%)]. Among medication-related falls (20), the majority were associated with the use of antihyperglycemics and antihypertensives. Increasing age, female gender, and multiple comorbidities were identified as risk factors for fall-related hospital admissions. Conclusions: Falls are a common reason for hospital admission among older populations. Clinicians need to focus on modifiable risk factors to reduce the prevalence of falls and advise patients and their caregivers about appropriate self-care behaviors.

There has been no research in Pakistan about how to improve quality of life (QOL) of aging populations through intergenerational learning. In this study we aimed to deliver an intervention for inte...

The COVID‐19 pandemic has resulted in the rapid implementation of telehealth. However, little is known about its suitability for the older population. We evaluated the use of telehealth in geriatric outpatient clinics. Half of the appointments needed to be re‐scheduled due to language barrier, poor connection, hard of hearing and inability to perform assessments. Advantages included time efficiency and ability to visualise the home. Preference for the future was initial appointments as face–face, but reviews as either telehealth or face–face.

The majority of rectal cancer patients are elderly. Biological age, not chronological age alone, is the main risk factor of postoperative morbidity in this group. Therefore, based on the Comprehensive Geriatric Assessment, we can differentiate three groups of patients: fit, pre-frail and frail. In the fit group, a standard multimodal oncologic treatment can be offered. In the pre-frail group, prerehabilitation should be recommended to improved resilience to surgical stress. In frail patients, a tailored approach should be discussed in a geriatric multidisciplinary team meeting. At present, a whole range of multimodal tailored approaches can be offered to rectal cancer patients. In this group, of much more importance is postoperative functional recovery, including both organ-specific outcomes and the ability to regain independence than currently used outcome indicators. Therefore, as important as cancer staging and tumour biology, it is crucial to understand the health status of an older patient with rectal cancer.

BackgroundA consistent approach to cervical spine injury (CSI) clearance for patients 65 and older remains a challenge. Clinical clearance algorithms like the National Emergency X-Radiography Utilisation Study (NEXUS) criteria have variable accuracy and the Canadian C-spine rule excludes older patients. Routine CT of the cervical spine is performed to rule out CSI but at an increased cost and low yield. Herein, we aimed to identify predictive clinical variables to selectively screen older patients for CSI.MethodsThe University of Iowa’s trauma registry was interrogated to retrospectively identify all patients 65 years and older who presented with trauma from a ground-level fall from January 2012 to July 2017. The relationship between predictive variables (demographics, NEXUS criteria and distracting injuries) and presence of CSI was examined using the generalised linear modelling (GLM) framework. A training set was used to build the statistical models to identify clinical variables that can be used to predict CSI and a validation set was used to assess the reliability and consistency of the model coefficients estimated from the training set.ResultsOverall, 2312 patients ≥65 admitted for ground-level falls were identified; 253 (10.9%) patients had a CSI. Using the GLM framework, the best predictive model for CSI included midline tenderness, focal neurological deficit and signs of trauma to the head/face, with midline tenderness highly predictive of CSI (OR=22.961 (15.178–34.737); pConclusionMidline tenderness, focal neurological deficit and signs of trauma to the head/face were significant in this older population. The absence of all three variables indicates lower likelihood of CSI for patients≥65. Future observational studies are warranted to prospectively validate this model.

Objectives Alcohol and medication use are increasingly prevalent in the older population. Concurrent use of alcohol and alcohol-interactive (AI) medication can lead to significant adverse consequences. Methods Three reference works were used to create an explicit list of drug substances for which information about the interaction with alcohol was available in at least one of them. Additional information was extracted from the Summary of Product Characteristics (SPC). The first aim was to generate a list of 256 substances with standardized advice regarding the concurrent use of each drug with alcohol. The second aim was to observe the prevalence of potential drug–alcohol-interactions. The list was applied to a database containing information about alcohol and medication use of 1,016 community-dwelling older patients (≥70 years) with polypharmacy. Results About half of the sample population reported to consume alcohol at least once a week. Around 22% were classified as frequent drinkers (5–7 days/week) and 11% as heavier drinkers (>7 units/week). Ninety-three percent alcohol consumers in our sample took at least one chronic drug that potentially interacts with alcohol and 42% used at least one chronic drug for which alcohol use is considered contraindicated. Conclusions We developed an explicit list of potentially drug–alcohol-interactions in older adults, with standardized handling advice. We observed that prevalence of potential drug–alcohol-interactions is substantial in community-dwelling older patients with polypharmacy.

