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Patient perspectives are now widely recognized as a key element in the evaluation of health interventions. Therefore, the provision of specific and validated Patient Reported Outcome Measures that emphasize the lived experience of patients suffering from specific diseases is very important. In the field of sarcopenia, the only validated specific health-related quality of life (HRQoL) instrument available is the Sarcopenia Quality of Life questionnaire (SarQoL). This self-administrated HRQoL questionnaire, developed in 2015, consists of 55 items arranged into 22 questions and has currently been translated into 35 languages. Nineteen validation studies performed on SarQoL have consensually confirmed the capacity of SarQoL to detect difference in HRQoL between older people with and without sarcopenia, its reliability and its validity. Two further observational studies have also indicated its responsiveness to change. A short form SarQoL, including only 14 items has further been developed and validated to reduce the potential burden of administration. Research on the psychometric properties of SarQoL questionnaire is still encouraged as the responsiveness to change of SarQoL has not yet been measured in the context of interventional studies, as limited prospective data currently exist and as there is still not cut-off score to define a low HRQoL. In addition, SarQoL has mainly been used in community-dwelling older individuals with sarcopenia and would benefit to be studied in other types of populations. This review aims to provide to researchers, clinicians, regulators, pharmaceutical industries and other stakeholders a clear summary of comprehensive evidence on the SarQoL questionnaire published up to January 2023Query.

© The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/., Vitamin D is a key component for optimal growth and for calcium-phosphate homeostasis. Skin photosynthesis is the main source of vitamin D. Limited sun exposure and insufficient dietary vitamin D supply justify vitamin D supplementation in certain age groups. In older adults, recommended doses for vitamin D supplementation vary between 200 and 2000 IU/day, to achieve a goal of circulating 25-hydroxyvitamin D (calcifediol) of at least 50 nmol/L. The target level depends on the population being supplemented, the assessed system, and the outcome. Several recent large randomized trials with oral vitamin D regimens varying between 2000 and 100,000 IU/month and mostly conducted in vitamin D-replete and healthy individuals have failed to detect any efficacy of these approaches for the prevention of fracture and falls. Considering the well-recognized major musculoskeletal disorders associated with severe vitamin D deficiency and taking into account a possible biphasic effects of vitamin D on fracture and fall risks, an European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) working group convened, carefully reviewed, and analyzed the meta-analyses of randomized controlled trials on the effects of vitamin D on fracture risk, falls or osteoarthritis, and came to the conclusion that 1000 IU daily should be recommended in patients at increased risk of vitamin D deficiency. The group also addressed the identification of patients possibly benefitting from a vitamin D loading dose to achieve early 25-hydroxyvitamin D therapeutic level or from calcifediol administration., Open access funding provided by University of Geneva

Summary The 2030 Sustainable Development Goals agenda calls for health data to be disaggregated by age. However, age groupings used to record and report health data vary greatly, hindering the harmonisation, comparability, and usefulness of these data, within and across countries. This variability has become especially evident during the COVID-19 pandemic, when there was an urgent need for rapid cross-country analyses of epidemiological patterns by age to direct public health action, but such analyses were limited by the lack of standard age categories. In this Personal View, we propose a recommended set of age groupings to address this issue. These groupings are informed by age-specific patterns of morbidity, mortality, and health risks, and by opportunities for prevention and disease intervention. We recommend age groupings of 5 years for all health data, except for those younger than 5 years, during which time there are rapid biological and physiological changes that justify a finer disaggregation. Although the focus of this Personal View is on the standardisation of the analysis and display of age groups, we also outline the challenges faced in collecting data on exact age, especially for health facilities and surveillance data. The proposed age disaggregation should facilitate targeted, age-specific policies and actions for health care and disease management.

Artificial intelligence (AI)-enhanced interventions show promise for improving the delivery of long-term care (LTC) services for older people. However, the research field is developmental and has yet to be systematically synthesised. This systematic review aimed to synthesise the literature on the acceptability and effectiveness of AI-enhanced interventions for older people receiving LTC services. We conducted a systematic search that identified 2720 records from Embase, Ovid, Global Health, PsycINFO, and Web of Science. 31 articles were included in the review that evaluated AI-enhanced social robots (n=22), environmental sensors (n=6), and wearable sensors (n=5) with older people receiving LTC services across 15 controlled and 14 non-controlled trials in high-income countries. Risk of bias was evaluated using the RoB 2, RoB 2 CRT, and ROBINS-I tools. Overall, AI-enhanced interventions were found to be somewhat acceptable to users with mixed evidence for their effectiveness across different health outcomes. The included studies were found to have high risk of bias which reduced confidence in the results. AI-enhanced interventions are promising innovations that could reshape the landscape of LTC globally. However, more trials are required to support their widespread implementation. Pathways are needed to support more high-quality trials, including in low-income and middle-income countries.

Over the past 100 years, life expectancy has increased dramatically in nearly all nations. Yet, these extra years of life gained have not all been healthy, particularly for older people aged 60 years and over. In 2020, the World Health Organisation (WHO) and United Nations (UN) member states embraced a sweeping 10-year global plan of action to ensure all older people can live long and healthy lives, formally known as the UN Decade of Healthy Ageing (2021–2030). With the adoption of the UN Decade of Healthy Ageing resolution, countries are committed to implementing collaborative actions to improve the lives of older people, their families and the communities in which they reside. The Decade addresses four interconnected areas of action. Adopting the UN's resolution on the Decade of Healthy Ageing has caused excitement, but a question that has weighed on everyone's mind is how governments will be held accountable? Besides, there have been no goals or targets set for the UN Decade of Healthy Ageing from a programmatic perspective for the action areas, and guidance on measures, data collection, analysis and reporting are urgently needed to support global, regional and national monitoring of the national strategies, programmes and policies. To this end, WHO in collaboration with UN agencies and international agencies established a Technical Advisory Group for Measurement of Healthy Ageing (TAG4MHA) to provide advice on the measurement, monitoring and evaluation of the UN Decade of Healthy Ageing at the global, regional and national levels.

