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Enhanced recovery after surgery (ERAS) is a perioperative management protocol used to accelerate patient recovery. This study evaluated its benefits in patients with resectable esophageal cancer.This retrospective study compared patients before (January 2013 to December 2016) and after (June 2018 to December 2020) ERAS protocol implementation in our hospital. A propensity score-matched analysis was used to compare short-term surgical outcomes between ERAS and non-ERAS groups. After propensity score matching each group included 243 patients.There were significant differences in hospital length of stay after surgery (7.40 vs 11.17 days, P.001) and hospitalization cost (¥69380 vs ¥78075, P.001) between the ERAS and non-ERAS groups. The time to chest tube removal (4.91 vs 7.16 days, P.001) and first bowel movement (2.87 vs 3.97 days, P.001) was significantly shorter in the ERAS group. However there was no significant difference in total postoperative complication morbidity (20.2% vs 25.1%, P = .193). The complication of postoperative atelectasis or pneumonia was significantly lower in the ERAS group (P = .003), but there was no significant difference in occurrence of at least grade III complications between the 2 groups (12.3% vs 11.5%, P = .889).We demonstrated that ERAS could reduce hospital stay, numerical pain scores, and hospitalization costs without increasing postoperative complication and readmission. Furthermore subgroup analyses revealed that ERAS was safe for older people (70 years old).

Background Engagement in leisure activities among older people is associated with a lower risk of mortality. However, no studies have been conducted focusing on the difference of associations with mortality risk among multiple types of leisure activities. Methods We examined prospectively the association of engagement in leisure activities with all-cause mortality in a cohort of older Japanese adults. The Japan Gerontological Evaluation Study included 48,216 participants aged 65 years or older. During a mean follow-up period of 5.6 years, we observed 5,575 deaths (11.6%). We investigated the total number of leisure activities, as well as combinations of 25 different leisure activities with Cox proportional hazards models, adjusting for potential confounding factors. Results We found a linear relationship between the total number of leisure activities and mortality hazard (adjusted hazard ratio 0.93; 95% CI, 0.92-0.95). Furthermore, engagement in leisure activities involving physical activity, as well as group-based interactions, showed the strongest associations with lowered mortality. By contrast, engagement in cultural leisure activities and solitary leisure activities were not associated with all-cause mortality. Conclusions Although we cannot rule out residual confounding, our findings suggest that encouraging engagement in physically-active group-based leisure activities may promote longevity in older adults.

Background There is a need for effective and cost-effective interprofessional care models that support older people to maintain their quality of life (QoL) and physical performance to live longer independently in their own homes. Objectives The objectives were to evaluate effectiveness, QoL and physical performance, and cost-utility of a people-centred care model (PCCM), including the contribution of clinically trained pharmacists, compared with that of usual care in primary care. Methods A randomised controlled trial (RCT) with a two-year follow-up was conducted. The participants were multimorbid community-living older people, aged ≥75 years. The intervention comprised an at-home patient interview, health review, pharmacist-led clinical medication review, an interprofessional team meeting, and nurse-led care coordination and health support. At the baseline and at the 1-year and 2-year follow-ups, QoL (SF-36, 36-Item Short-Form Health Survey) and physical performance (SPPB, Short Performance Physical Battery) were measured. Additionally, a physical dimension component summary in the SF-36 was calculated. The SF-36 data were transformed into SF-6D scores to calculate quality-adjusted life-years (QALYs). Healthcare resource use were collected and transformed into costs. A healthcare payer perspective was adopted. Incremental cost-effectiveness ratio (ICER) was calculated, and one-way sensitivity analysis was performed. Results No statistically or clinically significant differences were observed between the usual care (n = 126) and intervention group (n = 151) patients in their QoL; at the 2-year follow-up the mean difference was −0.02, (95 % CI -0.07; 0.04,p = 0.56). While the mean difference between the groups in physical performance at the 2-year follow-up was −1.02, (−1.94;-0.10,p = 0.03), between the physical component summary scores it was −7.3, (−15.2; 0.6,p = 0.07). The ICER was −73 638€/QALY, hence, the developed PCCM dominated usual care, since it was more effective and less costly. Conclusions The cost-utility analysis showed that the PCCM including pharmacist-led medication review dominated usual care. However, it had no effect on QoL and the effect towards physical performance remained unclear.

Background:The use of Potentially Inappropriate Medications (PIMs) is common and negatively affects elderly health and disease prognosis.Objective:This study aims to analyze the frequency of PIMs in the elderly health records registered to a family health center and to identify risk factors, prescription/nonprescription distribution, distribution by healthcare institutions, number of doctors visits, and health literacy.Methods:In this cross-sectional study, a stratified sampling method was used to select individuals aged ≥ 65 years. The health records of the participants up to the last 12 months were examined, and medicines used by participants were evaluated according to Beers 2019 criteria.Results:Most of the participants (89.7%, n:183) had PIMs in health records. The mean number of PIMs used by the elderly was 2.9±1.9 (min:0, max:8). A positive linear relationship was observed between multimorbidity and the number of PIMs (p=0.001). There was no significant difference in terms of PIMs frequency among healthcare institutions. Prescription and non-prescription PIMs were found to belong to the same drug groups (Pain relievers and stomach medications). A linear and significant correlation was found between the number of PIMs and doctor visits (p=0.047).Conclusion:The doctor should examine prescription and over-the-counter medications used by the elderly during the visit. It will be useful to establish a warning system stating that PIMs are available while registering the medications in the electronic system. So, it will be possible for health authorities to re-evaluate the treatment and replace PIMs with rational drug options.

Several vaccine candidates for control of the Coronavirus disease 19 (COVID19) are in phase three trials, with some being approved in different countries. A limited initial supply of vaccine doses is likely in most countries, and will require a judicious vaccination strategy to be developed until supply is unlimited. Vaccines may be effective as post-exposure prophylaxis (PEP) in contacts, but no data are yet available for COVID19 vaccines. If vaccines do have efficacy as PEP, this provides more options for strategies with limited supply. We simulated an epidemic response with limited supply (targeted or ring vaccination) and mass vaccination for the State of New South Wales (NSW) in Australia. For targeted vaccination, the effectiveness of vaccinating young adults was compared to older adults. For mass vaccination, we tested outcomes for varying vaccine efficacy and distribution capacities, and for ring vaccination, we tested different contacts tracing rates. With a limited vaccine stockpile of 1 million doses in NSW, if there is efficacy as PEP, the most efficient way to control COVID19 will be ring vaccination, however at least 90% of contacts per case needs to be traced and vaccinated. Age based strategies make minimal impact on the epidemic due to low coverage rates, but vaccinating older people prevents more deaths. Herd immunity and interruption of community transmission can only be achieved with mass vaccination using a high efficacy vaccine. With a 90% efficacy, herd immunity can be achieved by vaccinating 73% of the population. If the vaccine stockpile is unlimited, distributing at least 60,000 doses per day is required to achieve herd immunity. Slower rates of vaccination will result in the population living with COVID19 longer, and higher cases and deaths.