Aging is anecdotally associated with a prolonged recovery from resistance training, though current literature remains equivocal. This brief review considers the effects of resistance training on indirect markers of muscle damage and recovery (i.e., muscle soreness, blood markers, and muscle strength) in older males. With no date restrictions, four databases were searched for articles relating to aging, muscle damage, and recovery. Data from 11 studies were extracted for review. Of these, four reported worse symptoms in older compared with younger populations, while two have observed the opposite, and the remaining studies (n = 6) proposed no differences between age groups. It appears that resistance training can be practiced in older populations without concern for impaired recovery. To improve current knowledge, researchers are urged to utilize more ecologically valid muscle-damaging bouts and investigate the mechanisms which underpin the recovery of muscle soreness and strength after exercise in older populations.

Objectives To investigate alveolar bone loss (ABL), which is an indicator of periodontitis, and to identify risk factors for ABL in an older population between 2008 and 2018. Methods This longitudinal study used data from a questionnaire survey and a clinical examination administered on two occasions ten years apart to 273 individuals who were 65 years and 75 years in 2008. Results The mean number of teeth decreased significantly over the ten-year study period, while the proportion of individuals with calculus and moderate ABL visible on radiographs increased. For both ages, the number of teeth decreased by a mean of 2 teeth. The proportions of participants reporting poor general health, daily medication, xerostomia, living singly, visiting dental care irregularly and being in need of extra support in their homes all increased over the observation period. Conclusions Despite an increased progression of moderate alveolar bone loss, a fairly good dentition and chewing capacity was retained in this older population. However, the individual's age and fragility are important indicators that need to be considered when planning oral health care and the availability of dental care.

Purpose: This study investigated the impact of sex differences on the relationship of subclinical hypothyroidism (SCH) with the prevalence of metabolic syndrome (MetS) and its components in an olde...

Because of a growing older population, the sexual health (SH) of older adults, including sexual violence (SV), is becoming an increasingly important public health concern. Yet, reliable SV prevalence rates and risk factors are lacking, due to methodological shortcomings in current studies. SV research involves challenges regarding safety and disclosure, especially in older adults. In this paper, we reflect on the methods used in a sexual health and violence (SH&V) study in older adults balancing between privacy rules imposed by the General Data Protection Regulation (GDPR) and ethical and safety guidelines.To ensure the acceptability of the questionnaire, it was tested in a two-phase pilot study. To maximize SV disclosure, the questionnaire built up gradually towards the more sensitive SV modules. Interviewers were trained to approach participants in a non-judgmental manner. Due to GDPR, our data collection method was changed from a random sampling via the National Register to a cluster random probability sampling with a random walk finding approach.Older adults were willing to discuss SH&V during a structured face-to-face interview with trained interviewers. Following strict safety guidelines, no major incidents were reported. The cluster random probability sampling with random walk finding approach provided an adequate sampling frame, but was inefficient and time-consuming.Doing research on SH&V in older adults is feasible but requires a substantial investment of time and the challenges involved may incur greater costs. In order to guarantee further research on sensitive topics in older adults, we recommend that an interdisciplinary expert group consisting of researchers, donors, and policymakers investigates how GDPR and public health research in hard-to-reach populations can be better matched.

