Search

PURPOSE: Although Alzheimer’s disease (AD) was described over a century ago, there remains no cure, and with the global demographic shift to older ages, the impact is increasing rapidly. This article summarizes how the conceptualization of AD has evolved in response to research advances. Current challenges, including the impact of multimorbidity are outlined and potential targets for prevention are discussed. RECENT FINDINGS: The ability to study AD neuropathology in vivo and results from longitudinal epidemiologic studies have led to a consensus that AD has a long preclinical course spanning decades. This view is driving efforts to identify early markers that will identify individuals at risk for AD dementia. SUMMARY: Critical questions remain regarding the pathological mechanisms underlying AD and their relation to clinical symptoms. Nevertheless, evidence suggests that interventions targeting modifiable risk factors may slow or prevent the onset of disease while the search for a cure continues.

Background Korean society is afflicted with rapid aging. Aging is a risk factor for pain, and pain can reduce patients' quality of life. Thus, adequate management and monitoring of changing trends accompanying the demographic shift are highly valuable. However, this study was conducted because no studies have investigated the recent changes in the prevalence of pain. Methods The extent of the prevalence of pain was determined by questions related to quality of life based on the data derived from the Korea National Health and Nutrition Survey (KNHNS) from 2005 to 2016. The annual frequencies of the pain group and severe pain group were calculated using the survey questionnaire. Multiple logistic regression analysis was performed to determine possible differences in prevalence by year. Results The prevalence of pain in all populations was 30.6% in 2005 and 18.9% in 2016. The average prevalence from 2005 to 2016 was 21.9%. A declining trend occurred over time with an odds ratio of 0.929 per year (95% CI: 0.921-0.938). The prevalence of severe pain was 2.35% in 2005 and 1.88% in 2016. Likewise, a decrease was observed over time, with an odds ratio of 0.920 per year at 95% CI 0.901-0.939. The decline in age-/sex-stratified analysis also showed a statistically significant trend in all groups. Conclusions The prevalence of pain in Korean society, based on the KNHNS, has declined since 2005. Such a trend was observed in all ages and sexs, and was most significant in the elderly.

Background In the field of veterinary surgery, women neither marry nor have children at the same rate as men, and those who do may experience more career disruption as a result. The American College of Veterinary Internal Medicine (ACVIM) is 1 of the few areas of specialized medicine that is predominantly female; it is unknown if such a demographic shift would produce a different environment for individuals cultivating their personal life. Hypothesis/objectives To report data regarding subjective and objective aspects of the intersection of the personal and professional lives of Diplomates of the ACVIM. Sample Eight hundred ninety-six surveys (781 completed) of ACVIM Diplomates, including cardiology, large and small animal internal medicine, neurology, and oncology. Methods An 82-item online survey was distributed to ACVIM Diplomates via Diplomate college listservs. Participation was voluntary. Results Men were more likely to be married and have children than were women. Women had or adopted their first child at a later career stage compared with men, and agreed more strongly that career stage was an influential factor in family planning. Those with children worked fewer hours compared with those without, and this effect was greater among women. Women were more likely to require external childcare, but most men and women shared childcare responsibilities equally outside of working hours. Conclusions and clinical importance The intersection of personal and professional life differs between men and women in the ACVIM, which may create different needs, preferences, or barriers to work-life balance in the workforce.

Over the last century, Western societies experienced a demographic shift driven by increased lifespan and decreased fertility, resulting in the subversion of the world's demographic pyramid. In ageing societies, cardiovascular diseases are the major cause of morbidity and mortality, thus representing a major societal and economic burden. Indeed, ageing associates with the deterioration of a genetic network implicated in senescence and longevity, orchestrating deleterious cellular processes that converge in the structural and functional decline of both the myocardium and the vasculature. In this review, we revise a compendium of genes involved in these processes and delineate possible strategies to interfere with them. Dietary interventions (eg intermittent fasting) and sirtuin-activating compounds are among the most promising interventions shown to promote protective effects on the ageing cardiovascular system. We conclude that ageing and longevity genes modulate cardiovascular function by acting on deleterious downstream processes such as inflammation and oxidative stress, thus representing promising targets for the prevention and treatment of age-related cardiovascular dysfunction.

Background: Quality of life of elderly is becoming even more relevant with demographic shift happening towards an ageing society. With fast changing family condition and social contexts, lives of elderly people in Nepal have been changing dramatically. Old age homes have sprung up to cater to the needs of the elderly from different socio-economic backgrounds. The objective of this study is to compare the quality of life of senior citizens of selected old age homes and own residence and to find the association of quality of life with selected study variables.Methods: A comparative study was conducted among 120 senior citizens from Dhankuta, Morang and Sunsari districts of Koshi zone. Two strata were formed based on their residence, i.e., old age homes and own residence. Equal proportion of the samples were selected from both the settings. Data was collected using interview schedule through pretested semi-structured and standard World Helth Organization, quality of life – old questionnaires. Results: More than one fifth (23.33%) of research participants were from the age group 65-69 and 75-79 and more than half (55%) of them were female. More than half (58.33%) of the research participants residing in their own residence had high quality of life level, while among those residing in the old age homes, only about 40% had high quality of life level. Quality of life level was found to be significantly associated with sex and educational status of the research participants. Conclusions: Quality of life was found to be better among the people residing in their own residence as compared to those residing in old age homes.Keywords: Old age homes; quality of life; senior citizens

The last few decades have witnessed a global rise in the number of older individuals. Despite this demographic shift, morbidity within this population group is high. Many factors influence healthspan; however, an obesity pandemic is emerging as a significant determinant of older people’s health. It is well established that obesity adversely affects several metabolic systems. However, due to its close association with overall cardiometabolic health, the impact that obesity has on cholesterol metabolism needs to be recognised. The aim of the present review is to critically discuss the effects that obesity has on cholesterol metabolism and to reveal its significance for healthy ageing.