Background Cardiovascular disease (CVD) is the leading cause of mortality in India. Social and behavioural factors are strongly interrelated in the prevention and control of CVD. The ability to make lifestyle changes to control hypertension and diabetes (major risk factors for CVD) is determined by factors such as education, gender, caste, poverty, and urbanicity. This study aimed to improve our understanding of the inter-relationship of social and behavioural factors in the management of elevated serum glucose and high blood pressure and co-morbid mental health conditions. Methods A population-based catchment area cross sectional survey was conducted in Kerala, India. Data were collected from residents aged over 30 years (n = 997) using standardized tools and clinical measures. We performed latent class analysis incrementally to extract homogeneous latent classes of individuals based on their responses to social and behavioural risk factors in the survey. Using structural equation models, we assessed the mediating effect of depression and anxiety, and social or behavioural risk factors, on management of high blood pressure and raised serum glucose levels. Results The prevalence of high blood pressure and blood glucose in the sample was 33 and 26% respectively. Latent class analysis found three clusters of risk factors. One had a predominance of behavioural characteristics, another of social risk factors and the third was a low risk group. Age, female sex, and marital status had an effect on high blood pressure and high glucose, though were mediated by mental health, social and behavioural risk factors. Conclusions Interventions to improve the management of risk factors for CVD need to address social risk factors and be sensitive to the needs of population sub-groups that may require additional support to access health services. An integration of social and health services may be required to achieve this.

The WHO concept of Healthy Ageing (ie, the process of developing and maintaining the functional ability that enables well-being in older age) has initiated a global discussion about the need for shifting paradigms to reorient health and social services towards person-centred and coordinated models of care. In particular, the integration of health and social care services is critical to provide the basis for comprehensive information sharing and service delivery to support the evolution of the older person over time. The capability to monitor and respond to an older person’s changing health and social care needs will enable prompt and personalised health and social care plans to be implemented.The implementation of an integrated care approach involves all the settings where persons age, but also requires a concerted action among micro (clinical), meso (service delivery) and macro (system) level. The community is of particular relevance given the primary objective of "ageing in place". However, from the perspective of the continuum of care and services acting synergistically, all health and social care settings (including long-term care facilities and hospitals) need to evolve and embrace an integrated way of operating to support functional ability in older people, while maximising resource and information sharing efficiencies.In this paper, we explain that government actions to promote well-being in older age should be built on a seamless continuum of care starting from the assessment of the older person’s intrinsic capacity and functional ability with the final aim of providing care aligned with the individual’s needs and priorities.

The current paper compared the empirical structure of 280 variables from the 2016 wave of the Health and Retirement Study (N = 16,327) estimated using exploratory graph analysis with a theoretical structure based on 20 broad domains of intrinsic capacity, functional ability and environment, identified in the International Classification of Functioning, Disability and Health compendium. The results showed that a structure with 21 first-order factors had the best fit to the data (i.e., lowest total entropy fit value) for both the training and validation sample. A second-order exploratory graph analysis was applied on the interfactor correlation matrix and identified five second-order factors. The five-factor structure presented a better fit than the theoretical three-factor structure (approximately) representing intrinsic capacity, functional ability and environment. A close inspection of the network structure generated by analyzing the rotated network loadings of the 21 first-order factors revealed an interplay between cognition, mobility, need for help with daily activities, walking capacity, physical capacity, liver functioning, positive affect and perceived mastery, low perceived control, and depression/negative mood. Combined, our results can help guide future research by providing a framework for estimating the structure of multi-domain aging research as well as generating questions that can be addressed in future research.

Evidence shows that ageism negatively impacts the health of older adults. However, estimates of its prevalence are lacking. This study aimed to estimate the global prevalence of ageism towards older adults and to explore possible explanatory factors. Data were included from 57 countries that took part in Wave 6 of the World Values Survey. Multilevel Latent Class Analysis was performed to identify distinct classes of individuals and countries. Individuals were classified as having high, moderate or low ageist attitudes, and countries as being highly, moderately or minimally ageist, by aggregating individual responses. Individual-level (age, sex, education and wealth) and contextual-level factors (healthy life expectancy, population health status and proportion of the population aged over 60 years) were examined as potential explanatory factors in multinomial logistic regression. From the 83,034 participants included, 44%, 32% and 24% were classified as having low, moderate and high ageist attitudes, respectively. From the 57 countries, 34 were classified as moderately or highly ageist. The likelihood of an individual or a country being ageist was significantly reduced by increases in healthy life expectancy and the proportion of older people within a country. Certain personal characteristics&mdash, younger age, being male and having lower education&mdash, were significantly associated with an increased probability of an individual having high ageist attitudes. At least one in every two people included in this study had moderate or high ageist attitudes. Despite the issue&rsquo, s magnitude and negative health impacts, ageism remains a neglected global health issue.