Background Due to the rising number of acutely hospitalised older people in the coming years, there is increased interest in tailoring care to the individual goals and preferences of patients in order to reach patient-centered care. Aims This study aimed to investigate the goals of older hospitalised patients and the extent to which these goals were reached during hospitalisation. Methods A single centre prospective cohort study was performed in the Netherlands between December 2017 and January 2018. Participants aged 70 years or older were included. In the first three days of hospitalisation, a semi-structured interview was conducted to assess the patient goals regarding the hospital admission. One to two weeks after discharge patients were asked to which extent the recent hospitalisation had contributed to reaching their goals. Results One-hundred-and-four patients were included and for 86 patients follow-up was completed. The main goals reported at hospital admission were "remaining alive" (72.1%), "feeling better" (71.2%) and "improving condition"(65,4%). Hospitalisation seemed to have a positive contribution to reaching the goals "remaining alive", "knowing what is wrong", "feeling better", "reducing pain" and "controlling disease". Hospitalisation seemed to contribute little to reaching the goals in the categories "enjoying life", "independency and freedom", "improving daily functioning", "hobbies and work" and "social functioning". Conclusions It is important for healthcare professionals to know the goals of their patients. The majority of these goals were not achieved at hospital discharge. It is important to be aware of this, so sufficient aftercare can be arranged, and patients can be prepared. This article is protected by copyright. All rights reserved.

Background Medication self-management is complicated for older people. Little is known about older persons’ considerations and decisions concerning medication therapy at home. Objective (s): To explore how older people living at home self-manage their medication and what considerations and decisions underpin their medication self-management behavior. Methods Semi-structured interviews with consenting participants (living at home, aged ≥65, ≥5 different prescription medications daily) were recorded and transcribed with supporting photographs. Content was analyzed with a directed approach and presented according to three phases of medication self-management (initiation, execution, and discontinuation). Results Sixty people were interviewed. In the initiation phase, participants used different techniques to inform healthcare professionals and to fill and check prescriptions. Over-the-counter medication was seldom discussed, and potential interactions were unknown to the participants. Some participants decided to not start treatment after reading the patient information leaflets for fear of side effects. In the execution phase, participants had various methods for integrating the use of new and chronic medication in daily life. Usage problems were discussed with healthcare professionals, but side effects were not discussed, since the participants were not aware that the signs and symptoms of side effects could be medication-related. Furthermore, participants stored medication in various (sometimes incorrect) ways and devised their own systems for ordering and filling repeat prescriptions. In the discontinuation phase, some participants decided to stop or change doses by themselves (because of side effects, therapeutic effects, or a lack of effect). They also mentioned different considerations regarding medication disposal and disposed their medication (in)correctly, stored it for future use, or distributed it to others. Conclusions Participants’ considerations and decisions led to the following: problems in organizing medication intake, inadequate discussion of medication-related information with healthcare professionals, and incorrect and undesirable medication storage and disposal. There is a need for medication self-management observation, monitoring, and assistance by healthcare professionals.

Background Perceived comfort levels of older people living in long-term care facilities (LTCFs) influence their health and wellbeing. Aim This study aimed to investigate the comfort levels and factors that contributed to comfort among older people living in LTCFs. Methods A cross-sectional research design was used. Sociodemographic profile, physical function, pain, depressive symptom, social support, and comfort levels were collected. Stepwise multiple regression was utilised to identify the factors of residents’ comfort level in the LTCFs. Findings A total of 114 residents were recruited in the study. Depressive symptom (β = -0.630, p Discussion Comfort, as perceived by older people living in LTCFs, is influenced by a combination of physiological and psychological factors. For older people to live comfortably in LTCFs, clinicians need to consider early detection of potential mental health issues such as depression, enhance the social support networks within and external to LTCFs and effectively manage pain. Conclusion The findings inform gerontological nurses in assessing comfort levels of the residents and in implementing interventions to increase the comfort levels of older people living in long term care facilities.

Epilepsy is a neurological disease from which a large number of younger and older people suffer all over the world. The status of the patients is primarily examined by using Electroencephalogram (EEG) signals. The most important part for successful surgery is to locate the epileptic seizure in the brain. For this reason, it is very useful to detect the seizure area automatically before surgery. In this research, a novel method based on continuous wavelet transform (CWT) and two-dimensional (2D) convolutional neural networks (CNNs) has been proposed to predict focal and non-focal epileptic seizure. The AlexNet, InceptionV3, Inception-ResNetV2, ResNet50 and VGG16 pre-trained models have been used to automatically classify 2D-scalogram images into focal and non-focal epileptic seizure. The performances of 5 pre-trained models were compared and the detection results of 2D-scalograms were examined. The best classification accuracy of 92.27% is yielded by the InceptionV3 model among the other used four pre-trained models. As a result, it may be said that the pre-trained models and 2D-scalogram images of focal and non-focal EEG signals will be useful to neurologists for rapid and robust prediction epileptic seizure before surgery.

Background Since 2011, the Brazilian city of Belo Horizonte has been operating an innovative scheme to support care-dependent older people in disadvantaged communities: Programa Maior Cuidado (PMC – Older Person’s Care Program). This paper examines two potential associations between inclusion in PMC on types of outpatient health service utilization by dependent older people. The first is that being in PMC is associated with a higher frequency of outpatient visits for physical rehabilitation. The second is that being in PMC is associated with a higher frequency of planned versus unplanned outpatient visits. Methods We apply a quasi-experimental design to a unique set of health administrative data recording visits to outpatient health services. We focus on comparisons of the universe of visits, transformed to ratios of planned/unplanned visits and rehabilitation/other reasons for visiting the outpatient service. First, we preprocess our sample through different matching techniques such as ‘coarsened exact matching’ (CEM), ‘nearest neighbor’ based on logit scores (NN), ‘optimal pair’ (OP) and ‘optimal full’ (OF) methods. Second, we estimate marginal effects of being in PMC on our outcomes of interest. We use Poisson regressions controlling for individual and community factors and use robust standard errors. Our results are presented as the comparative incidence ratio of PMC on rehabilitation and planned visits. Results We find significant positive incidence rates for belonging to PMC for both outcomes of interest under all matching specifications. Poisson models using CEM shows a higher incidence rate for planned visits in comparison to unplanned visits, 1.3 (95% CI 1.1–1.4), by PMC patients compared to the non-PMC controls, and a higher proportion of visits for rehabilitation, 3.4 (95% CI 1.7–6.8). Similar positive results are found across other matching methods and models. Conclusions Our analysis reveals significant positive associations between older people included in PMC and a matched set of controls for a greater ratio of making outpatient visits that were planned, rather than unplanned. We find similar associations for the proportion of visits made for rehabilitation, as opposed to other reasons. These findings indicate that PMC influences some elements of outpatient health service utilization by dependent older people.