Background: The percentage of female medical students has been significant elevating worldwide. The demographic shift is expected to influence the proportion of male versus female surgeons soon. The objective of this study was to evaluate the gender differences in the acquisition of robotic suturing skills. Methods: We compared the robotic suturing performance between 39 male and 19 female medical students. We separated the training into two parts: phase I, involving virtual reality (VR) robotic simulation, and phase II, involving robotic dry-laboratory simulation training. Participants first conducted step-by-step exercises on the VR robotic simulator and then the robotic skin-suturing pad using the da Vinci robot. Results: The metric analysis of the VR task “suture sponge” showed that female students required less time (difference: −170.7 seconds, 95% CI: −247.4 to −94.0) and had fewer errors (error difference: −50, 95% CI: −74.2 to −25.8) to complete the suture sponge exercise compared to male students. Moreover, female students completed more stitches than male students (differences in mean stitch achieved: .35; 95% CI: .06 to .65). However, there was no difference in the quality scores of stitches by gender (p = 0.85). Conclusion: Female medical students performed better in the VR task of suture spongy and achieved more stitches than male students with the da Vinci system despite no difference in robotic suture quality by gender. Because this is the first study comparing gender performance on a robotic platform, further studies are required to investigate if different training approaches will affect the performance by gender. Keywords: Robotic surgery, Simulation, Gender difference, Virtual reality, Medical education

Successful management of HIV infection as a chronic condition has resulted in a demographic shift where the proportion of people living with HIV (PLWH) older than 50 years is steadily increasing. A dedicated clinic to PLWH older than 50 years was established at Chelsea and Westminster Hospital in January 2009 and then extended to HIV services across the directorate. We report the results of a service evaluation reviewing 10 years of activities of this clinic between January 2009 and 2019. We aimed to estimate the prevalence of major noninfectious comorbidities, polypharmacy (≥5 medications), and multimorbidity (≥2 non-HIV-related comorbidities) and describe algorithms devised for use in HIV outpatient clinics across the directorate. A cohort of 744 PLWH older than 50 years attending this service were analyzed (93% male; mean age of 56 ± 5.5 years; 84% white ethnicity); 97.7% were on antiretroviral treatment and 95.9% had undetectable HIV-RNA at the time of evaluation. The most common comorbidities diagnosed were dyslipidemia (50.1%), hypertension (21.5%), mental health disorders (depression and/or anxiety disorders, 15.7%), osteoporosis (12.2%), obesity (11.9%), chronic kidney disease (7.5%), and diabetes (5.8%). Low vitamin D levels were found in 62% of patients [43% with vitamin D deficiency (40 mmol/liter) and 57% with vitamin D insufficiency (40-70 mmol/liter)]. The overall prevalence of polypharmacy and multimorbidity was 46.6% and 69.3%, respectively. This study showed significant rates of non-HIV-related comorbidities and polypharmacy in PLWH older than 50 years, leading on to the implementation of clinical care pathways and new joint HIV/specialty clinics (cardiology, nephrology, neurology, metabolic, menopause, and geriatric) to improve prevention, diagnosis, and management of major comorbidities in people aging with HIV.

BACKGROUND There is a demographic shift toward older patients receiving home parenteral nutrition (HPN), but data on clinical outcomes are limited. The objective of this study was to determine differences between older and younger HPN patients in regard to HPN indications, prescriptions, and outcomes over the first 2 years receiving HPN. METHODS This was a retrospective analysis of prospectively collected data from HPN adult patients entered in the Canadian HPN Registry. New HPN patients enrolled between 2003 and 2017 and receiving HPN for at least 2 years were selected. Data included demographics, PN prescriptions, catheter-related bloodstream infections (CRBSIs) over the past year, survival, and quality of life based on Karnofsky Performance Status (KPS). RESULTS Four hundred two patients were included: 184 patients were ≥60 years old, and 219 patients were between 18 and 59 years old. There were no differences in the main indications for HPN, body mass index (BMI), and PN prescriptions at baseline. At 2 years, younger patients received more energy from PN than older patients (27.9 vs 19.6 kcal/kg; P < .001), but BMI remained comparable. There were fewer CRBSIs in the older group (20% vs 36%, P = .0023), but 78% of younger patients remained alive vs 69% in the older group (P = .0401). In those alive, the proportion of patients continuing to receive HPN was comparable and the proportion of patients with a KPS ≥60. CONCLUSIONS Older HPN patients have similar clinical characteristics as younger patients but have fewer CRBSIs and higher 2-year mortality.

Population shifts in the workforce have been noted for the past few decades. In the United States, the number of people aged 65 and older is expected to double, reaching almost a quarter of the population.1 By 2045, the US is expected to experience a demographic shift, with an increase in the percentage of minority populations to greater than 50%.

The presence of women in genitourinary (GU) specialty training and practice has lagged significantly behind other fields. Current challenges include maternity leave, sexual harassment, and pay disparities. Despite these obstacles, the prevalence of women in GU specialty training has risen rapidly. One consequence of retiring male providers and higher numbers of female graduates will be a notable demographic shift in the percentage of GU care provided by these younger women. It will be essential to anticipate and acknowledge the unique concerns of this workforce, particularly in light of the concomitant aging of the US population and the associated increase in demand for GU care.

As we are passing through an era of a demographic shift, we now have millions of older citizens around us. Growing old is not easy, either on bodies or minds. As we grow older, our knowledge grows, our experience grows, but at the same time, we lose so many things with our progression toward elderhood. Our general cognitive ability tends to decline throughout adulthood, and as an obvious consequence, the number of dementia patients is increasing in every part of the globe. Dementia, which is considered the progressive deterioration of the cognitive function of an individual, is one of the leading causes of death in the current world. Dementia is probably the most unrecognized and undertreated chronic condition in the present world. As there is no definitive curative management available, this is one of the significant public health concerns. This chapter discusses various aspects of dementia and its types, causes, and management, including the virtual dementia tour.

