Bacground, the increasing number of elderly is a new challenge for health care systems around the world. The phenomenon of the complex health problems experienced by the elderly encourages families to bring the elderly to a nursing home. The purpose of this study was to describe the condition of the elderly living in nursing homes and their care needs. Methodology, this research design is a literature review, article search using 5 databases, namely Scopus, ProQuest, Pubmed, CINAHL and Scient Direct. Articles reviewed from 2019 to 2021. Protocol and evaluation of literature review using the PRISMA checklist, and the assessment guide using the Joanna Briggs Institute Guideline. Results, the health conditions of the elderly who live in the orphanage are mostly aged 60 years and over, physically experiencing disturbances in their daily activities and dependence. Psychologically experiencing anxiety, depression, loneliness and even mental disorders and socially need family support. The care needs of the elderly in nursing homes include services by competent and culturally sensitive staff and nurses, safe and comfortable nursing home environmental services, privacy needs and social interactions, spiritual needs services, social guidance services, and skills guidance services. Conclusion, based on the literature review, it can be seen that nursing services should be provided in a humanistic and holistic manner, the elderly are clients who have both bio-psycho-socio-cultural and spiritual needs. So that nursing services are aimed at meeting the needs of the elderly in a comprehensive manner.

The purpose of the study was to explore older adults’ views and perceptions of psychotherapy in Cyprus. A total of 25 older adults, aged between 65- 89 participated in semi-structured interviews. Thematic analysis identified three main themes: Familiar term/Unfamiliar process; existential crises during this stage; and the issue of stigma. Participants indicated a basic understanding of what psychotherapy entails, but did not associate psychotherapy with serious mental illness. Participants identified a number of existential issues that are potentially major life stressors for an elderly person and referred to the historical stigma that has an impact on their own perceptions about psychotherapy. However, participants seemed to view their ability to overcome psychological difficulties on their own, as a proof of personal strength. Psychologists and other health professionals also need to be mindful of how they describe psychological concepts and treatment as older adults may not understand what they are being told or may be afraid of what treatment involves based on historical context. This study highlights the importance of using strategies that have the potential to empower this population in order to proactively attend to their mental health including community-based education and national mental health campaigns.

Introduction: Drug interactions (DDIs) represent an important clinical problem particularly in elderly patients due to polytherapy, comorbidity and physiological change in pharmacodynamic and pharmacokinetic pathways. In this study we investigated the association between drugs prescribed during hospital or clinical room discharge and the development of DDIs with drugs daily used from each patient. Methods: we performed an observational, retrospective, multicenter study on medical records of outpatients referred to general practitioners. Drug interactions (DDIs) were measured using the drug interactions probability scale. Collected data were analyzed using the Statistical Package for the Social Sciences. Results: During the study we evaluated 1,622 medical records. We recorded the development of DDIs in 10.3% of patients, of those 11.6% induced the hospitalization. Logistic regression showed an association between DDIs and sex and number of drugs used (P = 0.023). Conclusion: this real-life study shows that DDIs are common in elderly patients and physicians must take more attention after hospital discharge revaluating the treatment in order to reduce the risk of DDIs and hospitalization.

Total edentulism is the loss of all teeth for any cause by a multifactorial process that involves biological and patient-related factors. Studies on edentulism and risk factors in Mexico are limited, and the epidemiological surveillance data is scarce and controversial since official governmental reports are not statistically representative of the country. We estimate the distribution for edentulism according to sociodemographic and socioeconomic variables in adults from a low-income state in 2003 and its progress in Mexico. We analyzed data from the National Performance Evaluation Survey in Oaxaca, Mexico, and the annual reports of the Epidemiological Surveillance System of Oral Pathologies in 2009-2019 using X². Oaxacan patients older than 75 y.o (17.9%, p<0.05), those with lower schooling (11.2%), and diabetes (14.5%) presented the highest percentage of edentulism. We do not observe differences in edentulism between sex or residence (p>0.05). From 2009 to 2019, country data reports the lowest rate of edentulism in adults over 20 y.o (0.32%; 95% CI 0.18%-0.48%) and the most affected population over 79 y.o. (7.29%; 95% CI 5.2%-9.30%). As it is a cumulative phenomenon, it is necessary to establish better surveillance, prevention, and treatment programs to improve the oral health of older thus reducing edentulism.

Background: Differential diagnosis between polymyalgia rheumatica (PMR) and seronegative elderly-onset rheumatoid arthritis (SEORA) is not easy, to the point that in the past they were considered the same entity. In these patients, sleep disorders have been scarcely assessed, and considered as expression of mood disorders such as depression and anxiety. Methods: In 38 Caucasian elderly patients (median age: 73.9 ± 8.06 years) consecutively referred to two outpatient clinics from January to May 2018 with diagnosis of PMR and SEORA, sleep impairment was assessed using the Medical Outcomes Study-Sleep scale (MOS-SS). Depression and anxiety were assessed using the Neuropsychiatric Inventory (NPI) score, with point 0 for absent and point 3 for severe. Comorbidities were assessed using the Cumulative Illness Rating Scale (CIRS). Patients taking medications used to treat sleep disturbance or that could favor sleep disturbances were excluded. The study was approved by the local ethics committee and carried out in accordance with the Helsinki Declaration, revised 2013. Every patient signed an informed consent form at the time of the first visit. Results: MOS-SS total point in PMR patients was significantly higher than in SEORA patients (47.60 ± 8.4 vs 28.26 ± 12.4; P = 0.000). After six-month therapy with prednisone (12.5–15 mg/day, followed after 4 weeks by gradual tapering), MOS-SS total point improved in the two groups of patients, with no significant difference (17.0 ± 6.2 vs 17.8 ± 4.2; P = 0.644). No correlation was found between MOS-SS and comorbidities, and between MOS-SS, anxiety or depression. Conclusions: Our data suggest that the assessment of sleep impairment could be very useful in the differential diagnosis between PMR and SEORA. Up today, the reasons why patients with PMR have—at the time of diagnosis—a sleep impairment higher than SEORA are speculative. Further ad hoc complementary studies in multicenter cohorts are needed.

