Agitation in the elderly.

With the rise in the number of women giving birth at an advanced age, the association between advanced maternal age and adverse obstetrical outcomes is a growing concern in developed countries. Despite the well-established link between advanced maternal age and pregnancy-related complications, there has been limited research examining the specific risks related to unscheduled cesarean delivery in nulliparas at term. This study aimed to evaluate the risks associated with unscheduled cesarean delivery in nulliparas at ≥37 weeks of gestation, comparing the outcomes of younger patients with those aged ≥40 years. This retrospective cohort study was conducted in a tertiary maternity hospital in Switzerland (high-income country). The study included nulliparas who delivered a live-born infant at ≥37 weeks between January 2015 and December 2019. We excluded pregnant women who had a planned cesarean delivery, were aged <18 years, multiparous, delivered before 37 weeks of gestation, or had pregnancies that ended in stillbirth. Participants were divided into 2 age groups: (1) ≥40 years and (2) <40 years. The primary outcome was the incidence of unscheduled cesarean delivery. Its association with advanced maternal age was evaluated after adjusting for confounding factors by multivariate logistic regression, expressed as an adjusted odds ratio. Secondary outcomes included pregnancy outcomes and neonatal outcomes. A total of 5211 patients were included: 173 in the ≥40-years (advanced maternal age) group and 5038 in the <40-years (non-advanced maternal age) group; 26.01% (95% confidence interval, 19.65-33.22; n=45) of women in the advanced maternal age group had an unscheduled cesarean delivery, whereas 15.26% (95% confidence interval, 14.28-16.29; n=769) of women in the non-advanced maternal age group underwent the procedure. Advanced maternal age was associated with unscheduled cesarean delivery, with an adjusted odds ratio of 1.51 (95% confidence interval, 1.06-2.17; P=.024). Among vaginal deliveries, assisted procedures were performed on 29.7% (95% confidence interval, 21.9-38.4; n=38) of advanced maternal age patients vs 20.1% (95% confidence interval, 18.9-21.3; n=856) of non-advanced maternal age patients. Postpartum blood loss >1000 mL occurred in 5.8% (95% confidence interval, 2.8-10.4; n=10) of advanced maternal age patients and 3.1% (95% confidence interval, 2.6-3.6; n=156) of non-advanced maternal age patients. Advanced maternal age is associated with increased risk of unscheduled cesarean delivery among nulliparas. This provides healthcare professionals with confirmation that advanced age may represent an individual risk factor, suggesting that nulliparous patients aged over 40 years may benefit from improved information regarding the factors contributing to this pregnancy outcome.

Providing healthcare to older people is an essential policy in Taiwan. Previous studies have assessed the health needs of older people residing in urban areas. Evidence related to the differences in healthcare needs between older aboriginal and older ethnic Chinese people in Taiwan is insufficient. As both groups exhibit mutually distinct physical and socio-cultural attributes, understanding their different health needs is necessary to provide tailored and effective healthcare. To investigate the distinct health needs of older aboriginal and older ethnic Chinese using a comprehensive health-needs assessment tool. A cross-sectional study design was used. Older people aged 65 or over were proportionally sampled from communities. The Elderly Assessment System Care Standard instrument was used to collect data through interviews held in participant homes or in community activity centers between October 20th and December 20th, 2011. A total of 180 older people were recruited. A majority of participants had at least one chronic disease, disability, or frailty. Across a range of dimensions and categories of health needs, older aboriginal people had statistically significant higher health needs than non-aboriginal ones. However, older ethnic Chinese participants had higher levels of need in the domains of housing/financing and social participation/isolation. Regression analysis found that independence, risk of frailty, and risk of falls explained the majority of health needs, with R2 values of 64% and 69.6% for older aboriginal and older ethnic Chinese participants, respectively. However, the respective impact of these three categories on overall health needs varied between the two groups. Based on our findings, healthcare providers should focus on improving the self-care capabilities of older aboriginal people and on reducing the risk of breakdowns in care for older ethnic Chinese people in order to enhance the quality of elderly care in Taiwan.