Frailty is a clinically discernible state in which decreased physiological reserve and function result in a reduced ability to cope with stressors. Information and communication technology (ICT) has been proposed as an aid to help with frailty, yet the use of ICT by older people, particularly women, is an understudied area.To analyze the association between use of ICT (specifically internet functions and social media) and frailty status in postmenopausal midlife and elderly women.A cross-sectional study was designed to investigate whether frailty status is related to ICT use in postmenopausal midlife and older women. Community-dwelling women attending primary health care centers for health checks were invited to participate in the study. Postmenopausal status was the only inclusion criterion, whereas limitations that could interfere with use of ICT were exclusion criteria. The Fried phenotype was used to assess frailty. Four types of ICT use were examined: the internet for e-mail, the internet for other functions, and social media (WhatsApp or Facebook). Chi-square test and multivariate multinomial regression analysis were used to examine the association between frailty status and ICT use.We included 409 women (age = 67.45 ± 7.81 years, mean ± SD), who were frail (n = 135, 33.01%), pre-frail (n = 159, 38.87%), or robust (n = 115, 28.11%). Frailty status was significantly and inversely associated with any ICT use, showing a strong association with use of WhatsApp (P 0.001) and internet searches (P 0.001). ICT non-use was a predictor of frailty, while ICT users were more likely to be robust (OR 10.62; 95% [CI], 5.34-21.10) or pre-frail (OR 9.03; [CI], 95% 5.18-15.74).Postmenopausal midlife and older women not using ICT were more likely to be frail.

The pressure of our own finger on the arm feels differently than the same pressure exerted by an external agent: the latter involves just touch, whereas the former involves a combination of touch and predictive output from the internal model of the body. This internal model predicts the movement of our own finger and hence the intensity of the sensation of the finger press is decreased. A decrease in intensity of the self-produced stimulus is called sensory attenuation. It has been reported that, due to decreased somatosensation with age and an increased reliance on the prediction of the internal model, sensory attenuation is increased in older adults.In this study, we used a force-matching paradigm to test if sensory attenuation is also present over the arm and if aging increases sensory attenuation. We demonstrated that, while both young and older adults overestimate a self-produced force, older adults overestimate it even more showing an increased sensory attenuation. In addition, we also found that both younger and older adults self-produce higher forces when activating the homologous muscles of the upper limb.While this is traditionally viewed as evidence for an increased reliance on internal model function in older adults because of decreased somatosensory function, somatosensation appeared unimpaired in our older participants. This begs the question of whether the decreased somatosensation is really responsible for the increased sensory attenuation observed in older people.New and NoteworthyForces generated externally (by the environment on the participant) and internally (by the participant on her/his body) are not perceived with the same intensity. Internally-generated forces are perceived less intensely than externally generated ones. This difference in force sensation has been shown to be higher in elderly participants when the forces were applied on the fingers because of their impaired somatosensation. Here we replicated this finding for the arm but suggest that it is unlikely linked to impaired somatosensory function.

The human face is an important human structure, often judged by its esthetics. It serves great purpose, as it is and always has been involved in both cultural matters, such as art, as well as biological matters, such as exhibition of emotion and mate selection. Throughout history, there have been multiple studies on what makes a face attractive. Despite the myriad ways in which the face has been explored academically, there has been a lack of reports on which craniofacial elements are deemed the most important for attractiveness subjectively. To fill up this gap on the perception of the esthetics of the human face, as well as to provide a contemporary view on the matter, this research was conducted. Participants were asked to fill out a questionnaire with a visual analogue scale for each craniofacial element and questions about appearance satisfaction. A total of 299 participants were enrolled in this study. Eyes, hair and teeth were deemed to be the most important craniofacial elements for attractiveness. Women scored teeth, hair, and eyebrows significantly higher than men, men scored higher in satisfaction with their own appearance than women. Older people, married people and people in a relationship care less about the opinion of others regarding their appearance. The results from this study can be used to identify a focus in the future development of esthetically related matters, such as plastic surgery or art and will add to the academic knowledge on the perception of craniofacial beauty.

Aims and objectives To trial three mobile translation apps in the healthcare setting to address language barriers in everyday care between healthcare staff and older people with limited English proficiency (LEP). Design A mixed‐methods exploratory study. Methods A two‐month trial of three translation apps was conducted across four aged‐care hospital wards. Observed interactions during use of translation apps were recorded, and staff surveys regarding the use of translation apps were collected at the end of the trial. Data were analysed using descriptive statistics and thematic content analysis of open‐ended responses in the surveys and observations. Findings from the thematic content analysis are reported using the Standards for Reporting of Qualitative Research (SRQR) checklist. Results Translation apps were mostly used for identifying pain and assisting with activities of daily living. Qualitative findings revealed that translation apps aided staff in providing care and improved rapport; however, practical shortcomings were identified.

Purpose We aimed to determine root caries annual incidence (RCAI) and root caries annual progression (RCAP) and risk factors for them among older people requiring nursing care. Methods The target population comprised 186 dentate individuals aged ≥ 65 years who required nursing care while living in nursing homes (NHs) or their own homes (OHs) in Okayama, Japan. Survey items included presence/absence and severity of root caries, age, sex, living environment (NH or OH), the Clinical Dementia Rating, and the Barthel Index (BI). Baseline surveys were conducted from 2015 to 2017; subjects were followed up for one year. RCAI and RCAP per tooth and per person were calculated, and risk factors for them were identified using generalized estimating equations. Results In total, 104 individuals (mean age: 82.0 ± 12.4 years) completed the follow-up survey. RCAIs per tooth and per person were 14.6% (173/1188) and 59.6% (62/104), respectively. RCAP per tooth was 22.5% (51/227 teeth with root caries at baseline). Significant risk factors for RCAI were living environment (OH, odds ratio [OR]: 2.14), sex (male, OR: 1.84), clasped tooth (OR: 1.82), and older age (OR: 1.05) at baseline. Significant risk factors for RCAP were sex (male, OR: 5.20), regular dental checkup (OR: 2.74), and high BI score (OR: 1.02) at baseline. Conclusions At one-year follow-up, 59.6% of the subjects developed at least one root caries. Risk factors for RCAI were living environment (OH), male, clasped tooth, and older age, whereas those for RCAP were male, regular dental checkup, and high BI score.

The strict restrictions to reduce the spread of COVID-19 have disrupted the lives of many at-risk people and their family caregivers. This study explored how family caregivers perceived that family caregiving had changed during COVID-19 and the strategies they used to cope with these changes. We conducted 52 semi-structured interviews with family caregivers of adults over age 65 or adults with disabilities and analyzed the data through an inductive thematic analysis. Caregivers perceived the largest COVID-19-related caregiving changes to be limited social and physical contacts, changed caregiving tasks, reduced services and supports, and a new focus on vigilance and safety. Caregivers made numerous changes to caregiving, including keeping connected, keeping relatives occupied, getting support and services in new ways, and reducing caregiver stress.