Exploratory graph analysis (EGA) is a new technique that was recently proposed within the framework of network psychometrics to estimate the number of factors underlying multivariate data. Unlike other methods, EGA produces a visual guide-network plot-that not only indicates the number of dimensions to retain, but also which items cluster together and their level of association. Although previous studies have found EGA to be superior to traditional methods, they are limited in the conditions considered. These issues are addressed through an extensive simulation study that incorporates a wide range of plausible structures that may be found in practice, including continuous and dichotomous data, and unidimensional and multidimensional structures. Additionally, two new EGA techniques are presented: one that extends EGA to also deal with unidimensional structures, and the other based on the triangulated maximally filtered graph approach (EGAtmfg). Both EGA techniques are compared with 5 widely used factor analytic techniques. Overall, EGA and EGAtmfg are found to perform as well as the most accurate traditional method, parallel analysis, and to produce the best large-sample properties of all the methods evaluated. To facilitate the use and application of EGA, we present a straightforward R tutorial on how to apply and interpret EGA, using scores from a well-known psychological instrument: the Marlowe-Crowne Social Desirability Scale. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Additional file 2. Table S1 Four stage sequential modeling strategy to compare the Information fit criteria of the latent class models. Table highlighting method of selection of number of latent classes.

This study assesses socioeconomic differences in handgrip strength among older adults age 50 years and over in six middle-income countries, focusing on the association with selected measures of intrinsic capacity. Cross-sectional nationally representative data from the WHO’s Study on global AGEing and adult health (SAGE) was used. Three-level linear hierarchical models examine the association of demographic, socioeconomic status and multimorbidity variables with handgrip strength; regression-based Relative Index of Inequality (RII) examines socioeconomic inequalities in handgrip strength; multilevel linear and logistic hierarchical regression models document the association between handgrip strength and five domains of intrinsic capacity: locomotion, psychological, cognitive capacity, vitality and sensory. Age, sex, work status, nutritional status showed significant association with handgrip strength, an important biomarker of health among older adults, across countries. Socioeconomic differences in handgrip strength, are notable across all countries except South Africa. Further, handgrip strength showed significant association with measures of intrinsic capacity across five domains: locomotion, psychological, cognition, vitality and sensory. The significant association of handgrip strength with measures of intrinsic capacity, suggest handgrip strength as an important measure of health in old age. Life-course interventions to improve the handgrip strength will be useful for the overall wellbeing of older adults.

Additional file 1. Behaviour and lifestyles questionnaire. Questionnaire used to collect data on behaviour and lifestyle.

ObjectiveThe global population is rapidly ageing. To tackle the increasing prevalence of older adults’ chronic conditions, loss of intrinsic capacity and functional ability, long-term care interventions are required. The study aim was to identify long-term care interventions reported in scientific literature from 2010 to 2020 and categorise them in relation to WHO’s public health framework of healthy ageing.DesignScoping review conducted on PubMed, CINHAL, Cochrane and Google Advanced targeting studies reporting on long-term care interventions for older and frail adults. An internal validated Excel matrix was used for charting.Setting nursing homes, assisted care homes, long-term care facilities, home, residential houses for the elderly and at the community.Inclusion criteriaStudies published in peer-reviewed journals between 1 January 2010 to 1 February 2020 on implemented interventions with outcome measures provided in the settings mentioned above for subjects older than 60 years old in English, Spanish, German, Portuguese or French.Results305 studies were included. Fifty clustered interventions were identified and organised into four WHO Healthy Ageing domains and 20 subdomains. All interventions delved from high-income settings; no interventions from low-resource settings were identified. The most frequently reported interventions were multimodal exercise (n=68 reports, person-centred assessment and care plan development (n=22), case management for continuum care (n=16), multicomponent interventions (n=15), psychoeducational interventions for caregivers (n=13) and interventions mitigating cognitive decline (n=13).ConclusionThe identified interventions are diverse overarching multiple settings and areas seeking to prevent, treat and improve loss of functional ability and intrinsic capacity. Interventions from low-resource settings were not identified.

Introduction. Hypertension is one of the most important modifiable risk factors for cardiovascular diseases. The objective of this study is to estimate the prevalence, awareness, treatment, and control of hypertension and its associated risk factors in Ernakulam district, Kerala. Methods. In this prospective family-based cohort study, 573 families were included with a total of 997 participants aged 30 years and above. Baseline interviews were conducted in participant’s homes using a combination of self-structured and standardized questionnaire. Blood pressure and plasma glucose were assessed for each participant. Results. The prevalence of hypertension was 43%. It was slightly higher in women than men (43.7% vs. 41.4%). The mean systolic blood pressure in the hypertensive population was 141.9 mmHg and mean diastolic blood pressure was 85.3 mmHg. In total, 78% (86.2% in women, 62.9% in men) of the participants were aware of their hypertension. Among those aware, 60.4% (63.5% in women, 52.6% in men) of the participants were on treatment, and hypertension was controlled in 75.1% (77.5% women, 68% in men) of the participants on treatment. The prevalence of hypertension was higher among persons with comorbidities (diabetes 64.5%, transient ischemic attack 54.7%, and heart disease 64.4%). Prevalence was lower among persons who did regular vigorous intensity exercise versus those who did moderate intensity exercise (32% vs. 45.7%) and among nonsmokers versus smokers (42.2% vs. 46.6%). Conclusion. The prevalence of hypertension in Kerala is high. Although awareness is quite high, there is a need to improve the number of persons with hypertension taking treatment.