A conceptual model is evaluated that explores the relationship between church-based support and health. In the process, an effort is made to see if the relationships in this model differ for older White and African American people. Interviews were conducted with a national sample of 748 older White and 752 older Black people. The responses of 1,126 of these study participants are used in the analyses presented herein. Survey measures were administered to assess church-based social ties and health. Empirical support was provided for the following theoretical linkages: Older people who attend church often feel their congregations are more cohesive; older people in highly cohesive congregations receive more spiritual and emotional support from their fellow parishioners; older respondents who receive more church-based support have a more personal relationship with God; older people who feel more closely connected with God are more optimistic; and older people who are more optimistic enjoy better health. Data further reveal that older Black people are more likely than older White people to reap the health-related benefits of religion. The findings contribute to research on religion and health by specifying how the salubrious effects of religion may arise.

Aging welcomes wisdom; it entertains problem as well. In old age, there are special problems, which are different from those of younger persons. Some study on homeless and geriatric care reveals that there is disturbance cognitive ability in old age. Therefore, the researcher felt the need to study about the cognitive impairment among old people residing in old age home versus those staying with the family in Pune city, India. The results seldom documented 72% old age people from old age home had mild cognitive impairment, 17% of them fall under moderate cognitive impairment, and 10% were under normal cognitive ability. Among old people living with the family, 70% were in mild cognitive impairment and rest 30% of them were in normal cognitive ability, no one was under severe and moderate cognitive impairment. There is no correlation between cognitive impairment and age, sex, marital status, educational status, marital status, educational status, type of family among old age people who were living with the family because cognitive level was mild to normal. Keywords: Old age, cognitive impairment, old age home Cite this Article Gautam A. A comparative study to assess cognitive impairment of old people residing in old age home versus those living with the family in Pune city. Research & Reviews: Journal of Health Professions. 2016; 6(1): 1–3p.

Creating Text for Older Audiences

Although several reproductive factors have been associated with low bone mineral density (BMD) in elderly women, few studies have evaluated the long-term effects of delivery at a high-risk maternal age on BMD. Using nationally representative survey data collected from 736 women aged 65 years or older, we evaluated the relationship between delivery during adolescence or at an age of 35 years or older and osteoporosis in elderly women. Data regarding demographic and socioeconomic characteristics, medical history, lifestyle risk factors, reproductive history, and history of osteoporosis and fracture were collected by administration of self-report questionnaires. Anthropometric data and BMD were measured in accordance with standardized guidelines. Independent determinants of BMD were identified by stepwise multiple linear regression analysis, and the resulting model was used to evaluate the risk of osteoporosis according to delivery during adolescence or at an advanced age. Of the 736 subjects, 426 (60.1 %) were found to have osteoporosis (T score ≤ -2.5), and 19.2 and 38.9 % reported delivery during adolescence and at an advanced age, respectively. The incidence of delivery during adolescence or at an advanced age was significantly higher in subjects with osteoporosis than in those without osteoporosis. After adjustment for covariates, multiple logistic regression analysis revealed that elderly women with a history of delivery at an advanced maternal age are at an increased (2.164-fold greater) risk of osteoporosis (95 % confidence interval 1.109-4.223) compared with elderly women without a history of delivery at an advanced age. However, a history of delivery during adolescence did not affect the risk.

The article is devoted to assessment of changes in the health status of the older age people within the period of 2013–2023. Relevance of the study is due to the dynamics of life expectancy of the Russian population in recent years, which caused the acceleration and change in the nature of demographic aging, and the goals set in the field of life expectancy. The information base is provided by the results of three authorial sociological surveys «Problems of the third age», conducted on the territory of the Komi Republic with the interval of five years. The study has revealed a positive influence of the medical examination on the awareness of the older age population about their health; increasing responsibility of older people for it, strengthening the individual component of orientation to active, healthy lifestyle, increased physical activity. Older people have traditionally been more critical of assessing their own health than of psychological well-being, with the gap between the surveys widening that also indicates the growing responsibility of older age people for health. Distribution of responses in three surveys on prevalence of major chronic disease risk factors as well as the medical examination results shows the significant importance for older people’s health of high levels of blood pressure, overweight and unhealthy diets. In 2023 health status was assessed to be significantly higher than in the previous surveys. Further improvement of healthy life expectancy is linked to both development of health care and the activation of older age people, including in employment.