Aims/Introduction To investigate the association between midlife or late‐life diabetes and the development of sarcopenia in an older Japanese population. Materials and Methods A total of 824 Japanese residents aged 65 to 84 years without sarcopenia were followed up from 2012 to 2017. Sarcopenia was determined following the Asian Working Group for Sarcopenia definition. The time of diabetes diagnosis was classified as midlife or late‐life diabetes by the age at first diagnosis of diabetes (< 65 or ≥ 65 years) based on annual health checkups data over the past 24 years. The duration of diabetes was categorized into three groups of 15 years. The odds ratios of incident sarcopenia according to the diabetic status were estimated using a logistic regression analysis. Results During follow‐up, 47 subjects developed sarcopenia. The multivariable‐adjusted odds ratio for incident sarcopenia was significantly greater in subjects with diabetes at baseline than in those without it (odds ratio 2.51, 95% confidence interval 1.26–5.00). Subjects with midlife diabetes had a significantly greater risk of incident sarcopenia, whereas no significant association between late‐life diabetes and incident sarcopenia was observed. With a longer duration of diabetes, the risk of incident sarcopenia increased significantly (P for trend = 0.002). Conclusions The present study suggests that midlife diabetes and a longer duration of diabetes are significant risk factors for incident sarcopenia in the older population. Preventing diabetes in midlife may reduce the risk of the development of sarcopenia in later life., We investigated the association of midlife or late‐life diabetes with the development of sarcopenia in an older Japanese population. The present study has shown that midlife diabetes and a longer duration of diabetes are significant risk factors for incident sarcopenia, suggesting the prevention of diabetes in midlife is important for the prevention of sarcopenia in later life.

Frailty is a common geriatric syndrome and is characterized by decreased physiological reserve and increased vulnerability towards adverse health outcomes including falls. Turning is a challenging task and is reported to be one of the daily activities that leads to falling in older populations.Does 180° walking turns and 360° turning on the spot differ among frail, pre-frail, and non-frail older adults? Can 180° walking turns and 360° turning on the spot cutoffs discriminate older adults with frailty from those without?A cross-sectional study was conducted on community-dwelling older adults aged over 65 years. Frailty was assessed using Fried's phenotype method, and turning tasks were measured by inertial sensors. The turn duration (s) and angular velocity (°/s) were recorded for analysis.In total, 109 participants were enrolled including 50 pre-frail and 12 frail individuals. Frail older adults took significantly longer and had slower angular velocities to complete the 180° and 360° turning than did either pre-frail (p = 0.002 and p0.001, respectively) or non-frail (p = 0.03 and p0.001, respectively) older adults. Cutoff times of 2.45 and 3.46 s were found to best discriminate frail people from those without frailty in both the 180° (sensitivity 83.3 %, specificity 71.1 %, area under the receiver operating characteristic curve (AUC) 0.796) and 360° (sensitivity 91.7 %, specificity 74.2 %, AUC 0.857) turn tasks.Older individuals with frailty syndrome had difficulty turning as evidenced by a longer turning duration and a slower angular velocity. The turn duration could be a potential biomarker of frailty in older populations. Assessing the turning performance can facilitate early detection of the onset of frailty and inform early prevention and rehabilitation interventions in clinical practice.

Background Posttraumatic Stress Disorder (PTSD) is an increasingly prevalent condition among older adults and may escalate further as the general population including veterans from recent conflicts grow older. Despite growing evidence of higher medical comorbidity, cognitive impairment and dementia, and disability in older individuals with PTSD, there are very few studies examining brain cortical structure in this population. Hence, we examined cortical volumes in a cross-sectional study of veterans and civilians aged ≥50 years, of both sexes and exposed to trauma (interpersonal, combat, non-interpersonal). Methods Cortical volumes were obtained from T1-weighted structural MRI and compared between individuals with PTSD and Trauma Exposed Healthy Controls (TEHC) adjusting for age, sex, estimated intracranial volume, depression severity, and time elapsed since trauma exposure. Results The PTSD group (N = 55) had smaller right parahippocampal gyrus compared to TEHC (N = 36), corrected p(pFWER) = 0.034, with an effect size of 0.75 (Cohen's d), with no significant group differences in other cortical areas. Conclusions These findings are different from the structural brain findings reported in studies in younger age groups (larger parahippocampal volume in PTSD patients), suggesting a possible significant change in brain structure as PTSD patients age. These results need replication in longitudinal studies across the age-span to test whether they are neuroanatomical markers representing disease vulnerability, trauma resilience or pathological neurodegeneration associated with cognitive impairment and dementia.