Healthy ageing can be defined as "the process of developing and maintaining the functional ability that enables wellbeing in older age". Functional ability (i.e., the health-related attributes that enable people to be and to do what they have reason to value) is determined by intrinsic capacity (i.e., the composite of all the physical and mental capacities of an individual), the environment (i.e., all the factors in the extrinsic world that form the context of an individual's life), and the interactions between the two. This innovative model recently proposed by the World Health Organization has the potential to substantially modify the way in which clinical practice is currently conducted, shifting from disease-centered toward function-centered paradigms. By overcoming the multiple limitations affecting the construct of disease, this novel framework may allow the worldwide dissemination of a more proactive and function-based approach toward achieving optimal health status. In order to facilitate the translation of the current theoretical model into practice, it is important to identify the inner nature of its constituting constructs. In this article, we consider intrinsic capacity. Using the International Classification of Functioning, Disability and Health (ICF) framework as background and taking into account available evidence, five domains (i.e., locomotion, vitality, cognition, psychological, sensory) are identified as pivotal for capturing the individual's intrinsic capacity (and therefore also reserves) and, through this, pave the way for its objective measurement.

Older adults with reduced physical capacity are at greater risk of progression to care dependency. Progressive resistance strength exercise and multimodal exercise have been studied to restore reduced physical capacity. To summarize the best evidence of the two exercise regimes, this meta-analysis study appraised randomized-controlled trials from published systematic reviews. Medline, Embase, and the Cochrane Database of Systematic Review and Cochrane Central Register of Controlled Clinical Trials were searched for relevant systematic reviews. Two reviewers independently screened the relevant systematic reviews to identify eligible trials, assessed trial methodological quality, and extracted data. RevMan 5.3 software was used to analyze data on muscle strength, physical functioning, activities of daily living, and falls. Twenty-three eligible trials were identified from 22 systematic reviews. The mean age of the trial participants was 75 years or older. Almost all multimodal exercise trials included muscle strengthening exercise and balance exercise. Progressive resistance exercise is effective in improving muscle strength of the lower extremity and static standing balance. Multimodal exercise is effective in improving muscle strength of the lower extremity, dynamic standing balance, gait speed, and chair stand. In addition, multimodal exercise is effective in reducing falls. Neither type of exercise was effective in improving activities of daily living. For older adults with reduced physical capacity, multimodal exercise appears to have a broad effect on improving muscle strength, balance, and physical functioning of the lower extremity, and reducing falls relative to progressive resistance exercise alone.