BACKGROUND Increasing life expectancy has led to higher incidence of fragility fractures of the pelvis. These demographic changes may have a direct impact on fracture patterns. The goal was (1) to evaluate demographical trends in patients with pelvic ring injuries at a tertiary Swiss trauma center and (2) to analyze the influence on fracture patterns. METHODS We performed a retrospective cross-sectional study including 958 patients (mean age 57 �� 21 years, 48% women) with a pelvic ring injury between 2007 and 2017. Fractures were classified according to Tile, Young and Burgess or Rommens and Hofmann (fragility fractures) using conventional and CT imaging. Low-energy fractures were defined as fractures resulting from fall from standing height or less. Fracture classifications, age, gender, injury severity score (ISS) and trauma mechanism were compared using analysis of variance (ANOVA) or chi-square test. Cluster analysis was performed to identify groups with similarities in fracture patterns and demographic parameters. RESULTS From 2007 to 2017, the frequency of pelvic ring injuries increased by 115% (increase per decade), mean age increased by 15% (p = 0.031). A trimodal age distribution was found; highest increase for fractures occurred in the 'older' (265%) patient group. Low-energy fracture was the most common trauma mechanism (43% of all fractures, an increase of 249%). Changes in fracture pattern showed a disproportioned increase of 'lateral compression (LC)' fractures (LC type 1 in 64%) or partially stable fracture (B2: with 39%). In patient aged over 65 years, the strongest increase was found for 'non-displaced posterior' fractures with an overall prevalence of 62%. Five clusters were found with the most frequent cluster representing 'older female patients with low-energy fracture (LC, Tile type B)' in 30%. CONCLUSION The current results corroborate the trend of increasing frequency of fragility fractures in an aging society. The demographic shift has a direct impact on fracture pattern with a disproportionate increase in partially stable compression fracture of the pelvis. LEVEL OF EVIDENCE Level III.

Generations are cohorts of individuals born in a particular time period who share similar values or value systems owing to historic events that occurred at crucial times during their development. Generations are defined to study how views and values change over time and to assess the differential impact that formative experiences have on groups. Understanding and navigating generational differences will be a critical skill for radiology leaders in the coming decade, as four distinct generations are working side by side for the first time in history. The four generations currently in the workforce are categorized as traditionalists, baby boomers, Generation Xers, and millennials. Beginning in 2016, millennials became the largest generation in the U.S. workforce, surpassing the number of Generation Xers. This major demographic shift will have a profound impact on workplace culture, recruitment efforts, and trainee education. While each generation has similar basic needs, meeting those needs and motivating individuals of different generations are best accomplished using different approaches. Radiology leaders must encourage and support these varied generations to work harmoniously to foster high-performance organizations. ©RSNA, 2018.

The number of Americans over the age of 65 has been growing much faster than the overall population's growth rate. These changes can be largely attributed to the improvement in life expectancy. This demographic shift yields a unique and exciting opportunity to provide both expedient and cost-efficient care to a growing patient population.

China faces an aging tsunami. By the end of 2016, the number of older adults aged 60 and older reached 230 million. This number is projected to reach 418 million by 2035 and peak at 487 million by 2053. The number of individuals aged 80 and older, the oldest adults, reached 26 million and continues to grow by 1 million a year. The socioeconomic context, characterized by an inverted pyramid family structure and the number of "empty nesters," has greatly compromised traditional Chinese family support for older adults. This article aims to provide an overview of geriatrics development in China. It begins with a brief account of the dramatic demographic shift, major socioeconomic factors, China's healthcare system, and reform related to senior health with a historical perspective. It then describes recent advances in government policy and support and development of a geriatrics physician workforce, care models, primary care networks, and privately owned senior care facilities and support services. Although it is impossible to cover all aspects of the topic, it is hoped that this article provides readers an overall picture of Chinese geriatrics and senior healthcare development in a complex and evolving healthcare system. Geriatrics communities in the United States and around the world will undoubtedly learn and benefit from the unparalleled and continued efforts to address this unprecedented opportunity and challenge in China.

[Figure][1] ![Figure][1] ![Figure][1] Over the past 2 decades, the engagement of the cardiology community in the unique care considerations of older adults has been transformational. In part due to the demographic shift as well as the arrival of new therapeutic options, our

Increasingly, humans are an urban species prone to ‘plant blindness’. This demographic shift and situation has implications for both individual and collective perceptions of nature, as well as for ...

Although the current low workforce availability of care of the elderly (COE) physicians, geriatric medicine specialists, and geriatric psychiatrists is undeniable, the ongoing demographic shift means this situation will only worsen. This evolving crisis is outlined clearly in the article “Updated Inventory and Projected Requirements for Specialist Physicians in Geriatrics” by Basu et al. found in this issue of the Canadian Geriatrics Journal.

Alongside a globalized world and a demographic shift in Sweden, future nurses must provide globally significant nursing care based on relevant knowledges and skills. To contribute to the global nursing discourse, this article aims to describe the process undertaken in developing and implementing a global nursing approach and curriculum in the Swedish Red Cross undergraduate nursing program. A comprehensive process of educational change was carried out, targeting both faculty and students with various academic activities. The new global-oriented curriculum was evaluated positively by nursing students, and a definition of global nursing was disseminated among educators. Nursing students at the Swedish Red Cross University College are now encouraged to advocate for vulnerable persons in need of healthcare services and to counteract inequalities and social injustice in sustainable ways. It is suggested that a global nursing framework is what is required when educating nurses to meet tomorrow’s nursing care needs.