Background: The utilization of dental services among older people is an important parameter in health service planning. Studies show that the utilization of dental services among older people in India is low. This study aims to explore the barriers in the utilization of dental services among older people. Materials and Methods: A cross-sectional study was done on 399 older people to examine the barriers in the utilization of dental services among the older population, who are defined as people aged 60 years and above, in South Kerala. Circular systemic random sampling was used to recruit the sample from the district of Kollam in Kerala. All the study participants, as defined by the inclusion criteria were considered for the study. Results: The mean age of the study population was 65.3±5.5 (n=399). The main barrier that prevented older people from utilizing oral health care was their adaptation to the present health situation 343(86), followed by perceived high expense 309(77.4). The frequency of previous dental visits among participants was highest in the past year 129(33.4). More than half of the participants 244(61) had visited a dentist to extract their teeth and only 7(1.7) had visited the dentist for their routine dental check-ups. A 206(51.4) participants had visited a private clinic to receive dental care and 70(17.7) had visited a government facility to take dental care. The main reasons for visiting a particular centre among the participants were accessibility 168(42.2), and the least reported reason was the familiarity of the dentist 32(8). Conclusion: To minimize the barriers to utilization of dental services and to address the health needs of the increasing older population, the health system needs to be strengthened especially the primary health care centres with the need to integrate oral health programs and emphasis on health promotion. Keywords: Utilisation of dental services, Barriers, Dental diseases, Oral health, Dental caries, Dental visit, Ol

Data linking solar radiation with fractures are lacking. We found that lower solar radiation was associated with higher hip fracture admission rates in men from Chile. This supports the idea that solar radiation, a surrogate of vitamin D, may be involved in the development of fractures in older population. To explore the associations between solar radiation and latitude with hip fracture admission rates in people aged 65 years or older in Chile, the country with the greatest variation in solar radiation in the world. In this ecological study, we investigated the associations between regional solar radiation and latitude with hospitalizations due to hip fracture in population aged 65 years or older, by reviewing national records between 2013 and 2018. We also evaluated the role of sociodemographic factors such as poverty, education, indigenous ethnicity, and rurality rates. Between 2013 and 2018, there were 44,328 admissions due to hip fracture in people aged 65 years or older; 77.5% were women and 65.1% were aged 80 years or older. The national admission rate was 389.3 per 100,000 inhabitants (95% CI: 382.4–396.2). The highest admission rate was registered in the Region IX (445.3 per 100,000, 95% CI: 398.3–492.4), which has the highest poverty rates, indigenous ethnicity rates, and rurality rates. We found a north-south increasing gradient of admission rates in men (β=1.5 [95% CI: 0 to 3], p=0.044) and a significant association between solar radiation and admission rates in men (β=−4.4 [95% CI: −8 to 0.8], p=0.02). Admission rates in men were also associated with sociodemographic variables such as poverty (β=2.4 [95% CI: 0 to 4.8], p=0.048) and rurality rates (β=1.2 [95% CI: 0.1 to 2.4], p=0.039). Regional solar radiation and latitude were associated with hip fracture admission rates in men aged 65 years or older in Chile, with highest admission rates at higher latitudes and lower solar radiation.