There is lack of a suitable assessment tool that can be used routinely and systematically by hospital staff to address family caregivers’ (FCs’) support needs. This paper describes a novel approach to identifying and addressing FCs’ needs following hospital discharge of the older person receiving care.Setting and participantsFC recruitment occurred on the patient’s discharge from a tertiary hospital in Western Australia; 64 completed the study; 80% were female; mean age 63.2 years.InterventionThe Further Enabling Care at Home (FECH) programme was delivered over the telephone by a specially trained nurse and included: support to facilitate understanding of the patient’s discharge letter; caregiver support needs assessment and prioritisation of urgent needs; and collaborative guidance, from the nurse, regarding accessing supports.ResultsSixty-four FCs completed the FECH programme. The top three support needs identified by the FCs were: knowing what to expect in the future (52%), knowing who to contact if they were concerned (52%) and practical help in the home (36%). The telephone-based outreach service worked well and was convenient for the nurse and the FCs, and saved on transport, time and money. Most of the FCs appreciated the systematic approach to identify and articulate their needs and were satisfied with the support they received, mainly navigation through the systems, problem solving, self-care strategies, explanation of illness, symptoms and medication and access to after-hours services.ConclusionsIn order to guide services which may consider adopting this systematic approach to supporting FCs and integrating it into their routine practice, this evaluation of the FECH programme has described the processes implemented and highlighted the factors that hindered or facilitated these processes to engage caregivers with appropriate services in a timely manner. Positive feedback indicated that the programme was a useful addition to hospital discharge planning.Trial registration numberACTRN12614001174673; Results.

Very few studies today validate the use of various sensory tools among elderly subjects, although the population is ageing rapidly. This chapter deals with applied sensory assessment in the food sector. It first presents heterogeneity factors in this population: physical and psychological health and dependency, decrease of chemosensory capacities, changes in oral-motor skills and modifications of cognitive abilities. Then, a study aiming at comparing the capacity of young and more or less dependent elderly subjects to use a discrete scale (discriminatory power and repeatability) in a monadic sequential presentation is described. Finally, recommendations are given about the cases where a panel of elderly people should be necessary and the precautions to undertake during a sensory test among elderly subjects.

Objective To determine the effects of the training duration and frequency on lip-seal strength (LSS) in older people. Background Lip-seal is important for speaking, eating and swallowing. LSS decreases after training ends; therefore, continuous training is essential. Materials and methods Participants underwent the resistance training of LSS. Regarding training duration, eight women aged ≥65 years participated in a crossover study with trainings A (direction: 1, duration: 50 seconds) and B (directions: 3, duration: 3 minutes), daily for 4 weeks. Regarding training frequency, 40 women aged ≥65 years were divided into four groups based on frequency (everyday, every-other-day, once-a-week and control groups), and all groups excluding the control group performed training B for 4 weeks. LSS was measured at weeks 0, 2 and 4 using a digital strain gauge. Friedman's test was used, followed by Steel-Dwass test (α = 0.05). Results Regarding the effects of the training duration, significant differences in LSS were noted between weeks 0 and 4 for training B, but no difference was noted for training A. Regarding training frequency, significant differences were observed between weeks 0 and 2 or 4 in the everyday and once-a-week groups. Significant differences were observed in the every-other-day group between weeks 0 and 4 and no difference in the control group. For all groups, median LSS was higher in week 2 or 4 than that in week 0. Conclusion Lip-seal training for 3 minutes per session everyday, every-other-day or once-a-week for 4 weeks increased LSS of older people.

BACKGROUND & AIMS The nutritional status is seldom defined in general, but is considered to be important throughout life span, especially in times of diseases and disabilities. We previously proposed a theoretical model of the nutritional status from a functional perspective [1], however without proposing a definition of the nutritional status. The model comprises four domains that might affect the nutritional and functional status in a bidirectional way. These four domains are: Food and nutrition; Health and somatic disorders; Physical function and capacity; and Cognitive, affective, and sensory function. This study contributes to the existing literature and knowledge by empirically analysing patterns and relationships of possible nutritional status indicators within and between the four domains. METHODS This study is based on a sample of 69 men and women; older than 65 years, receiving home health care. They were followed up for three years. A broad set of nutritional status indicators in the participants were assessed in their home yearly. Given the small sample size and large number of variables, we used both correlation and factor analysis to explore patterns of nutritional status indicators within the four domains and relationships between the four domains suggested by the theoretical model of nutritional status which we proposed earlier. RESULTS At baseline, between 4 and 18 components were extracted from the four domains, separately, using factor analysis. The first three components of each domain (called main components) were correlated (p

Objective: The Zero Suicide (ZS) framework is increasingly used in Australia, but without published adaptations for older people, and limited access by older people when implemented. The aim of this paper is to inform Towards Zero Suicide (TZS) implementations to benefit older adults by considering the key differences in older adults at risk of suicide according to each clinical component of the ZS framework. Conclusion: TZS aspires to reduce deaths by suicide for people within healthcare by refocusing interventions on suicidality rather than diagnosis alone, emphasising evidence-based practices and cultural change. For TZS to be effective for older people, it is essential to ensure practices are based upon evidence relevant to older people and to ensure ageism is effectively counteracted. Older adults have distinct patterns of help seeking and service use, accompanied by differences in risk factors, presentations, and outcomes of suicidal behaviours. Ageism affects assessment, decision-making and actions to address self-harm and suicide for older people. Immediate and longer-term actions are essential to effectively implement TZS in this population.

COVID-19 has had an extreme effect on older people. Now more than ever we need collaborative approaches to address complex issues within research on aging. However, the pandemic has dramatically changed the way we conduct, interact, and organize research within interdisciplinary groups. This paper describes a case study of how an interdisciplinary institute for research on aging has managed the process of change during COVID-19 restrictions. A design lead, researcher centered approach was used to understand the needs of researchers as they adapted across 6 months. Firstly, an online survey (n=51) was conducted to understand the scope of change and needs. The survey found broad themes ranging from assistance with finding additional funding to adjusting current research proposals. Following the survey, two Co-Design Sessions were conducted. The first session (n=53) diverged thinking to scope ideas from the survey and actionable themes were created. The second session (n=36) was conducted to converge thinking and focus on solutions based on one of these themes. The results revealed a diversity of ideas addressing the needs of interdisciplinary researchers in aging. These ideas spanned from exploring the capacity to do research remotely and creating virtual collaboration spaces to rethinking stakeholder engagement. Received: 1 July 2021Accepted: 12 October 2021

Purpose This paper aims to provide an evidence assessment and narrative synthesis of literature regarding the key characteristics of older people living in service-integrated housing (SIH) facilities and their “accommodation journey”. Design/methodology/approach A rapid evidence assessment was conducted: 22 research publications met the inclusion criteria and were analysed using narrative synthesis. Findings The quality of studies in this area is low, but consistency across components of the results of studies included in the review is apparent. Results suggest key characteristics of older people that drive moves into SIH are a decline in health, increased dependency, increased health service use and carer burden. Suggested key characteristics of SIH residents are high levels of health problems, dependency and health service use, but high self-reported health and well-being. Results indicate that the key driver for older people leaving SIH is a lack of workforce competency to manage further declines in health and dependency status. Research limitations/implications Current policy may not realise or account for the complex health and care needs of SIH residents. Investment into integrated care, robust community health services and workforce development to facilitate a comprehensive assessment approach may be required to support residents to remain in SIH and live well. Further longitudinal studies are required to map the progression of SIH residents’ health status in detail over time to provide an understanding of preventative and enablement support, development of care pathways and workforce planning and development requirements. Originality/value This evidence assessment is the first to consider the accommodation journey of older people residing in SIH.