Research shows that successful development of sexual identity is essential for healthy and well-adjusted ageing. Gay and bisexual (GB) older people have experienced cumulative events throughout their lives that may have affected the development of their identity. In addition, the few previous studies show an alarming lack of community connectedness among older GB people in Portugal. This study assessed the factors that have contributed to the development of sexual identity in Portuguese GB older adults throughout their lives, using an inductive qualitative cross-sectional approach based on Life Course Theory. Twenty-two semi-structured interviews were carried out with older (60+ years) GB people living in the community and using the lifeline technique. The interviews were analyzed using thematic analysis with a codebook approach. Results suggest a multifactorial contribution of factors throughout the life cycle that have affected the development of GB older people’s sexual identity. These include historical–cultural factors (e.g., sexual repression and traditionalism of the dictatorship), psychosocial factors (e.g., cumulative sexual stigma), relational factors (e.g., relational clandestinity) and intrapersonal factors (e.g., concealment of sexual orientation). The existence of the Internalized Sexual Minority Disconnectedness phenomenon and its contribution to the formation of the sexual identity of older GB adults were also verified. These results reveal important clues about the development of older GB people in Portugal and the factors that may be affecting the current invisibility of these people in the social and health-related context. Relevant implications for the clinical context are also discussed.

Objective To explore the relationship between sarcopenia and the risks of osteoporosis and fragility fractures among community-dwelling middle and old people (≥50 years). Methods OVID/Medline, Pubmed, EMBASE, Cochrane Library, Web of Science (SCI), China National Knowledge Infrastructure (CNKI), and Chinese WanFang Database were searched systematically for literatures related to the relationship between sarcopenia and osteoporosis and fragility fractures from January 1987 to July 2018. The searched literatures were screened based on the inclusion and exclusion criteria. The quality of the literatures were evaluated by using the risk assessment tool NOS (Newcastle-Ottawa Scale) and AHRQ (Agency for Healthcare Research and Quality). Meta-regression analysis was used to explore the cause of heterogeneity between studies. The subgroup analysis was used to assess the differences in the risk of osteoporosis based on the important characteristic variables, such as gender, ethnicity, age, diagnostic criteria of sarcopenia, and outcome type. Sensitivity analysis and trim and fill method were conducted to test the stability of the results of this Meta-analysis. Data collected and summarized by Stata 12.2 software. Results A total of 23 studies in line with quality requirements were included eventually, including 56, 544 subjects. The results of this Meta-analysis were relatively robust. Compared with non-sarcopenia, the relative risk (RR) for osteoporosis among subjects with sarcopenia was 1.61 (95% CI: 1.42~1.82, P<0.000 01). Especially, compared with postmenopausal women RR=1.37 (95% CI: 1.23-1.53, P<0.000 1) and yellow race RR=1.53 (95% CI: 1.34-1.75, P<0.000 1), sarcopenia had a higher impact trend on the risk of osteoporosis in older men RR=2.26 (95% CI: 1.71-2.98, P<0.000 1) and Caucasian RR=2.03 (95% CI: 1.46-2.81, P<0.000 1). Conclusion Among community-dwelling middle and old aged people(≥50 year), sarcopenia increases the risk of osteoporosis and fragility fracture by 61% and 59% -61% significantly, respectively. Middle and old aged people should be prevented and screened early for sarcopenia, which attributes to identify high risk groups of fragile fractures and reduce the risk of adverse outcomes. Key words: Sarcopenia; Osteoporosis; Fragility fractures; Meta-analysis

Background: As the world’s population ages, so the number of old and frail people increases. Respiratory disease is a common reason for hospital admission for older people. Aspiration of saliva, which is probably infected, is the likely etiological agent. The presence of an abnormal swallow has been found to be high in frail older people. Despite the high incidence of swallow problems amongst older people, many hospital services do not routinely screen older people for dysphagia. Methods: A survey, using Research Electronic Database Capture (REDCap), was emailed to contacts working in hospital. They were asked ; 1) type of medical services, 2) does your service screen older (>80 years) people for swallowing problems, 3) are nursing staff and medical staff trained to administer a swallow screen, 4) is a swallowing rehabilitation program offered to older people, and 5) which elements of a rehabilitation programme are offered and used. Results: 150 people with consent from 29 countries responded the survey. 75% work in an acute hospital, 15% in rehab, and 10% in community. 62% responded that they do not or only occasionally screen older people for swallowing difficulties. 50% of the medical staff and 27% of the nursing staff were not trained to administer a swallowing screen. 63% offered a rehabilitation swallowing program with chin tuck against resistance (83%), tongue strengthening (87%), and shaker manoeuvre (79%) being more common than electric stimulation (21%). Conclusions: The results of this study suggest that many health facilities are not routinely screening older people for swallowing problems, and the majority do not train their staff. The majority of facilities were offering a rehabilitation programme. In addition, it is likely that many people are not receiving appropriate proactive intervention because swallowing problems are not being proactively sought.