In most countries, a fundamental shift in the focus of clinical care for older people is needed. Instead of trying to manage numerous diseases and symptoms in a disjointed fashion, the emphasis should be on interventions that optimize older people's physical and mental capacities over their life course and that enable them to do the things they value. This, in turn, requires a change in the way services are organized: there should be more integration within the health system and between health and social services. Existing organizational structures do not have to merge; rather, a wide array of service providers must work together in a more coordinated fashion. The evidence suggests that integrated health and social care for older people contributes to better health outcomes at a cost equivalent to usual care, thereby giving a better return on investment than more familiar ways of working. Moreover, older people can participate in, and contribute to, society for longer. Integration at the level of clinical care is especially important: older people should undergo comprehensive assessments with the goal of optimizing functional ability and care plans should be shared among all providers. At the health system level, integrated care requires: (i) supportive policy, plans and regulatory frameworks; (ii) workforce development; (iii) investment in information and communication technologies; and (iv) the use of pooled budgets, bundled payments and contractual incentives. However, action can be taken at all levels of health care from front-line providers through to senior leaders - everyone has a role to play.Dans la plupart des pays, un changement fondamental de priorité dans l'organisation des soins cliniques destinés aux personnes âgées est nécessaire. Plutôt que d'essayer de gérer la variété des maladies et symptômes de manière individuelle, l'accent devrait être mis sur les interventions qui optimisent les capacités physiques et mentales des personnes âgées sur tout leur parcours de vie et qui leur permettent de continuer de réaliser les activités qui comptent pour elles. Mais cela suppose de modifier le mode d'organisation des prestations, avec une meilleure intégration à l'intérieur du système de santé et entre les services de santé et d'aide sociale. Cela ne signifie pas que les structures existantes doivent fusionner, mais plutôt qu'une grande diversité de prestataires doit travailler ensemble de manière plus coordonnée. Des données factuelles montrent que des prestations de santé et d'aide sociale intégrées entraînent de meilleurs résultats sur la santé des personnes âgées que les prestations de soins habituelles, pour un coût équivalent; d'où l'obtention d'une meilleure rentabilité des investissements comparativement aux modes de travail classiques. Elles permettent aussi aux personnes âgées de s'impliquer socialement et d'apporter leurs contributions à la société pendant plus longtemps. Une telle intégration est particulièrement importante au niveau des soins cliniques: des évaluations exhaustives devraient être réalisées chez les personnes âgées dans une optique d'optimisation de leurs capacités fonctionnelles, et les plans de soins devraient être communs à tous les prestataires. Au niveau du système de santé, l'intégration des prestations nécessite: (i) l'adoption de politiques, programmes et cadres réglementaires favorables; (ii) le développement du personnel de santé; (iii) un investissement dans les technologies de l'information et de la communication; et (iv) la mise en place de budgets communs, de paiements regroupés et de mesures contractuelles incitatives. Toutefois, des actions peuvent être entreprises à tous les niveaux d'organisation des soins de santé, depuis les prestataires de première ligne jusqu'aux hauts responsables – tout le monde a un rôle à jouer.En la mayoría de países se necesita un cambio fundamental en el enfoque de la atención clínica que reciben las personas mayores. En lugar de intentar gestionar numerosas enfermedades y síntomas por separado, debería ponerse énfasis en las intervenciones que optimizan las capacidades físicas y mentales de las personas mayores durante su vida y que les permitan hacer lo que ellos valoran. Esto, a su vez, requiere un cambio en la forma en la que se organizan los servicios: debería haber más integración dentro del sistema sanitario y entre los servicios sanitarios y sociales. Las estructuras organizativas existentes no deben fusionarse, sino que el amplio conjunto de proveedores de servicios debe trabajar conjuntamente de una forma más coordinada. Las pruebas indican que la atención sanitaria y social integrada para las personas mayores contribuye a unos mejores resultados sanitarios a un coste equivalente a la atención habitual. De esta forma, se obtiene una mayor rentabilidad de la inversión que la obtenida con formas de trabajar más familiares. Además, las personas mayores pueden participar y contribuir en la sociedad durante más tiempo. La integración a nivel de la atención clínica es especialmente importante: las personas mayores deberían someterse a asesoramiento integral con el objetivo de optimizar la capacidad funcional, y deberían compartirse los planes de atención entre todos los proveedores. A nivel del sistema sanitario, la atención integrada requiere: (i) política, planes y marcos normativos de apoyo; (ii) desarrollo del personal sanitario; (iii) inversión en tecnologías de la información y comunicación; y (iv) el uso de presupuestos y pagos combinados e incentivos contractuales. No obstante, esto puede realizarse en todos los niveles de la atención sanitaria, desde los proveedores de primera línea hasta el personal directivo; todos juegan un papel.في معظم البلدان، توجد حاجة إلى تحول رئيسي في تركيز الرعاية السريرية لكبار السن. فبدلاً من محاولة إدارة العديد من الأمراض والأعراض بطريقة مفككة، ينبغي التركيز على التدخلات التي تحسن القدرات البدنية والعقلية لكبار السن على مدى حياتهم بالطبع والتي تمكنهم من القيام بالأشياء التي يُقدروها. وهذا بدوره يتطلب تغييرًا في طريقة تنظيم الخدمات: ينبغي أن يكون هناك تكامل أكبر داخل النظام الصحي وبين الخدمات الصحية والاجتماعية. ولا يلزم دمج الهياكل التنظيمية القائمة؛ بل يجب أن تعمل مجموعة كبيرة من مقدمي الخدمات معًا بطريقة أكثر تنسيقًا. وتشير الدلائل إلى أن الرعاية الصحية والاجتماعية المتكاملة لكبار السن تسهم في تحقيق نتائج صحية أفضل بتكلفة تعادل الرعاية المعتادة، مما يعطي عائد استثمار أفضل من الطرق المألوفة للعمل. وعلاوة على ذلك، يمكن لكبار السن المشاركة في المجتمع والمساهمة فيه لفترة أطول. للتكامل في مستوى الرعاية السريرية أهمية خاصة: حيث ينبغي أن يخضع كبار السن لتقييمات شاملة بهدف تحسين القدرة الوظيفية، وينبغي مشاركة خطط الرعاية بين جميع مقدمي الخدمات. وعلى صعيد النظام الصحي، تتطلب الرعاية المتكاملة ما يلي: (أ) السياسات والخطط والأطر التنظيمية الداعمة؛ و(ب) تنمية القوى العاملة؛ و(جـ) الاستثمار في تكنولوجيات المعلومات والاتصالات؛ و(د) استخدام الميزانيات المجمعة والمدفوعات المجمعة والحوافز التعاقدية. ومع ذلك، يمكن اتخاذ إجراءات على جميع مستويات الرعاية الصحية بدءًا من مقدمي الرعاية في الخطوط الأمامية إلى كبار المسؤولين – فكل شخص دورٌ للقيام به.许多国家需对老年人临床护理的重点进行根本性转变。 重点应放在能够在生活过程中优化老年人的行为及心智能力并使其能够做其认为有价值的事情的干预措施上，而不是试图以一种杂乱的方式应付无数的疾病和症状。 相应地，这要求改变建立服务的方式： 应加强卫生系统内部及卫生与社会服务之间的一体化。 现有组织机构无需进行合并，但是，各类服务提供商必须以更协调的方式进行合作。 证据表明对于老年人来说，在与常规护理成本相同的情况下，一体化的健康与社会护理更利于产生更好的健康结果，因此较更多常见工作方式而言，能带来更大的投资回报。 此外，老年人能够更长久地参与社会并为社会做出贡献。 临床护理级别的一体化尤为重要： 老年人应在优化功能性能力的目标下接受全面评估，并且护理计划应与所有供应商共享。 卫生系统级别的一体化护理需要： (i) 支持性政策、计划及监管框架；(ii) 人力开发；(iii) 投资于信息与通讯技术；以及 (iv) 使用集合预算、捆绑支付和契约式激励。 但，从健康护理的一线提供商到高级领导者，所有层面均可采取行动——各方均发挥自己的作用。.В большинстве стран необходим фундаментальный сдвиг в сфере оказания клинической помощи пожилым людям. Вместо того чтобы пытаться лечить бесчисленные болезни и симптомы, акцент должен делаться на вмешательствах, которые оптимизируют физические и умственные способности пожилых людей в течение их жизни и позволяют им быть более дееспособными. Это, в свою очередь, требует изменения порядка организации услуг, а именно большей интеграции в систему здравоохранения, а также лучшего взаимодействия между здравоохранением и социальными услугами. Не должно происходить слияния существующих организационных структур. Скорее, широкий круг организаций, предоставляющих услуги по оказанию медицинской и социальной помощи, должен работать сообща более согласованным образом. Имеющиеся данные свидетельствуют о том, что комплексная система здравоохранения и социальной помощи пожилым людям способствует улучшению клинических последствий при стоимости, эквивалентной стандартной медицинской помощи, что дает лучшую отдачу от инвестиций, чем более привычные методы работы. Более того, пожилые люди более продолжительное время могут принимать участие в общественной жизни и вносить в нее свой вклад. Интеграция на уровне клинической помощи особенно важна: пожилые люди должны проходить всестороннее обследование с целью оптимизации умственных и физических способностей, а планы по уходу должны распределяться между всеми организациями, предоставляющими услуги по оказанию медицинской и социальной помощи. На уровне системы здравоохранения комплексный уход требует: (I) применения поддерживающей политики, планов и нормативной базы; (II) подготовки трудовых ресурсов; (III) инвестиций в информационно-коммуникационные технологии; (IV) использования объединенных бюджетов, комплексной оплаты и вознаграждений, предусмотренных контрактами. Тем не менее действия могут быть предприняты на всех уровнях здравоохранения: от врачей, работающих непосредственно с пациентами, до старших руководителей. Каждый должен играть определенную роль.