Aim: This study aimed to compare the perceptions and working experiences of two age cohorts of nurses' about care of older people. Material and Methods: A qualitative descriptive study was used. The research sample consisted of 68 internal medicine and surgery nurses representing X and Y generations. Data were collected using a demographic form and a semi-structured interview form. Data were subjected to thematic analysis. Results: The general themes for generation X were: care time, emotional responses, and provide resources for older patients. The general themes for generation Y were: increasing workload and time problems, categorization of older people, and finally, the need for holistic care. Conclusions: All nurses experienced that caring for elderly is difficult. However, they emphasized the needs of older people. This may be an essential component in organizing older people care. It is recommended regulation of working conditions to reduce the difficulties experienced by nurses in care of older people.

The IoT is a new concept that provides a world where smart, connected, embedded systems operate, giving rise to the amount of data from different sources that are considered to have highly useful and valuable information. Data mining would play a critical role in creating smarter IoT. Traditional care of an elderly person is a difficult and complex task. The need to have a caregiver with the elderly person almost all the time drains the human and financial resources of the health care system. The emergence of Artificial intelligence has allowed the conception of technical assistance where it helps and reduces the time spent by the caregiver with the elderly person. This work aims to focus on analyzing techniques that are used for prediction purposes of falls in the elderly. We examine the applicability of three classification algorithms for IoT data. These algorithms are analyzed and a comparative study is undertaken to find the classifier that performs the best analysis on the dataset using a set of predefined performance metrics to compare the results of each classifier.

PURPOSE OF THE REVIEW Early palliative care (EPC) is known to generally improve both health-related quality of life (QoL) and symptom intensity at small effect sizes. However, it is unclear whether EPC is effective in older people, a population that is notoriously unaccounted for. This review summarizes the recent evidence concerning the efficacy of EPC in older patients with advanced cancer and delineates existing barriers to accessing respective services. RECENT FINDINGS The search for studies published in MEDLINE from January 2020 to September 2021 yielded six relevant records. Data from a recent feasibility trial and subgroups from larger randomised trials point to a somewhat lesser decline in QoL for patients undergoing EPC compared to those receiving treatment as usual. However, enrolling older patients in such trials remains a major challenge mostly due to them feeling too ill to participate. SUMMARY For older patients, the efficacy of EPC, like many other medical interventions, has hardly been studied so far. Existing work yielded several specific barriers for older patients to access this type of care. Future research should prioritize efficacy trials of EPC tailored to the needs of older patients enabling clinicians to enter truly evidence-based shared decision-making with their patients.

Population aging has become a global challenge. Drawing data from Chinese Longitudinal Healthy Longevity Survey 2008, 2011, and 2014, this study examines the effect of informal care receipt on functional limitations and depressive symptoms among older people in China using lagged fixed effects model. Our findings suggest that receiving informal care is significantly associated with a slower functional decline. We also find that this effect varies across different income groups. The protective effect of informal care is more pronounced among older people with higher income compared to those with lower income. We do not observe any significant associations between receiving informal care and depressive symptoms of older people. This study highlights a pressing need for the Chinese government to establish a comprehensive long-term care system.

Sarcopenia, the age-associated decline in skeletal muscle mass and function, is a major cause of functional decline and mortality in older adults. Despite its importance, sarcopenia often remains unrecognized and inadequately managed in routine clinical care. A major hinderance to its clinical integration is the variation in diagnostic tools for sarcopenia. Diagnostic tools include those of the European Working Group on Sarcopenia in Older People (versions 1 and 2), those of the Asian Working Group for Sarcopenia (versions 1 and 2), and that of the Sarcopenia Definition and Outcomes Consortium. The management decision process of sarcopenia warrants an evaluation of risk factors such as a sedentary lifestyle, inadequate exercise, poor nutritional intake, smoking, depression and living circumstances. Herein, we provide an evidence-based update of the prevention and management of sarcopenia and propose practical information to facilitate the disease’s adoption into routine care. This Review provides an evidence-based update of the prevention and management of sarcopenia and proposes practical information to facilitate the disease’s adoption into routine care.

Background for shared decision-making, it is important to discuss of the patients’ priorities in order to align treatment decisions with these priorities. Objective to assess the most important health outcome for older patients on the verge of making a treatment decision, using the Outcome Prioritization Tool (OPT). Secondary objectives were the feasibility of the OPT and patient variables associated with prioritising different health outcomes. Design retrospective cohort study. Setting and subjects at the University Medical Hospital Groningen, the Netherlands, 350 patients were included who visited the geriatric outpatient clinic during the work-up regarding a complex treatment decision (such as cancer treatment or heart valve replacement). Methods during geriatric assessment, patients prioritised between four health outcomes, using the OPT. Results median age was 78.5 years, 172 (49.1%) were referred regarding a treatment decision for a malignant disease. Cognitive impairment was present in 23.6%. Most patients (55.2%) prioritised maintaining independence as their most important goal, followed by extending life in 21.1%. Only cognitive impairment was significantly associated with prioritising extending life as the most important health outcome. For 107 patients (30.6%), the OPT was not feasible; these patients more often had malnutrition and assisted living. Conclusions the main health outcome of older patients on the verge of making a treatment decision was maintaining independence, followed by extending life. Patients with cognitive impairment more often prioritised extending life. The OPT was feasible as a decision aid for most patients. For optimal shared decision-making, it is crucial to take patient preferences into account.

Background Due to an ageing population, dengue among older patients is encountered more frequently in many countries. Our study aimed to explore the clinico-laboratory parameters and outcomes among dengue-infected older patients in comparison with younger patients. Methods This retrospective chart review involved dengue patients with dengue non-structural protein 1 (NS1) antigen positivity admitted to a tertiary hospital in Malaysia from January to July 2015. A comparison was made between older people (aged ≥60 y) and others. Results Among 406 dengue patients, 43 (10.6%) were older people. Older dengue patients were less likely to present with persistent vomiting (adjusted OR [AOR] 0.247, 95% CI 0.093 to 0.656, p=0.005), while restlessness and confusion were more common at presentation (AOR 3.356, 95% CI 1.024 to 11.003, p=0.046). Older patients had significantly lower albumin upon admission (38 vs 40 g/L, p=0.036) and during hospital stay (35 vs 37 g/L, p=0.015). Compared with younger patients, older patients were more likely to have experienced nadir platelet counts of Conclusions Diagnosis of dengue in older people may be challenging because of atypical presentations. Increased vigilance is necessary as there is an increased tendency to develop severe thrombocytopenia, hypoalbuminemia and prolonged hospitalisation in older people.