Because older donor age is a major concern when considering kidneys for potential transplantation, we explored the actual impact of donor age on the features of kidneys that have been transplanted. We studied the correlations of donor age with molecular injury and rejection scores in 4502 kidney transplant biopsies assessed by microarrays, as well as function and postbiopsy survival. We used multivariable analyses to correct for the correlations of donor age with other predictive variables: recipient age, time of biopsy posttransplant, and deceased vs. living donors. Older donor age correlated with lower GFR and increased acute and chronic injury transcripts, but had no effect on rejection, which anti-correlated with recipient age. Acute injury transcripts peaked immediately posttransplant and regressed. Older donor age had little effect on acute molecular injury immediately posttransplant but strongly increased molecular injury scores at later times, peaking about 1-year posttransplant, indicating that older age does not increase molecular injury but increases failed repair post-injury. As expected, older donor age correlated with increased chronic injury and lower GFR, evident from the earliest time posttransplant, pre-transplant aging. However, despite significant age-related effects, the quantitative contribution of donor aging to molecular injury, function, and survival was very small.

ABSTRACTOBJECTIVE:To analyze the association between age extremes and maternal and perinatal outcomes in births in the state of Rio de Janeiro, Brazil.METHODS:Data from the Birth in Brazil II: National Survey on Abortion, Delivery, and Birth (2021–2023) were used. A total of 1,734 postpartum women were included, with live or stillborn newborns, interviewed in the immediate postpartum period. Information was obtained from interviews, clinical records, and prenatal cards. Multiple logistic regression was carried out to evaluate associations between maternal age and outcomes, having women aged 20–34 years as reference.RESULTS:Delivery in adolescents represented 10.1% of the participants, while women with advanced maternal age (AMA ≥ 35 years) corresponded to 18.0%. Adolescents were less likely to receive guidance as to reference maternity hospital (odds ratio — OR = 0.68) and to have a companion at all times (OR = 0.77), in addition to presenting lower prevalence of gestational diabetes (OR = 0.26). In turn, women with advanced maternal age were more often guided on reference maternity hospitals (OR = 1.46) and presented a higher risk of gestational hypertension (OR = 1.78), gestational diabetes (OR = 1.87), placental abruption (OR = 3.30), and severe maternal morbidity (OR = 1.84). In perinatal outcomes, adolescents had a higher risk of perinatal death (OR = 4.52) and spontaneous early-term delivery (OR = 1.47); however, there was a lower probability of early-term delivery by obstetric intervention (OR = 0.48). Newborns of women with advanced maternal age presented higher risk of 5-minute Apgar index < 7 (OR = 3.05) and lower chance of congenital syphilis (OR = 0.34).CONCLUSIONS:Adolescents were provided worse care compared to adults, while women with advanced maternal age presented a higher frequency of age-related complications. These results highlight the need for special care, particularly considering the increase in deliveries in women with advanced age.

Improving services for older people.

A randomized placebo controlled trial of vitamin B12 supplementation to prevent cognitive decline in older diabetic people with borderline low serum vitamin B12.

In order to promote healthy aging, it is important to know older people’s perceptions of healthy aging. The aim of this study is to conduct a Turkish validity and reliability study of the Healthy Aging Perception Scale for Older People with Chronic Diseases. This study was conducted between November and December 2023 with older adult people living in a region in eastern Turkey. A total of 210 older people were included in the sample for the exploratory factor analysis and 214 for the confirmatory factor analysis. A Sociodemographic Information Form and Healthy Aging Perception Scale was used to collect the data of the study. The collected data were analyzed using SPSS 27.0 and AMOS 22.0. Confirmatory factor analysis for the 18-item scale, a four-factor structure with an eigenvalue exceeding 1, was obtained, and it was determined that the factor loadings ranged between 0.834 and 0.637 and the total variance explained was 64.619%. The confirmatory factor analysis of the goodness of fit indices was found to be at an acceptable level. CMIN/DF = 2.834, RMSEA = 0.05, CFI = 0.929, TLI = 0.910, NFI = 0.920, and GFI = 0.901. Cronbach’s alpha of the scale was determined to be 0.826, and the test–retest reliability coefficient was determined to be 0.822. Factor analysis showed a better model fit, and it was determined that the Healthy Aging Perception Scale is a valid and reliable measurement tool in determining the perceptions of the healthy aging of older people with chronic diseases.