BACKGROUND: The incidence of rectal cancer is higher in the older population. In developed nations, there has been a rise in incidence in young onset colorectal cancer (CRC). We examined the outcomes of locally advanced rectal cancer (LARC) in younger patients (yRC) compared with older patients, using a retrospective audit. METHODS: All cases of LARC referred to two tertiary referral cancer centres in Western Sydney were examined. Patient demographics, presenting symptoms, treatment, relapse free survival (RFS), overall survival (OS) and progression free survival (PFS) were obtained. Under 50 years old was used as the cut-off age for defining yRC. RESULTS: All 145 consecutive patients were treated for LARC, including 28 in the yRC and 117 in the older patient group. Median follow-up was 54 months. yRC were more likely to complete neoadjuvant therapy (100% vs. 86%; P=0.032) and to undergo more extensive surgical procedures (24% vs. 2%, P

Elderly people account for more than 9% of the global population, and more than 6% of the Indian population. Covid-19 has badly affected the older population, identification of risk factors for severe disease and early intervention results in reduced mortality. Older adults may have a varied spectrum of presentation which ranges from mild to severe disease. Milder diseases are more in older adults without prior comorbidities whereas severity increases with increase in number of illness. Till date there is no definitive treatment and vaccines are also at different stages of trial only preventive methods and early detection of cases are important tools for fighting this pandemic. Dedicated centre's for elder care as well as trained geriatricians are very few in India. Prevention should be the most important strategy for older adults. Follow social distancing and maintain a distance of 1 meter from others even if you are healthy. Wash hands repeatedly with soap and water or use hand sanitizer and generous use of masks. Older adults should be encouraged to take their regular medication and the baseline disease should be under controlled. Frequent teleconsultation from the primary physician should be done repeatedly to identify the symptoms and also control of baseline disease. Considering Covid-19 increased mortality and severity in the older population we are providing practical suggestions for family physicians while managing elderly Covid patients.

Objectives This study aims to identify older adult malnutrition in Texas, examine county-level characteristics associated with crude malnutrition death rates, and describe assets and opportunities available to address and improve malnutrition among the older population. Design Secondary data analysis using the Centers for Disease Control and Prevention’s WONDER online database, the U.S. Census 2014–2018 American Community Survey, and the U.S. Department of Agriculture’s Food Access Research Atlas data. Setting All 254 counties in the state of Texas. Participants Individuals aged 65 years and older. Measurement The dependent variable was the proportion of county-level malnutrition crude death rates. Independent variables included Health Provider Shortage Area designations, rurality, poverty status, food access, age, race, ethnicity, and education. Results The overall malnutrition crude death rate in Texas was 65.6 deaths per 100,000 older Texans, ranging from 0 to 414.46 deaths per 100,000 depending on the county. Higher malnutrition crude death rates were associated with non-metropolitan counties (P=0.018), lower education (P=0.047), greater household poverty (P=0.010), and low food access (P

Background The Hospital Readmissions Reduction Program (HRRP) was introduced to reduce readmission rates among Medicare beneficiaries, however little is known about readmissions and costs for HRRP-targeted conditions in younger populations. The primary objective of this study was to examine readmission trends and costs for targeted conditions during policy implementation among younger and older adults in the U.S. Methods We analyzed the Nationwide Readmission Database from January 2010 to September 2015 in younger (18–64 years) and older (≥65 years) patients with acute myocardial infarction (AMI), heart failure (HF), pneumonia, and acute exacerbations of chronic obstructive pulmonary disease (AECOPD). Pre- and post-HRRP periods were defined based on implementation of the policy for each condition. Readmission rates were evaluated using an interrupted time series with difference-in-difference analyses and hospital cost differences between early and late readmissions (≤30 vs. > 30 days) were evaluated using generalized linear models. Results Overall, this study included 16,884,612 hospitalizations with 3,337,266 readmissions among all age groups and 5,977,177 hospitalizations with 1,104,940 readmissions in those aged 18–64 years. Readmission rates decreased in all conditions. In the HRRP announcement period, readmissions declined significantly for those aged 40–64 years for AMI (p p = 0.003). Readmissions decreased significantly in the post-HRRP period for those aged 40–64 years at a slower rate for AMI (p = 0.003) and HF (p = 0.05). Readmission rates among younger patients (18–64 years) varied within all four targeted conditions in HRRP announcement and post-HRRP periods. Adjusted models showed a significantly higher readmission cost in those readmitted within 30 days among younger and older populations for AMI (p p p p Conclusion Readmissions for targeted conditions decreased in the U.S. during the enactment of the HRRP policy and younger age groups (