Purpose This paper aims to describe the RE-COV study and to summarise its findings. It focuses particularly on the implications of lessons learned for national, operational and building design policy and practice. Design/methodology/approach Invitations to take part in a RE-COV study survey were emailed to the operators of 270 retirement villages and older people’s extra care housing schemes in England which were known to the Elderly Accommodation Counsel. Completed questionnaires were returned from 38 operators, online or electronically, between December 2020 and February 2021. Findings Survey findings evidenced the breadth and depth of the operators’ responses, the effects these had on residents’ lives and worthwhile changes which could be made. Outcomes demonstrated included higher levels of protection for residents from the COVID-19 virus compared to older people living in the general community, and high levels of residents feeling safe, supported and reassured. Practical implications The findings are used to offer evidence-based recommendations for housing operators, building designers and policymakers which could enhance resident, staff and operators’ health and well-being, both going forward and during possible future pandemics. Social implications There is evidence that retirement villages and extra care housing provided safe, resilient and supportive environments during the first year of the pandemic which were highly valued by residents. Originality/value This study addressed a knowledge gap regarding how the COVID-19 pandemic had impacted housing-with-care stakeholders, evidencing specifically how operators had responded, and what their response achieved.

Background COVID-19 has resulted in large scale infection rates, significant death rates and an economic crisis for many countries. Older people were identified as being in a high-risk group in terms of morbidity severity and mortality rates. This led to many governments recommending older people shield as a protective, public health measure. This study considers how older people experienced shielding in an urban area of Ireland. Methods Twenty participants were recruited through nursing services in one Community Healthcare Organisation. Semi-structured interviews were conducted between 14/1/21 to 8/3/21 and analysed using thematic analysis (Braun & Clarke, 2006). Results Two overarching themes were identified: 1) Shielding experienced as a social disruption: Compliance resulted in transformed lives with marked impacts on social roles, identities, ways of living as well as the personal consequences of adhering to restrictions. Older participants spoke of careful strategies of self-protection and acute awareness of the personal and societal effects of the ongoing pandemic. 2) Coping with and countering social disruption: Participants described strategies they engaged in to adapt to, resist, address or avoid the impacts of shielding that challenged pre-COVID-19 social roles, identities, or ways of living. Conclusion As global societies slowly emerge from the pandemic, particularly in the context of vaccination roll out, older people’s experiences are important to acknowledge. In this study, there was evidence of both the resilience of older people but also the multi-faceted negative impact on their health and welfare. In addition, the experience of the pandemic has highlighted pre-existing service issues (home care service provision fragmentation), digital divides and the lack of older people’s voices in political decision making. This points to the need to have robust, and accessible rehabilitation services incorporating comprehensive geriatric assessment and to reform health care delivery to enhance capacity to sustain services in pandemic times.

Objective To review current guidelines and literature regarding continuous glucose monitoring (CGM) use in the management of type 2 diabetes mellitus (T2DM) in older people. Data Sources A PubMed search of articles published through August 2020 using a combination of the following: older people, T2DM, continuous glucose monitoring, hypoglycemia, and hyperglycemia. Study Selection/Data Extraction Relevant randomized control trials, meta-analyses, and guidelines were assessed for the use of CGM in older patients with T2DM. Articles were included based on relevance to the topic, detailed methods, and complete results. Data Synthesis CGM use in T2DM management in older people is not well defined. CGM may be a valuable technology in older people who face unique challenges, such as hypoglycemia, decline in cognitive function, and variable glucose levels. This article provides a review of recommendations for glucose monitoring in T2DM and discusses the role of specific CGM products. Conclusion CGM is a viable option for older people with T2DM to help improve overall diabetes control. Pharmacists can play an important role in educating patients about this technology.

espanolAntecedentes y objetivo Se espera que los adultos mayores de 60 anos en Colombia representen el 15,5% de la poblacion en el ano 2025. Esto aumentara la necesidad de servicios sociales y sanitarios de cuidado, especialmente por la presencia de multiples enfermedades a edades avanzadas. El objetivo fue determinar el estado de salud autoevaluado de adultos mayores con multimorbilidad y sus determinantes segun genero en un asegurador del sistema de salud colombiano. Metodologia Mediante un estudio transversal se analizaron las caracteristicas sociodemograficas, clinicas y estado de salud (cuestionario EQ-5D-3L) de 438 adultos mayores de 75 anos durante la primera consulta de geriatria de un programa de atencion integral. Se realizo un analisis de regresion lineal multivariable para identificar los determinantes del estado de salud. Resultados Las mujeres tuvieron peor estado de salud autoevaluado que los hombres (media [DE] del EQ-5D: 0,77 [0,20] vs. 0,65 [0,18]; p Conclusiones Los factores asociados al estado de salud de los adultos mayores de un programa de atencion integral en Colombia varian segun el genero. Esto permitira orientar de manera diferencial las intervenciones en salud de los programas de atencion al adulto mayor. EnglishBackground and objective In Colombia, older adults (60 years and older) are expected to represent 15.5% of the overall population by 2025. Consequently, the demand for social and healthcare services will increase, especially because of the numerous medical conditions associated with aging. The purpose of the present study was to determine the patient's self-rated health status of older adults with multimorbidity and its determining factors based on gender in an insurance company of the Colombian health system. Methodology A cross-sectional study was performed to analyze the sociodemographic and clinical characteristics of 438 patients older than 75 years as well as their self-rated health status (EQ-5D-3L questionnaire) during the first geriatric consultation of a comprehensive healthcare program. A multivariate linear regression analysis was performed to identify factors determining their self-rated health status. Results Women had a worse self-rated health status than men [mean (standard deviation) EQ-5D index score: 0.77 (0.20) vs. 0.65 (0.18); p Conclusions Factors associated with the self-rated health status of older adults who were part of a comprehensive healthcare program in Colombia varied according to gender. This study will help in approaching health interventions in healthcare programs for older adults in a differentiated manner.