PURPOSE/OBJECTIVES In view of the demographic shift, undergraduate dental students should be prepared for growing numbers of older people and their specific needs. The study examines changes in undergraduate dental teaching in Austria, Germany and Switzerland between 2004 and 2014. METHODS Questionnaires were mailed in 2004, 2009 and 2014 to all deans and all department heads of Austrian (n = 4), German (n = 30) and Swiss (n = 4) dental schools. RESULTS Response rates were 51% for deans and 47% for heads of department. Gerodontology was taught in 5 German universities, all 3 Swiss and 1 Austrian dental school. Aspects of gerodontology were included in traditional core subjects; however, in a large number of German (88%) and Austrian (50%) universities, dedicated lecture series and seminars are lacking. Changes over time indicate firmly established teaching in Switzerland, minor fluctuations in Austria and reduced dedicated teaching activities in Germany. CONCLUSIONS Inclusion of gerodontology in the national syllabus is a decisive factor for the integration of the subject into undergraduate courses. The recommendations of the European College of Gerodontology (2009) regarding didactical and practical teaching should be implemented in the respective compulsory syllabus to prepare current undergraduate dental students for the challenges of tomorrow.

The methadone maintenance treatment (MMT) has been initiated in Wuhan, China since early 2006. To understand the social-demographic, behavioral, and infectious diseases characteristics of drug users enrolled in their first-ever-MMT between 2006 and 2015, a retrospective observational study was implemented to also provide evidence for health policy-decisions to reduce harm and control disease. Pearson chi-square tests and t-tests were used to assess significant differences between two 5-year periods, 2006–2010 and 2011–2015. We observed increases in the mean age (38.65 vs. 42.43 years, P

BACKGROUND The aim of this study is to describe the influence of geography, socio-economic development, and demographic shift on the trends in global incidence, mortality, and prevalence of liver cancer (LC). METHODS Data (2012-2030) relating to LC and demographic shifts based on WHO regions and HDI areas were extracted from GLOBOCAN 2012 and analyzed to evaluate trends in incidence, mortality, and prevalence. RESULTS The results of our study document a rising global burden of LC with the maximum impact in the WPRO region. We did not observe a definite association between LC and higher socio-economic status with the highest burden in the MHD region. For the MHD region, we noticed age reversal in burden from the younger age group currently to the older age group in the future (2030). Another finding is the high burden and early onset of disease in some low-income countries such as Mongolia, Lao PDR, and Vietnam. CONCLUSION The results of our study demonstrate a rising global burden of LC with some significant but uneven trends based on geography, age, and socio-economic status. This information can be used to shape policy and aid strategic targeting of resources to areas with the highest burden.

One of the primary risk factors in the development of cancer is older age. The demographic shift to an ageing population has given rise to an increased number of older patients with cancer. The extreme heterogeneity within this population renders applying standardised treatment pathways hazardous [1]. Disparities in physiological reserve and an increased risk of multiple comorbidities further exacerbates the complexity of cancer treatment management in older patients [2]. Individual modifications to tailor treatment for each specific patient would be the gold standard; thus, detailed patient assessment providing a comprehensive health profile in addition to existing diagnostic test results are paramount when devising a personalised treatment care approach [3].

Joint cartilage has been a significant focus on the field of tissue engineering and regenerative medicine (TERM) since its inception in the 1980s. Represented by only one cell type, cartilage has been a simple tissue that is thought to be straightforward to deal with. After three decades, engineering cartilage has proven to be anything but easy. With the demographic shift in the distribution of world population towards ageing, it is expected that there is a growing need for more effective options for joint restoration and repair. Despite the increasing understanding of the factors governing cartilage development, there is still a lot to do to bridge the gap from bench to bedside. Dedicated methods to regenerate reliable articular cartilage that would be equivalent to the original tissue are still lacking. The use of cells, scaffolds and signalling factors has always been central to the TERM. However, without denying the importance of cells and signalling factors, the question posed in this chapter is whether the answer would come from the methods to use or not to use scaffold for cartilage TERM. This paper presents some efforts in TERM area and proposes a solution that will transpire from the ongoing attempts to understand certain aspects of cartilage development, degeneration and regeneration. While an ideal formulation for cartilage regeneration has yet to be resolved, it is felt that scaffold is still needed for cartilage TERM for years to come.

The population of India is aging rapidly. Between 2001 and 2031, the percentage of people 60 years and older will almost double, and by mid-century will increase to an estimated 20%. In general, this has been brought about by the continuing declines in “communicable, maternal, neonatal and nutritional” causes of morbidity and mortality, to an increased burden of disease from non-communicable illness and injuries, including self-harm. The resulting demographic shift brings with it a host of challenges to the health and well-being. For example, diseases of the elderly, e.g., cardiovascular conditions, diabetes, and cancer, are now among the leading causes of morbidity and mortality in India, and the prevalence rates of these conditions are expected to increase significantly in the coming decades. Still, the government attitude toward to it is in sad state and need to be talked. In India where we regard the old age people high on ground of our ethics and still a large population are started abandoning their old age parents and its difficult time for them as they were in their last years of life and need extra care on health and many things. In rural area it’s a bad condition with respect to govt. policies implication. This paper talks about all the problem related with ageing and well-being India with data available and tries to link all the aspect.

The demographic shift toward older populations of physicians is well documented across much of the globe. As a result, it is becoming imperative that academic organizations generate research to inform understanding of both individual and institutional needs relating to these faculty members. The 2 reports by Skarupski and colleagues in this issue of Academic Medicine build on the research that is available, expose some new areas for consideration, and raise new lines of inquiry for researchers interested in studying late-career faculty and faculty transitions. The author of this Invited Commentary aims to situate Skarupski and colleagues' findings relative to what the academic medicine community knows-and does not know-about late-career faculty members, the institutions that employ these faculty, and the complex relationships therewith. Specifically, the author explores the following: the demographics of those considering retirement; the connection between identity and retirement decisions; the alignment between institutional and faculty member needs; institution preparedness; mentoring; and theoretical constructs and areas for inquiry that may inform future investigations.