BACKGROUND: Although many studies demonstrated reduced mortality risk with higher greenness, few studies examined the modifying effect of greenness on air pollution–health associations. We evaluated residential greenness as an effect modifier of the association between long-term exposure to fine particles (PM(2.5)) and mortality. METHODS: We used data from all Medicare beneficiaries in North Carolina (NC) and Michigan (MI) (2001–2016). We estimated annual PM(2.5) averages using ensemble prediction models. We estimated mortality risk per 1 μg/m(3) increase using Cox proportional hazards modeling, controlling for demographics, Medicaid eligibility, and area-level covariates. We investigated health disparities by greenness using the Normalized Difference Vegetation Index (NDVI) with measures of urbanicity and socioeconomic status. RESULTS: PM(2.5) was positively associated with mortality risk. Hazard ratios (HRs) were 1.12 (95% confidence interval (CI) 1.12, 1.13) for NC and 1.01 (95% CI 1.00, 1.01) for MI. HRs were higher for rural than urban areas. Within each category of urbanicity, HRs were generally higher in less green areas. For combined disparities, HRs were higher in low greenness or low SES areas, regardless of the other factor. HRs were lowest in high-greenness and high-SES areas for both states. CONCLUSIONS: In our study, those in low SES and high greenness areas had lower associations between PM(2.5) and mortality than those in low SES and low greenness areas. Multiple aspects of disparity factors and their interactions may affect health disparities from air pollution exposures. Findings should be considered in light of uncertainties, such as our use of modeled PM(2.5) data, and warrant further investigation.

Objectives To determine whether catheterization rates after intradetrusor onabotulinumtoxinA injection for nonneurogenic overactive bladder and urgency incontinence differ between women with urgency urinary incontinence only and women with urgency-predominant mixed urinary incontinence. Methods This was a retrospective cohort study of patients that underwent intradetrusor onabotulinumtoxinA injection of 100 U for nonneurogenic urgency urinary incontinence. The primary outcome was the difference in catheterization rates between women with urgency urinary incontinence alone compared with women with urgency-predominant mixed urinary incontinence. Descriptive statistics and multivariate logistic regression analysis were performed. Results Of the 177 women included in the final analysis, 105 had urgency urinary incontinence and 72 had urgency-predominant mixed urinary incontinence. The overall catheterization rate after onabotulinumtoxinA injection was 11.3%, with significantly fewer women with mixed urinary incontinence requiring catheterization when compared with women with urgency urinary incontinence alone (4.2% vs 16.2%; P = 0.03), despite an older population (P = 0.02). Patient-reported improvement (P = 0.37) and decision to continue onabotulinumtoxinA treatments (P = 0.89) were similar between groups. Multivariate logistic regression analysis revealed that women with mixed urinary incontinence had significantly lower odds of requiring catheterization after onabotulinumtoxinA injections than women with urgency urinary incontinence alone (odds ratio, 0.16; 95% confidence interval, 0.04-0.67; P = 0.01). Conclusions Findings suggest that the presence of symptomatic stress urinary incontinence is associated with lower rates of catheterization after intradetrusor onabotulinumtoxinA, but does not compromise efficacy of treatment for urgency-predominant mixed urinary incontinence.