This article presents an issue narrative non-systematic review about social network typologies for the older population. We analysed 18 studies with large samples from 14 countries worldwide. The position of family ties, network composition, network size, frequency of contacts and community participation are central to social network typologization in the older population. Restricted and diverse networks emerged in typologies associated, respectively, with less and more effective social support features, and are good predictors of well-being, health, mental health, social support and social participation. Cross-nationally, there is an unequal distribution of the construction of network typologies. The different typologies, that should be culturally grounded, provide guidelines to intervention planning, inform social service providers about emerging needs and contribute to social policy debate. Resumo O artigo apresenta uma revisão temática e narrativa não sistemática sobre tipologias de redes sociais pessoais da população idosa. Analisámos 18 estudos com amostras grandes de 14 países. A posição dos laços familiares, a composição da rede, o tamanho, a frequência de contactos e a participação comunitária são centrais na definição dos tipos de rede nesta população. As redes restritas e diversificadas emergem nas tipologias associadas, respetivamente, a menor ou maior apoio social, e são bons indicadores do bem-estar, saúde, saúde mental, apoio social e participação social. Transnacionalmente, verifica-se uma distribuição desigual da construção de tipologias. As diferentes tipologias, que devem ser culturalmente fundadas, fornecem diretrizes para planejar a intervenção, repensar serviços sociais e planejar políticas sociais.

Objectives The COVID-19 pandemic has provided a rich environment for ageist attitudes towards both older and younger people. However, publications on ageism during the outbreak have been mostly non-empirical and have concentrated on ageist beliefs directed towards older people. To overcome these limitations, we examined empirically the prevalence and the determinants of ageism towards older and younger people in the wake of COVID-19. Study design A cross-sectional study using an online survey was conducted with 503 Israeli adults (51.9% male, 79.5% Jews, mean age 47 years). Main measures We used a structured questionnaire that measured the following: COVID-19 ageism towards older people, COVID-19 ageism towards younger people, stereotyping, the experience of discrimination, perceived fears about contracting COVID-19, subjective knowledge about COVID-19, and sociodemographic characteristics. Results Overall, participants reported a relatively low level of COVID-19 ageism towards older people but a significantly higher level of COVID-19 ageism towards younger people. Hierarchical regressions revealed that negative age stereotypes were the most important determinants of both types of ageism. Sociodemographic variables (including age and majority/minority) were significant determinants only for COVID-19 ageism towards older people. That is, older and Jewish participants reported lower levels of this type of ageism. Conclusions Our findings demonstrate that negative age-related stereotypes have played a central role in ageist beliefs towards both older and younger people during the COVID-19 crisis. It is recommended that the public and scientific media start disseminating messages aimed at reducing rather than increasing negative stereotypes directed towards younger and older people.

Background Older people are projected to make up almost one third of the European population by 2060. Healthy and active ageing (HAA) is a key to maximising the opportunities that the increasingly older demographic presents. A multinational survey was conducted to inform a new online EU-based master’s programme in active ageing, and a fundamental initial issue to explore was stakeholders’ understanding of the concept of ‘active ageing’. Methods An anonymous online survey, in five partner countries (Ireland, Greece, Austria, Slovenia and Greece) asked senior undergraduates and recent graduates; future employers; relevant academics; and other key stakeholders (e.g. advocacy groups, policy makers, and ‘expert’ older people): ‘What does the term active ageing mean to you?’. Content analysis of their replies ensued. Results Within the first 473 responses, the most common concept (at nearly 50%) was active participation in society, including social engagement and other gainful activities, while hobbies and activities were also mentioned. The other main concept was that active ageing means favourable personal life qualities. This encompassed a broad range of aspects such as dignity, and physical, psychological, and social wellness. Health (physical and psychological), living longer in good health, and health promotion were often specified, while positive self-esteem, self-image, and self-respect were mentioned occasionally. Independence, including autonomy, ability to self-care, and decision-making and financial independence, was another key concept. Service provision in health and social care, and policy and rights were frequently mentioned. Most concepts were similarly reported in all five countries, but there were some nuances, such as Irish participants citing autonomy and service provision less often. Conclusion This European data highlights the understanding, among a range of stakeholders, of the concept of ‘active ageing’, as occurring at both a societal/service level, and at a personal level, with health, wellness and independence being key elements of the latter.

Background Social relationships play a fundamental role in individuals’ lives and health, and social isolation is prevalent among older people. Chronic non-communicable diseases (NCDs) and frailty are also common in older adults. Aims To examine the association between number of NCDs and social isolation in a cohort of community-dwelling older adults in the UK, and to consider whether any potential association is mediated by frailty. Methods NCDs were self-reported by 176 older community-dwelling UK adults via questionnaire. Social isolation was assessed using the six-item Lubben Social Network Scale. Frailty was assessed by the Fried phenotype of physical frailty. Results The median (IQR) age of participants in this study was 83.1 (81.5–85.5) years for men and 83.8 (81.5–85.9) years for women. The proportion of socially isolated individuals was 19% in men and 20% in women. More women (18%) than men (13%) were identified as frail. The number of NCDs was associated with higher odds of being isolated in women (unadjusted odds ratio per additional NCD: 1.65, 95% CI 1.08, 2.52, p = 0.021), but not in men, and the association remained robust to adjustment, even when accounting for frailty (OR 1.85, 95% CI 1.06, 3.22, p = 0.031). Discussion Number of self-reported NCDs was associated with higher odds of social isolation in women but not in men, and the association remained after considering frailty status. Conclusions Our observations may be considered by healthcare professionals caring for community-dwelling older adults with multiple NCDs, where enquiring about social isolation as part of a comprehensive assessment may be important.

Background Potentially Inappropriate Medications (PIMs) and polypharmacy are widely used indicators of suboptimal prescribing for older people. The aim of this study was to describe the changes in the prevalence of PIMs and polypharmacy among people aged 75 years and over between 2011 and 2019 in France. Methods PIMs and polypharmacy were assessed among people aged 75 years and over every two years between 2011 and 2019 using the French health insurance data system. Sixteen PIM criteria from the 2015 Beers and STOPP lists were assessed. Polypharmacy (5 to 9 drugs) and hyper-polypharmacy (≥10 drugs) were defined based on the average number of drugs dispensed per quarter. The Annual Percent Change (APC) and 95%CI were assessed using linear regression models after standardization of the prevalence on age and sex. Results The study population included 5,777,645 individuals over 75 years old in 2011 and 6,328,155 in 2019. The prevalence of PIMs decreased from 49.6 to 39.6% over the study period (APC: − 1.19% [− 1.35;-1.04]). Of the sixteen indicators assessed, the prevalence of thirteen decreased between 2011 and 2019. Benzodiazepines were the most frequent PIMs (34.7% in 2011 to 26.9% in 2019), followed by anticholinergic drugs (12.1% in 2011 to 8.3% in 2019), oral non-steroidal anti-inflammatory drugs (11.4 to 7.8%), and PIMs related to antihypertensive drugs (7.4 to 6.0%). Overall, women and individuals aged 85 years and older were more likely to receive PIMs. The prevalence of hyper-polypharmacy decreased from 30.5 to 25.9% over the study period. Conclusion This study, which is the first to assess the change in prevalence of PIMs and polypharmacy over time from comprehensive health data in France, highlights that PIMs and hyper-polypharmacy declined between 2011 and 2019. However, PIMs remains frequent for older people and often involves benzodiazepines.