Islene Araujo de Carvalho and coauthors discuss the WHO guidelines on integrated care for older people.

The accurate identification of the content and number of latent factors underlying multivariate data is an important endeavor in many areas of Psychology and related fields. Recently, a new dimensionality assessment technique based on network psychometrics was proposed (Exploratory Graph Analysis, EGA), but a measure to check the fit of the dimensionality structure to the data estimated via EGA is still lacking. Although traditional factor-analytic fit measures are widespread, recent research has identified limitations for their effectiveness in categorical variables. Here, we propose three new fit measures (termed entropy fit indices) that combines information theory, quantum information theory and structural analysis: Entropy Fit Index (EFI), EFI with Von Neumman Entropy (EFI.vn) and Total EFI.vn (TEFI.vn). The first can be estimated in complete datasets using Shannon entropy, while EFI.vn and TEFI.vn can be estimated in correlation matrices using quantum information metrics. We show, through several simulations, that TEFI.vn, EFI.vn and EFI are as accurate or more accurate than traditional fit measures when identifying the number of simulated latent factors. However, in conditions where more factors are extracted than the number of factors simulated, only TEFI.vn presents a very high accuracy. In addition, we provide an applied example that demonstrates how the new fit measures can be used with a real-world dataset, using exploratory graph analysis.

Although populations around the world are rapidly ageing, evidence that increasing longevity is being accompanied by an extended period of good health is scarce. A coherent and focused public health response that spans multiple sectors and stakeholders is urgently needed. To guide this global response, WHO has released the first World report on ageing and health, reviewing current knowledge and gaps and providing a public health framework for action. The report is built around a redefinition of healthy ageing that centres on the notion of functional ability: the combination of the intrinsic capacity of the individual, relevant environmental characteristics, and the interactions between the individual and these characteristics. This Health Policy highlights key findings and recommendations from the report.

Background: The burden of disability on individuals and society is enormous in India, and informal care systems try to reduce this burden. This study investigated the association between neighbourhood cohesion and disability in a community-based population in Kerala, India. To the best of our knowledge, no previous studies have examined this association in India. Methods: A cross-sectional household survey was conducted with 997 participants aged 30 years and above, in Kerala. Neighbourhood cohesion was assessed by three scales: trust, community participation, and perceived safety. Functional ability was measured by WHODAS 2.0. Explanatory covariates included chronic disease conditions, age, gender, education, income, and mental health conditions. Results: Of 997 participants (37% male; mean age, 53.9 [range, 30–90] years), the majority were married or cohabiting. Univariate analysis showed functional ability to be positively associated with most demographic and health characteristics. However, after adjustment, only social cohesion, age, income, education, chronic diseases and mental health conditions remained significant. Mediation analysis showed the effect of personal and health characteristics on functional ability as mediated by social cohesion. Conclusion: Social cohesion is an important moderator of functional ability. Interventions targeting the creation of stronger ties among neighbours and a sense of belonging should be scaled-up and evaluated in future research.

Objective The World Health Organization (WHO) recently proposed an Integrated Care for Older People approach to guide health systems and services in better supporting functional ability of older people. A knowledge gap remains in the key elements of integrated care approaches used in health and social care delivery systems for older populations. The objective of this review was to identify and describe the key elements of integrated care models for elderly people reported in the literature. Design Review of reviews using a systematic search method. Methods A systematic search was performed in MEDLINE and the Cochrane database in June 2017. Reviews of interventions aimed at care integration at the clinical (micro), organisational/service (meso) or health system (macro) levels for people aged ≥60 years were included. Non-Cochrane reviews published before 2015 were excluded. Reviews were assessed for quality using the Assessment of Multiple Systematic Reviews (AMSTAR) 1 tool. Results Fifteen reviews (11 systematic reviews, of which six were Cochrane reviews) were included, representing 219 primary studies. Three reviews (20%) included only randomised controlled trials (RCT), while 10 reviews (65%) included both RCTs and non-RCTs. The region where the largest number of primary studies originated was North America (n=89, 47.6%), followed by Europe (n=60, 32.1%) and Oceania (n=31, 16.6%). Eleven (73%) reviews focused on clinical ‘micro’ and organisational ‘meso’ care integration strategies. The most commonly reported elements of integrated care models were multidisciplinary teams, comprehensive assessment and case management. Nurses, physiotherapists, general practitioners and social workers were the most commonly reported service providers. Methodological quality was variable (AMSTAR scores: 1–11). Seven (47%) reviews were scored as high quality (AMSTAR score ≥8). Conclusion Evidence of elements of integrated care for older people focuses particularly on micro clinical care integration processes, while there is a relative lack of information regarding the meso organisational and macro system-level care integration strategies.