Objectives This study had two objectives: (1) to determine if, in the United States of America (US), the proportion of non-US citizen international medical graduates (non-US IMGs) entering pathology residencies had increased (again) in 2019 and (2) to assess how this multi-year trend might impact transfusion medicine in the US. Methods The most recent (2019) “National Resident Matching Program” (NRMP) data were analyzed. To assess potential future impact, using controversies related to Plasmodium falciparum (Pf) malaria, conflicting US and non-US perspectives were reviewed. Differences between published US and non-US views were identified regarding, for example, the value of Pf-resistant (“variant”) red blood cells (RBCs) and exchange transfusions. Results Year 2019 is the first year non-US IMGs were the largest group to fill residency-training positions for a major US specialty via the “Main Residency Match.” Also notable, US and non-US views were found to differ markedly regarding (1) the value and safety of Pf-resistant RBC variants and exchange transfusions, and (2) the threat of drug-resistant Pf-malaria parasites. Non-US clinicians and researchers seem more concerned about Pf-malaria, and their interest in cellular therapies seems greater and more optimistic. Conclusions In 2019, the historically high proportion of non-US IMGs among incoming pathology residents dramatically highlights the steady demographic shift that began years ago: “the internationalization of pathology” in the US. Fortunately, a review of publications related to exchange transfusion, Pf-malaria, and variant RBCs suggests non-US IMGs may markedly promote and advance cell therapies such as therapeutically-rational exchange (T-REX) of disease-resistant RBCs.

In the United States, osteoporosis affects over 10 million adults, has high societal costs ($22 billion in 2008), and is currently being underdiagnosed and undertreated. Given an aging population, this burden is expected to rise. We projected the fracture burden in US women by modeling the expected demographic shift as well as potential policy changes. With the anticipated population aging and growth, annual fractures are projected to increase from 1.9 million to 3.2 million (68%), from 2018 to 2040, with related costs rising from $57 billion to over $95 billion. Policy‐driven expansion of case finding and treatment of at‐risk women could lower this burden, preventing 6.1 million fractures over the next 22 years while reducing payer costs by $29 billion and societal costs by $55 billion. Increasing use of osteoporosis‐related interventions can reduce fractures and result in substantial cost‐savings, a rare and fortunate combination given the current landscape in healthcare policy. © 2019 The Authors. JBMR Plus published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research.

The global population is aging, and with this demographic shift, the incidence and prevalence of dementia are expected to increase. According to the World Health Organization, an estimated 50 million people are living with dementia worldwide, and this number is expected to triple to 150 million by 2050. Dementia initially affects the brain, eventually affecting the entire body culminating in death, commonly from the complications and comorbidities. People with dementia often experience eating difficulties in addition to a severe decline in cognitive, verbal, and functional abilities secondary to gradual neurodegenerative process, leading to weight loss, malnutrition, and dehydration. When eating difficulties and weight loss occur, health care providers and families often feel obligated to decide to either continue the oral feeding or opt for feeding tube placement. Primary care clinicians, both nurse practitioners and physicians, are presented with challenges when facilitating the decision regarding the feeding options in patients with advanced dementia. This narrative review aims at evaluating the impact of enteral nutrition versus oral feeding by comparing the rates of survival and adverse events in older adults with advanced dementia. It also highlights the best approaches to optimizing nutrition for this frail population.

e24047 Background: The incidence of colorectal cancer in patients younger than 50 has been increasing over the past 2 decades. This demographic shift has important implications for survivorship care, in particular regarding issues of future fertility especially in light of USPSTF’s recommendation for colorectal cancer screening to begin at 45. Although ASCO has longstanding recommendations for fertility counseling in patients with cancer, the rates of fertility counseling in younger patients with colorectal cancer are unknown. Methods: Records for new patient visits for colorectal cancer in patients younger than age 55 in a large academic cancer center between 2012 and 2019 were queried for patient demographics, disease characteristics, and documentation of fertility counseling. Associations between demographic/clinical characteristics and fertility counseling were explored. Univariate and multivariable logistical regression analyses were performed using SAS v9.4. Results: Among 194 patients who met inclusion criteria, 39.2% of patients were female, 10.4% were African American, 31.4% had rectal cancer, and 69.6% were treated with curative intent. Approximately 14.5% of patients had Medicaid insurance. Age ranged from 22-55. The overall rate of fertility counseling among all patients was 15.5%. Of these patients, 43.3% were male. In univariate analysis, age less than or equal to 40 (p < 0.01), female gender (p = 0.03) and curative intent therapy (p = 0.03) were associated with fertility counseling. These factors were again statistically significant in multivariate analysis: age < 40, female, and curative intent therapy (Table). Race, stage of cancer, insurance status, prior exposure to chemotherapy, year of diagnosis and colon vs rectal cancer were not associated with counseling. Conclusions: The rate of fertility counseling was very low among patients with colorectal cancer, and exceptionally low among men. Despite changes in the demographics of colorectal cancer, it does not appear that appropriate changes have been made in fertility counseling. Increases in fertility counseling were not seen in more recent years despite recognition of increasing incidence in younger patients. Additional studies to identify barriers to counseling and strategies to improve survivorship care are urgently needed.[Table: see text]

Background The aim of this study is to describe the trends and variations in the global burden of gallbladder cancer (GBC) with an emphasis on geographic variations and female gender. Methods Data (2012-2030) relating to GBC was extracted from GLOBOCAN 2012 database and analyzed. Results The results of our study document a rising global burden of GBC with geographic and gender variations. The highest burden was noted in the WPRO region (based on WHO regions), Asia (based on continents) and India, Chile, and China (based on countries). The less developed regions of the world account for the majority of the global burden of GBC. The geographic variations are also present within individual countries such as in India and Chile. Females are afflicted at a much higher rate with GBC and this predilection is exaggerated in countries with higher incidence such as India and Chile. In females, people of certain ethnic groups and lower socio-economic standing are at a higher risk. Conclusions Our study demonstrates a rising global burden of GBC with some specific data on geographic and gender-based variations which can be used to develop strategies at the global as well as the high-risk individual country level.