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.

Background: Frailty has become a major health problem among Indonesian elders. Immunosenescence specifically inflammaging are essential components in the development of frailty. Early screening and timely tailored intervention may effectively prevent or delay the adverse outcomes in elders. This study measured the CD4/CD8 ratio from the immunosenescence pathway and plasma IL-6 levels as inflammatory markers from the inflammaging pathway and observed the correlations between robust and frail elders groups Methods: We conducted a cross-sectional survey. Using multistage random sampling, we enrolled 64 participants across Malang city, divided into frail and robust groups. We analyzed the plasma IL-6 levels and CD4/CD8 ratio using an independent t-test and the Mann–Whitney U test. Results: Significant differences between frail and robust elders were found in age and education level, with the frail participants being older than the robust (p=0.001) and lower educational level (p

Although the share of older people has been growing in Brazil in past decades, studies investigating trends in overweight and obesity prevalence in this population remain scarce. The objective of this study was to analyze the time trend of overweight and obesity prevalence in older adults in Brazilian State Capitals and the Federal District from 2006 to 2019. This is a time trend study based on data from the Surveillance System for Risk and Protective Factors for Chronic Diseases by Telephone Survey. The subsample used was composed of individuals aged 60 years or older (n = 202,049). Self-reported weight and height data were used to calculate Body Mass Index (BMI). Overweight (BMI ≥ 25 kg/m2) and obesity (BMI ≥ 30 kg/m2) prevalence were estimated per year for the total population and according to sex, age, schooling, region, and NCD presence. Prais–Winsten regression models were used to identify significant trends in overweight and obesity prevalence over the years. Overweight prevalence increased (p

This paper aims to develop a sensory methodological framework to explore older user's landscape experience. Applying empirical experience in Australian aged-care facilities, it addresses a methodological gap in the current literature to help move beyond the current taken-for-granted approaches such as interviews, cognitive mapping, behavioural observation and visual methods. We propose a more holistic method which enables the exploration of older people'sin situenvironmental experience. The multisensory framework we propose here is based on the first author's doctoral fieldwork experience that took place in two aged-care facilities in Brisbane, Australia. Findings suggest this framework facilitates an understanding of users’ olfactory, auditory and visual responses to the physical environment, and promotes a deeper engagement with the landscape. We argue that this is essential to promoting good landscape design which genuinely connects with older people's needs.

OBJECTIVE To determine the prevalence rates of frail, prefrail, robust and mobility disabled older adults living in retirement villages within regional Victoria, Australia. METHODS This cross-sectional, observational study invited residents of retirement villages to complete the self-report questionnaires Fried Frailty Phenotype and Frail Non-Disabled screening tool to classify respondents as frail, prefrail, robust and/or mobility disabled. RESULTS From 212 respondents, prevalence rates of frail and prefrail status were 34% and 35%, respectively. A fifth (20%) of residents were mobility disabled. The prevalence of residents classified as frail or prefrail (ie, not robust) was higher in women (74%) than in men (58%). Classification as not robust increased with increasing age. CONCLUSIONS This study is the first to estimate prevalence rates of frailty and mobility disability in retirement village residents in regional Australia. Findings from this study have potential to inform the development of facilities and programs to support people living in this setting.

This study focuses on older participants' experiences of and views on a lifelong learning program at the Hong Kong Polytechnic University in Hong Kong. As many third age adults tend not to have the opportunity to receive tertiary education when they were young, this program aims to fulfil their dream of studying at a university and boost their self-esteem and self-confidence. Using qualitative research methods, this research was conducted after the MiniU program (supported by the Institute of Active Aging of the Hong Kong Polytechnic University). Semi-structured interviews were conducted with 32 participants after the program. While participants had acquired knowledge and experience of university life from the Mini-U program, they also reported concerns and difficulties with participation including difficulties in memorizing course content and financial difficulties. The program has offered a unique opportunity for enhancing participants' interpersonal relationships and wellbeing. The research also further informs the development of creative lifelong learning programs aimed at improving the well-being of older people.

Currently the number of older people with chronic rheumatic diseases is increasing. Distinctive features of this population are the increased risk of cardiovascular and infectious diseases, tumours, as well as iatrogenic complications, while this group of patients is rather heterogeneous. On the one hand, modern biological and targeted synthetic drugs, provide new, previously inaccessible, treatment options; on the other hand, their use is associated with risk of side effects. In this review specifics of prescribing immunosuppressive drugs in older patients with rheumatoid arthritis and spondyloarthritis has been analyzed. An effective and safe approach to the use of these drugs in older people can be based on a comprehensive interdisciplinary approach, taking into account geriatric characteristics of the patients.

OBJECTIVES Little is known about the association between oral status and homebound status, and there is a possibility of a bidirectional relationship between them. In this exploratory prospective cohort study, we examined the association between four oral status measurements and being homebound bidirectionally. METHODS We used 2010-2016 panel data gathered from the Japan Gerontological Evaluation Study. All functionally independent participants aged 65 years or older (n = 26,579) were included in this study. Multiple imputation and Poisson regression were used for analyses. We adjusted for age, sex, education, comorbidity, and depressive symptoms. RESULTS In the fully adjusted model, the prevalence ratio (PR) of being homebound at follow-up was 1.42 for having

An increasing focus in aged care policy is supporting older people to age at home. However, there is little recognition of the health and independence of older private renters living in a space the...

Context Being involved in one's care is prioritised within UK healthcare policy to improve care quality and safety. However, research suggests that many older people struggle with this. Design We present focused ethnographic research exploring older peoples' involvement in healthcare from hospital to home. Results We propose that being involved in care is a dynamic form of labour, which we call ‘involvement work’ (IW). In hospital, many patients ‘entrust’ IW to others; indeed, when desired, maintaining control, or being actively involved, was challenging. Patient and professionals' expectations, alongside hospital processes, promoted delegation; staff frequently did IW on patients' behalf. Many people wanted to resume IW postdischarge, but struggled because they were out of practice. Discussion Preference and capacity for involvement was dynamic, fluctuating over time, according to context and resource accessibility. The challenges of resuming IW were frequently underestimated by patients and care providers, increasing dependence on others post‐discharge and negatively affecting peoples' sense and experience of (in)dependence. Conclusions A balance needs to be struck between respecting peoples' desire/capacity for non‐involvement in hospital while recognising that ‘delegating’ IW can be detrimental. Increasing involvement will require patient and staff roles to be reframed, though this must be done acknowledging the limits of patient desire, capability,and resources. Hospital work should be (re)organised to maximise involvement where possible and desired. Patient/Public Contribution Our Patient and Public Involvement and Engagement Panel contributed to research design, especially developing interview guides and patient‐facing documentation. Patients were key participants within the study; it is their experiences represented.