BACKGROUND: Sarcopenia is increasingly recognized as a correlate of ageing and is associated with increased likelihood of adverse outcomes including falls, fractures, frailty and mortality. Several tools have been recommended to assess muscle mass, muscle strength and physical performance in clinical trials. Whilst these tools have proven to be accurate and reliable in investigational settings, many are not easily applied to daily practice. METHODS: This paper is based on literature reviews performed by members of the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) working group on frailty and sarcopenia. Face-to-face meetings were afterwards organized for the whole group to make amendments and discuss further recommendations. RESULTS: This paper proposes some user-friendly and inexpensive methods that can be used to assess sarcopenia in real-life settings. Healthcare providers, particularly in primary care, should consider an assessment of sarcopenia in individuals at increased risk; suggested tools for assessing risk include the Red Flag Method, the SARC-F questionnaire, the SMI method or different prediction equations. Management of sarcopenia should primarily be patient centered and involve the combination of both resistance and endurance based activity programmes with or without dietary interventions. Development of a number of pharmacological interventions is also in progress. CONCLUSIONS: Assessment of sarcopenia in individuals with risk factors, symptoms and/or conditions exposing them to the risk of disability will become particularly important in the near future. ispartof: BMC Geriatrics vol:16 issue:1 pages:170-179 ispartof: location:England status: published

Today, for the first time in history, most people can expect to live into their sixties and beyond. By 2050, the world's population aged 60 years and older is expected to double to nearly 2 billion people, 80% of whom will live in low-and middle-income countries. The health of older people is unfortunately not keeping up with increasing longevity. The World report on ageing and health highlights great diversity in health and functioning in older age and marked health inequities in this group. (1) There is little evidence to suggest that people today are experiencing older age in better health than previous generations. (1) Pervasive misconceptions, negative attitudes and assumptions about older people are serious barriers to developing good public policy on ageing and health. Negative attitudes and stereotypes about older adults as frail, out of touch, burdensome or dependent are ubiquitous. A recent analysis carried out by the World Health Organization (WHO) using world values survey data of 83034 adults from 57 countries found low respect for older adults. (2) Sixty percent of participants reported that older adults are not well respected, with respondents from higher income countries being more likely to report so. Stereotyping and discrimination against individuals or groups on the basis of their age is called ageism. (1) Unlike other forms of discrimination, including sexism and racism, ageism is socially acceptable, strongly institutionalised, largely undetected and unchallenged. (3,4) Ageism limits the questions that are asked and the way problems are conceptualized. Recent analysis suggests that ageism influences the development of global health policy and targets. (5) The authors highlight that age limits placed on global goals to prevent and control noncommunicable diseases and the use of premature mortality thresholds, including in the sustainable development goals (SDGs), may be used to discriminate against older adults in the allocation of health resources and data collection. (5) Changing public discourse around population ageing, which largely depicts older people as burdens on public spending and economic growth, can help to capitalise on the great human capacity that older people represent. Although most older people will eventually experience multiple health problems, older age is not the most significant driver of health care costs and does not imply dependence. For example, in a period of unprecedented population ageing in the United States of America (1940-1990) ageing contributed to around 2% of the increase in health expenditures, compared to 51% related to technology innovation in medical practice. (6) Older adults make significant social and economic contributions to their societies. In the United Kingdom of Great Britain and Northern Ireland, the contributions older people made through taxation, consumer spending and other economically valuable activities were worth nearly 40 billion pounds sterling ([dollar]), more than expenditure on them through pensions, welfare and health care combined. …

The absolute and relative increases in the number of older persons are evident worldwide, from the most developed countries to the lowest-income regions. Multimorbidity and need for social support increase with age. Age-related conditions and, in particular, disabilities are a significant burden for the person, his or her family, and public health care systems. To guarantee the sustainability of public health systems and improve the quality of care provided, it is becoming urgent to act to prevent and delay the disabling cascade. Current evidence shows that too large a proportion of community-dwelling older people present risk factors for major health-related events and unmet clinical needs. In this scenario, the "frailty syndrome" is a condition of special interest. Frailty is a status of extreme vulnerability to endogenous and exogenous stressors exposing the individual to a higher risk of negative health-related outcomes. Frailty may represent a transition phase between successful aging and disability, and a condition to target for restoring robustness in the individual at risk. Given its syndromic nature, targeting frailty requires a comprehensive approach. The identification of frailty as a target for implementing preventive interventions against age-related conditions is pivotal. Every effort should be made by health care authorities to maximize efforts in this field, balancing priorities, needs, and resources. Raising awareness about frailty and age-related conditions in the population is important for effective prevention, and should lead to the promotion of lifelong healthy behaviors and lifestyle.