Zusammenfassung Entwicklungen wie der Rückgang land- und forstwirtschaftlicher Betriebe sowie der demografische Wandel stellen die österreichische Landwirtschaft sowie das Gesundheitssystem vor enorme Herausforderungen in der Zukunft. Ein möglicher unterstützender Lösungsansatz für die strukturellen und finanziellen Herausforderungen der landwirtschaftlichen, gesundheitlichen und gesellschaftlichen Entwicklungen bietet das Modell Green Care Tagesbetreuung für SeniorInnen. Die Green Care Tagesbetreuung auf landwirtschaftlichen Betrieben ermöglicht vor allem Bäuerinnen mit einer sozialen Grundausbildung den Schritt in die Selbstständigkeit. Um die Umsetzbarkeit von niederländischen Referenzprojekten in Österreich überprüfen zu können, wurden im Rahmen einer empirischen Erhebung Experteninterviews in Österreich sowie in den Niederlanden durchgeführt. Es zeigt sich, dass Green Care Tagesbetreuung für einzelne land- und forstwirtschaftliche Betriebe eine sinnvolle Ergänzung zur bestehenden Betriebsausrichtung darstellen kann, wenn hierfür ein entsprechender Rahmen gegeben ist.

The global demographic shift to an older population has led to the emergence of the new field of geriatric neurosurgery. Beyond the complexities of disease states and multimorbidity, advanced age brings with it intricate ethical issues pertaining to both the practice and provision of medical and surgical care. In this paper, the authors describe the central ethical themes seen across the spectrum of common neurosurgical conditions in the elderly and highlight the use of foundational ethical principles to help guide treatment decision-making.

Supplemental Digital Content is available in the text., Introduction: Factors affecting exclusive breastfeeding rates are complex. Evaluations for early-onset sepsis can negatively impact breastfeeding success. We sought to determine whether implementing an algorithm utilizing the sepsis risk score (SRS) in chorioamnionitis-exposed newborns would increase exclusive breastfeeding rates. We collaborated with healthcare systems experts to analyze and understand our outcomes. Methods: We describe a retrospective cohort study of chorioamnionitis-exposed newborns 35 weeks and older gestation in the Mother-Baby Unit at our institution following a quality improvement project that implemented an SRS algorithm. We compared exclusive breastfeeding rates over 2 time periods, 33 months before and 15 months after SRS algorithm implementation. We completed bivariate comparisons using chi-square and Mann–Whitney U tests to understand the factors contributing to exclusive breastfeeding rates. In a secondary analysis, breastfeeding rates and demographic patterns were examined using p-charts. Results: Following algorithm implementation, exclusive breastfeeding rates increased from 49% to 58% (P = 0.10) in chorioamnionitis-exposed newborns. Factors associated with increased exclusive breastfeeding included Caucasian race, English as the primary language, private insurance, vaginal delivery, and positive group B Streptococcus status. In the secondary analysis, the proportion of non-Hispanic mothers increased from 63% to 80% during the study. Conclusions: Despite SRS implementation, exclusive breastfeeding rates increased but not significantly, and certain sociodemographic factors remain associated with exclusive breastfeeding. Secondary analysis revealed an overall demographic shift affecting the dataset, highlighting the importance of thorough data analysis when evaluating a quality improvement project.

e24081 Background: The incidence of colorectal cancer in patients younger than 50 has been increasing over the past two decades. This demographic shift has important implications for survivorship care, in particular regarding issues of future fertility. Although ASCO has a longstanding recommendation for fertility counseling in patients with cancer, the rates of fertility counseling in younger patients with colorectal cancer are unknown. Methods: Records for new patient visits for colorectal cancer in patients younger than age 55 in a large academic cancer center between 2016 and 2019 were retrospectively queried for patient demographics, disease characteristics, and documentation of fertility counseling. Associations between patient demographic/clinical characteristics and receipt of fertility counseling were explored. Univariate analyses and multivariable logistical regression analyses were performed using SAS v9.4. Results: Among the 136 patients who met inclusion criteria, 37.5% of patients were female, 16.2% were African American, 31.6% had rectal cancer, 20.7% of patients had Medicaid insurance. 63.7% were treated with curative intent. Age ranged from 22-55 (median = 46). Among all patients, 21/136 (15.4%) had documented fertility counseling. Of these, 11/51 (21.6%) patients were female and 10/85 (11.8%) were men. In univariate chi-square analysis, age less than or equal to 40 was associated with fertility counseling (p < 0.001) and curative intent therapy was numerically but not statistically associated with fertility counseling (p = 0.07). In multivariable analysis with logistical regression, age less than 40 (OR = 3.90, 95% CI [1.95, 7.81]), female gender (OR = 2.37, 95% CI [1.16, 4.84]), and curative intent therapy (OR = 3.26, 95% CI [1.14, 9.35]) were associated with fertility counseling. Race, stage of cancer, insurance status, prior exposure to chemotherapy, and colon vs rectal cancer were not associated with fertility counseling. Conclusions: The rate of fertility counseling was very low among patients with colorectal cancer, and exceptionally low among men with colorectal cancer. Despite changes in the demographics of colorectal cancer, it does not appear that appropriate changes have been made in fertility counseling. Additional studies to identify barriers and implementation strategies for fertility counseling are urgently needed in a disease that affects more young patients each year.

As lifespans increase, the number of older-aged adults in the United States and many other countries worldwide is increasing. This demographic shift in the United States has been driven in part by the aging of the so-called baby boomers (those born between the years following the end of World War II in 1946 and about 1964). By 2030, approximately one out of every five Americans will be above the age of 65 years (Ortman et al., Econ Stat Adm US Dep Commer [Internet]. 2014;1964:1–28. Available from: https://www.census.gov/prod/2014pubs/p25-1140.pdf). This projected growth of older people means that most physicians, including ophthalmologists, will have to acquire skills in evaluating and treating the unique physiologic and pathologic changes which are common in older patients. This chapter reviews physiologic and pathologic changes of the aging eye and reviews interventions which can prevent diseases that affect vision and cause disability.