AIM With improved life expectancy over time, the burden of kidney failure resulting in kidney replacement therapy (KRT) in older persons is increasing. This study aimed to describe the age distribution at dialysis initiation in Australia and New Zealand (ANZ) across centres and over time. METHODS Adults initiating dialysis as first KRT in ANZ from 1999 to 2018 reported to the Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry were included. The primary outcomes were the age distribution and the proportion of older persons (75 years and older) initiating dialysis across centres and over time. Secondary outcomes were characterization of the older population compared with younger people and differences in dialysis modality and treatment trajectories between groups. RESULTS Over the study period, 55 382 people initiated dialysis as first KRT, including 10 306 older persons, in 100 centres. Wide variation in age distribution across states/countries was noted, although the proportion of older persons at dialysis initiation did not significantly change over time (from 13% in 1999 to 19% in 2003, then remaining stable thereafter). Older persons were less likely to be treated with home therapies compared with younger people. Older persons were mostly Caucasians; had higher socioeconomic position, more cardiovascular comorbidities and higher eGFR at baseline; and resided in major cities. Higher proportions of older persons per centre were noted in privately funded facilities. CONCLUSION Wide variations were noted in the proportions of older persons initiating dialysis across centres and states/country, which were associated with different case-mix across regions, particularly in terms of ethnicity, remoteness and socioeconomic advantage.

About 20% of people older than forty years old face more bone degenerative diseases. The older population is increasing quite rapidly than before which increases the need for knee or hip implants tremendously. One of the major problems of the current implants is their short lifetime and their impact on the surrounding human tissue. The short life can be attributed to implant wear, loosening, and misalignment, which often cause pain and discomfort to the patient. Functional failure of the implant may be followed by a revision surgery, which is often painful and has a relatively low success rate. Moreover, to avoid unexpected failure and unnoticed deterioration of the implant, it is important to make provision for monitoring implants’ performance. Instrumented implants can provide accurate monitoring of the loosening state of the implant, which can delay the revision surgeries and its consequences. This study provides a comprehensive review of the technological development of instrumented hip implants to monitor the status of the implants. The main requirements for the implants are highlighted by reviewing different aspects of the instrumented hip implant systems. In-vivo studies reported in the literature were summarized. Vibration and Acoustic Emission (AE) measurement based loosening detection were found to be the most common methods for in-vitro studies. A comprehensive review of power supply and communication modules was presented. Despite the advancement in this field, current systems are not yet able to provide effective monitoring of the implant’s status during the daily activities of patients.

Background The coronavirus (COVID-19) pandemic was reported from Wuhan, China, on December 31, 2019, and the pandemic was spread to more than 212 countries in the globe. This meta-analysis aimed to assess the pooled incidence of COVID-19 complications and to identify the association between the incidence of complications and age. Methods Comprehensive databases, PubMed, Hinari, and Google Scholar, were used to locate potential articles for this review. Data were extracted using Microsoft Excel and imported to the STATA/MP version 16.0 software for analysis. Heterogeneity between studies was assessed using the Cochrane Q test statistics and I2 test, and small study effect was checked using Egger’s statistical test at 5% significant level. Sensitivity analysis was checked. A random-effects model was conducted to estimate the pooled incidence of COVID-19 complications. Univariate meta-regression was conducted to identify the association between the mean ages with each complication. Results From the total of 1237 studies, 12 studies were included with a total of 3064 COVID-19 patients. The most complications were acute respiratory distress syndrome (30.93%, 95%CI 21.3–40.6%) followed by acute liver injury (22.8%, 95%CI 14–31.5%), shock (10.9%, 95%CI 7.4–14.4%), acute kidney injury (7%, 95%CI 3.8–10.4%), and acute cardiac injury (6.4%, 95%CI 2.8–15.6%). Univariate meta-regression revealed that as the mean age increased by 1 year, the incidence of acute respiratory distress syndrome, acute kidney injury, acute cardiac injury, and shock increased by a factor of 2.9 (β = 2.9, 95%CI 2.4–3.4, adjusted R2 = 88), 0.4 (β = 0.4, 95%CI 0.04–0.72, adjusted R2 = 54), 1.6 (β = 1.6, 95%CI 1.1–2.1, adjusted R2 = 85), and 1.1 (β = 1.1, 95%CI 0.8–1.5, adjusted R2 = 26) times respectively. Conclusion Significant complications of COVID-19 viral infections were reported. Older populations were a high-risk group of developing adverse complications as compared to their counterparts. Health care professionals should give primary attention to those risk group individuals.