BACKGROUND: Restricted social networks have been associated with higher mortality in several developed countries but there are no studies on this topic from developing countries. This gap exists despite potentially greater dependence on social networks for support and survival due to various barriers to health care and social protection schemes in this setting. Thus, this study aims to examine how social network type at baseline predicts all-cause mortality among older adults in six Latin American countries, China, and India. METHODS: Population-based surveys were conducted of all individuals aged 65+ years in eight countries (Cuba, Dominican Republic, Peru, Venezuela, Mexico, Puerto Rico, China, and India). Data on mortality were obtained at follow-up (mean 3.8 years after cohort inception). Follow-up data for 13,891 individuals were analysed. Social network types were assessed using Wenger's Practitioner Assessment of Network Type (PANT). Cox proportional hazard models were constructed to estimate the impact of social network type on mortality risk in each country, adjusting for socio-demographics, receipt of pension, disability, medical conditions, and depression. Meta-analysis was performed to obtain pooled estimates. RESULTS: The prevalence of private network type was 64.4% in urban China and 1.6% in rural China, while the prevalence of locally integrated type was 6.6% in urban China and 86.8% in rural China. The adjusted pooled estimates across (a) all countries and (b) Latin America showed that, compared to the locally integrated social network type, the locally self-contained [(b) HR = 1.24, 95%CI 1.01-1.51], family dependent [(a) HR = 1.13, 95%CI 1.01-1.26; (b) HR = 1.13, 95%CI 1.001-1.28], and private [(a) HR = 1.36, 95%CI 1.06-1.73; (b) HR = 1.45, 95%CI 1.20-1.75] social network types were significantly associated with higher mortality risk. CONCLUSION: Survival time is significantly reduced in individuals embedded in restricted social networks (i.e. locally self-contained, family dependent, and private network types). Social care interventions may be enhanced by addressing the needs of those most at risk of neglect and deteriorating health. Health policy makers in developing countries may use this information to plan efficient use of limited resources by targeting those embedded in restricted social networks. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved. KEYWORDS: Ageing; Developing countries; Interpersonal relations; Mortality; Social networks; Social support; Survival rate

This study aims to assess the construct validity of the Wenger social support network typology in low and middle income countries. We hypothesize that, in comparison with the integrated network type, the non-integrated network type is associated with loneliness, depression, poor quality of life (less happiness), poor self-reported health, increased disability and higher care needs. Cross-sectional one-phase surveys were conducted of all residents aged 65 and over in catchment areas in eight low and middle income countries (India, China, Cuba, Dominican Republic, Venezuela, Mexico, Peru and Puerto Rico). Wenger's Practitioner Assessment of Network Type (PANT) was used to measure social network type. Family dependent, local self-contained, wider community-focused and private restricted network types were considered non-integrated, in comparison to the locally integrated network type. Overall, 17,031 participants were interviewed. Family dependent and locally integrated network types were the most prevalent. Adjusted pooled estimates across sites showed that loneliness, depression, less happiness, poor health, disability, and need for care were significantly associated with non-integrated network type. The findings of this study support the construct validity of Wenger's network typology in low and middle income countries. However, further research is required to test the criterion validity of Wenger typology using longitudinal data. Identifying older people who are vulnerable could inform the development of social care interventions to support older people and their families in the context of deteriorating health.

The K6 scale is a shortened version of the K10, a 10‐question scale originally developed to provide an efficient population‐level screen for serious mental disorders (SMI) in the USA. Evidence that the six‐item shortened version performed as well as the original 10‐item version, coupled with strong psychometric properties, led to rapid dissemination and replicated validation of the K6 in a number of other countries around the world. Based on these results, the K6 is now often included in large general‐purpose government health tracking surveys in a number of different countries. Until now, though, the scoring rules for the K6 in these surveys were inconsistent. The first paper in this special issue introduces the K6 scale and summarizes the results of a series of investigations to resolve these inconsistencies by providing optimal scoring rules for the K6 in 14 countries. Subsequent papers explore the usefulness of the K6 to screen for serious emotional disturbance among adolescents and report findings from validation efforts based on independent diagnostic assessments as well as of other measures of impairment and disability (World Health organization Disability Assessment Scale). Finally a highly innovative analysis using a Bayesian multilevel modeling approach is presented, designed to estimate the prevalence of SMI in small areas, such as cities, states, or schools, from surveys carried out in a larger population that includes only relatively small samples of respondents in each of the areas in which prevalence estimates are to be made. Taken together, these studies demonstrate that the K6 is an efficient and useful screening tool. The psychometric and methodological explorations will hopefully stimulate additional interest in the use of short screening scales in large‐scale general health surveys to supplement the more in‐depth information obtained in periodic psychiatric epidemiological surveys on the basis of diagnostic interviews. Copyright © 2010 John Wiley & Sons, Ltd.

Background: Breast cancer is the most frequent cancer in women globally and represents the second leading cause of cancer death among women (after lung cancer). India is going through epidemiologic transition. It is reported that the incidence of breast cancer is rising rapidly as a result of changes in reproductive risk factors, dietary habits and increasing life expectancy, acting in concert with genetic factors. Materials and Methods: In order to understand the existing epidemiological correlates of breast cancer in South India, a systematic review of evidence available on epidemiologic correlates of breast cancer addressing incidence, prevalence, and associated factors like age, reproductive factors, cultural and religious factors was performed with specific focus on screening procedures in southern India. Results: An increase in breast cancer incidence due to various modifiable risk factors was noted, especially in women over 40 years of age, with late stage of presentation, lack of awareness about screening, costs, fear and stigma associated with the disease serving as major barriers for early presentation. Conclusions: Educational strategies should be aimed at modifying the life style, early planning of pregnancy, promoting breast feeding and physical activity. It is very important to obtain reliable data for planning policies, decision-making and setting up the priorities.