Long considered as a paediatric pathology, cystic fibrosis concerns in France more adults than children since 2015. Considering this demographic shift, the way healthcare is organized requires constant adaptation, particularly in the care of adults where new needs are rapidly emerging.

Otília Menyhárt,1,2 János T Fekete,2 Balázs Győrffy1,2 1MTA TTK Lendület Cancer Biomarker Research Group, Institute of Enzymology, Hungarian Academy of Sciences, Budapest, Hungary; 22nd Department of Pediatrics, Semmelweis University, Budapest, Hungary Background: Population aging is a common demographic pattern in developed countries, and aging increases the risk of cancer. The disproportionately high cancer burden, as a consequence, is especially pronounced in Central and Eastern European countries, including Hungary. Methods: We summarized current and projected future cancer incidences and mortalities utilizing data from the last two decades. Predictions are based on cancer incidence and mortality collected between 1996 and 2015 in Hungary. In addition to the crude rates, data were age standardized to the European standard population (ESP) of 2013, ESP of 1976, and local census of 2011.Results: The lifetime probability of developing cancer and cancer-related mortality has already reached 56.9% and 27.6% in men, respectively, and 51.9% and 21.7% in women. Between 2016 and 2030, the total population is expected to shrink by 6%, while the number of 60-year olds and above will grow by 18%. This will lead to a 35% increase in cancer incidence and 30% increase in cancer death among 65–85-year olds. Joinpoint regression identified the period 2007–2015 as starting point for this coming increase in new cases. In women, lung and breast cancer will increase yearly by 1.9% and 1.7%, respectively, between 2016 and 2030, while in men, the prostate and colorectal cancer rates will increase yearly by 3.6% and 2.1%.Conclusion: In the aging population of Hungary, cancer incidence will increase considerably over previous projections. Although a large portion of the most rapidly rising cancers are avoidable by implementing public health programs, a substantial portion remains inevitably incurable. Keywords: cancer, biostatistics, aging, lung cancer, colon cancer, breast cancer, prostate cancerA Letter to the Editor has been received and published for this article.&nbsp

The global population, including the United States, is experiencing a demographic shift with the proportion of older adults (aged ≥ 65 years) growing faster than any other age group. This demographic group is at higher risk for developing nutrition-related chronic conditions such as heart disease and diabetes as well as infections such as influenza and pneumonia. As a result, an emphasis on nutrition is instrumental for disease risk reduction. Unfortunately, inadequate nutrient status or deficiency, often termed hidden hunger, disproportionately affects older adults because of systematic healthcare, environmental, and biological challenges. This report summarizes the unique nutrition challenges facing the aging population and identifies strategies, interventions, and policies to address hidden hunger among the older adults, discussed at the scientific symposium “Hidden Hunger: Solutions for America’s Aging Population”, on March 23, 2018.

Japan, as a ‘super-aged’ society, is at the forefront of the socioeconomic change resulting from the unprecedented demographic shift of aging societies, and is an exemplar for other countries. Within neurodegenerative disorders, a deeper understanding of the issues faced by aging societies, and their ramifications on the mental well being and cognitive health of older adults, is important. Japan's pioneering approaches in assistive technology and ‘gerontotechnology’ have the potential to enhance the field of dementia in terms of assessment, diagnosis and care. This article is a narrative review of the issue of aging and dementia in Japan by discussing demographics, implications of a ‘super-aged’ society, challenges and potential solutions to the growing issue of dementia in the world's most aged nation.

Alzheimer’s disease: challenges & concepts The neurodegenerative disease described by Alois Alzheimer in 1906 is now recognized as a major aging-related dementia worldwide, affecting more than 35 million individuals. With the demographic shift toward aging societies, this number is expected to double every 20 years, to an estimated 135.5 million worldwide afflicted with the disease by 2050 [1]. The global costs related to diminished social functioning in AD patients are similar to the financial burdens of heart disease and cancer, placing Alzheimer’s disease (AD) among major public health concerns [2]. AD develops for tens of years in the pre

In the next 45 years it is estimated that individuals aged 65 and older will increase by 93% in the United States. This population will require a reexamination in thinking related to what retirement is and how seniors desire to maintain their quality of life. Thus, with this demographic shift, new career opportunities will be available for students in older adult fitness, and kinesiology graduates can be at the forefront of providing physical activity to promote public health. Through the exploration of an off-campus clinical exercise gerontology experience at Northern Illinois University, specifics of the program and potential barriers are discussed, with an eye toward assisting other institutions that wish to begin/enhance a similar program. Finally, benefits and future opportunities are highlighted showing how this partnership has led to an improved quality of life for seniors and strengthened relationships with the larger community.

Italy is expected to experience the largest growth in persons ≥65 years (20% by 2020). This demographic shift allows for geriatric research on predictive clinical and biological markers of outcomes related to frailty, re-hospitalization and mortality.To describe rationale and methods of the Report-AGE study project of acute care patients in Italian National Research Center on Aging (INRCA) research hospitals.Report-AGE study is a large observational study on health conditions and outcomes of hospitalized elderly patients (≥65 years). The primary objective of the study is to create a high-level data resource of demographics, comprehensive geriatric assessments, clinical and diagnostic information, as well as biological and molecular markers in all older patients admitted to INRCA Hospitals. Assessments in physical and nutritional parameters, co-morbid health conditions, and associations with frailty parameters are ongoing in older hospitalized adults following an acute event. Study collection began in September 2011.Up to date, there are 3479 patients ≥65 years (mean age: 85 ± 7years) with 1543 men and 1936 women enrolled. Data have been recorded regarding functional and clinical parameters before, during hospital admission and at discharge. Data collection for primary outcome analyses related to re-hospitalization and mortality is estimated for September 2016.This study aims at collecting precise clinical data, comprehensive geriatric assessment, risk factors, and biological data from acute care patients. Data will also be used to identify mechanisms underlying frailty in this specific population.This study provides a descriptive epidemiological collection of the health conditions of older in-patients.

At present, the most effective way to deal with the demographic shift of elders is encouraging them to live in nursing homes for more effective health care. However, such move dramatically increases their risk of social isolation. A contextual inquiry in a local nursing home revealed that most elderly people have few connections with the outside environment because of their decreased mobility and have difficulty establishing relationships with fellow residents. In addition, they show great interests in sharing stories. Based on the above findings, we present Interactive Gallery, a system consisting of a cluster of specially designed camera kits and a gallery-like interactive installation utilized with the metaphor of gallery and postcards. This system aims to make the elders feel more connected to the outside environment, stimulate them to reminisce, and further facilitate their sharing of stories with fellow residents and citizens from local communities.

Despite astounding economic growth and TB control efforts, incidence remains the highest among high-income countries., After the Korean War (1950–1953), nearly 6.5% of South Korea’s population had active tuberculosis (TB). In response, South Korea implemented the National Tuberculosis Program in 1962. From 1965 to 1995, the prevalence of bacteriologically confirmed pulmonary TB in South Korea decreased from 940 to 219 cases per 100,000 population. Astounding economic growth might have contributed to this result; however, TB incidence in South Korea remains the highest among high-income countries. The rate of decrease in TB incidence seems to have slowed over the past 15 years. A demographic shift toward an older population, many of whom have latent TB and various concurrent conditions, is challenging TB control efforts in South Korea. The increasing number of immigrants also plays a part in the prolonged battle against TB. A historical review of TB in South Korea provides an opportunity to understand national TB control efforts that are applicable to other parts of the world.

Neurodegenerative diseases, including Parkinson's and Alzheimer's, are a heterogeneous group of brain disorders characterized by the progressive degeneration of the structure and function of the central or peripheral nervous system. It is thought that the number of people affected by these pathologies will increase in future decades, particularly in the more economically developed countries, where the populations are experiencing a demographic shift towards older ages. For many of these pathologies, and in particular for Alzheimer's disease, no effective treatments are available, and the consequent economic and social costs are very high. Scientific progress in recent decades has provided a better understanding of the genetic and biological mechanisms responsible for these neurodegenerative diseases, and offers the hope for new therapeutic approaches in the near future. Meanwhile, the lack of effective therapies for these diseases has caused researchers to focus attention on the powerful opportunity of prevention, seen on the one hand as a series of healthcare measures and patient behaviors, and on the other hand as treatments exploiting several molecules or compounds with the potential to slow down the appearance of the first signs of pathology or even to prevent these diseases. Among these, curcumin, flavonoids, such as quercetin, Gingko biloba, and folic acid have attracted the attention of scientists, and ways are being explored to increase their effectiveness and bioavailability in the site of action. Most molecules suffer from problems of solubility, or bioavailability, or the ability to cross the blood brain barrier, and one solution to this limitation being explored is nanomedicine. Polymeric nanoparticles, as well as liposomes, and functionalized nanosystems may overcome several bioavailability limits of active molecules and increase their effectiveness in the brain. This review offers an overview of small molecules that may prove effective in preventing neurodegenerative diseases, and describes the strategies in nanomedicine that are being studied to improve their bioavailability.

Amidst a national opioid epidemic, the need for treatment of Opioid Use Disorder continues to grow. A demographic shift now suggests that older adults comprise a greater proportion of those receiving Methadone Maintenance Treatment (MMT); Recent findings from a study of MMT recipients living in New York City suggests that 13% of the population is over 60 years of age. Additionally, adults aged 50 – 59 years are among the largest age demographic, evidence that the total number of older adults receiving MMT will continue to increase. As medical comorbidities, cognitive impairment, and neurobehavioral changes often accumulate with age, older adults on MMT become increasingly vulnerable. Additionally, cost of MMT and logistical considerations pose challenges to continued care. This growing and understudied population warrants a reconsideration of emerging concerns and health policies. Especially relevant is the need for evidence-based guidelines and supportive policies that consider the unique treatment needs of older populations receiving MMT. Given the changing health care system and the growing opioid epidemic, re-consideration of this topic is especially timely.

Globally, growing populations and longer mean life spans are leading to a large aging population. This demographic shift comes together with an increased global incidence of non-communicable diseases (NCDs), especially the incidence rate of neurodegenerative diseases in the elderly population. Neurodegenerative diseases include the chronic exposure to oxidative stress and inflammation, loss of protective signaling, and the accumulation of toxic proteins. Tree nuts are dry fruits with one seed in which the ovary wall becomes hard at maturity. Nutrients are bioactive molecules that are essential for human health and functioning. Most cannot be synthesized by the human body and need to be obtained from food. Natural antioxidants present in foods include vitamins, minerals, carotenoids, and polyphenols. Nuts are good sources of nutrient antioxidants. Nut extract, particularly walnut extract, has been shown to be neuroprotective against numerous stressors. Nuts contain various macronutrients and micronutrients, as well as bioactive phytochemicals with good health-promoting properties.

The world’s population is ageing and an important part of this demographic shift is the development of chronic illness. In short, a person who does not die of acute illnesses, such as infections, and survives with chronic illnesses is more likely to develop additional chronic illnesses. Chronic respiratory diseases are an important component of these diseases associated with ageing. This article reviews the relationship between ageing and chronic respiratory disease, and also how certain chronic diseases cluster with others, either on the basis of underlying risk factors, complication of the primary disease or other factors, such as an increased state of inflammation. While death is inevitable, disabling chronic illnesses are not. Better understanding of how individuals can age healthily without the development of multiple chronic illnesses should lead to an improved global quality of life.