Background: Indonesia is an archipelago with various cultured, will bee affects all aspects of people's lives, including beliefs related to health behavior and health care. One problem that needs serious attention is the elderly group because the elderly are a vulnerable group who have a high risk of experiencing health problems, such as anemia with hypertension, so they need good care management. The research objective was to determine self-management intervention for hypertensive elderly. Methods: This research is a literature review with five databases (Scopus, CINAHL, ScienceDirect, PubMed, Proquest), the study design used is an experimental, descriptive, cross-sectional, and review systematic, in March 2021. Guidelines for using JBI to measure quality and listing check out Prisma in this review guide. A feasibility study based on title, abstract, full text, and research methodology. The data analysis used narrative analysis based on the research findings. Results: Twelve articles met the predefined review inclusion criteria. The study found eight interventions for self-management in elderly hypertension, namely: 1) Knowledge of hypertension, 2) Regulation of physical activity, 3) Limitation of alcohol and cigarette consumption, 4) Sleep rest and stress management, 5) Diet and body weight management, 6) Blood pressure control, 7) Family and social support, 8) Adherence to therapy regimens. Conclusion: The conclusion of the study results obtained eight elderly self-management interventions, this done properly will affect compliance in optimizing the health of the elderly.

With the rising trends in elderly populations around the world, there is a growing interest in understanding how climate sensitivity is related to their thermal perception. Therefore, we analyzed the associations between mortality in the elderly due to cardiovascular (CVD) and respiratory diseases (RD) and meteorological variables, for three cities in the State of São Paulo, Brazil: Campos do Jordão, Ribeirão Preto and Santos, from 1996 to 2017. We applied the Autoregressive Model Integrated with Moving Average (ARIMA) and the Principal Component Analysis (PCA) in order to evaluate statistical associations. Results showed CVD as a major cause of mortality, particularly in the cold period, when a high mortality rate is also observed due to RD. The mortality rate was higher in Campos do Jordão and lower in Santos (and intermediate values in Ribeirão Preto). Campos do Jordão results indicate an increased probability of mortality from CVD and RD due to lower temperatures. In Ribeirão Preto, the lower relative humidity may be related to the increase in CVD and RD deaths. This study emphasizes that, even among subtropical climates, there are significant differences. Therefore, this can assist decision makers in the implementation of mitigating and adaptive measures.

(1) Background: Our paper aimed to examine the ways in which the care centers for the elderly acted and adapted during the pandemic period, by taking into account the opinions of the beneficiaries, of the employees and of the managers of those centers. (2) Methods: in order to conduct the research we used a mixed-method approach. Considering the quantitative research, we applied a questionnaire to 430 institutionalized elderly from Timis county, Romania. Considering the qualitative analysis, we conducted interviews with 31 institutionalized elderly, with 7 employees and 4 managers. (3) Results: most institutionalized elderly were mainly satisfied with their life in the care centers, the main difficulties they had were: the impossibility of being close to loved ones, and the difficulty of adapting to the living conditions within the center, and the elderly were satisfied with the interactions they had with the staff of the care centers. (4) Conclusions: the research conducted provides a view on the lifestyle of the elderly from care centers during the pandemic, it highlights the struggles of the elderly and it can be used as a point of reference for the further improvement of the lifestyle of the elderly within the care centers.

The rapid development of transportation infrastructure in Malaysia had changed the mobility landscape of the country. While it would be a welcome advancement for many, older adults might find it difficult to keep up with their transportation uses and remain active. This study reviewed published articles on the travel behavior of older adults and its associated transportation determinants to explore how sustainable the transportation system is for this vulnerable cohort. Four databases were searched: PubMed, Scopus, ProQuest, and EBSCOhost. Inclusion criteria were older respondents, living in a community in Malaysia, addressing any travel behavior characteristics and written in English language. Review paper, letters, book citations, comments, editorials, and experimental and animal studies were excluded from this study. All in all, this review included seven studies extending from the year 2007 to 2020. The result showed that transportation use of older adults had shifted from relying on public transports to driving their own vehicle to move around. According to the finding of this study, besides personal and health factors, transport use of older adults was affected mainly by cost, public transport availability, road traffic and safety, the complexity of the transportation system, distance to public transit, availability of parking space, road condition and signage. It is concluded that an effective strategy to improve the transportation system is lauded to prevent unmet travel needs among the older adults in Malaysia.

Diabetes is a chronic disease that often causes progressive complications in the elderly. Along with the decline in cognitive function in the elderly, it causes dependence on disciplined management of diabetes mellitus. This dependence causes a very important mentoring role to be given. The purpose of this study is to provide knowledge, attitudes, and family skills to care for the elderly with diabetes mellitus at home through the empowerment of elderly cadres in Lampung. This research method is a quasi-experimental research with a control group design with a total of 64 elderly respondents and 64 families selected by simple random sampling technique. The assessment used an instrument for assessing family abilities that the researcher developed included aspects of knowledge, attitudes, and skills. The results of the dependent t-test analysis showed a significant increase in the knowledge and skills variable in the intervention group (0.000) but decreased in the attitude variable with p 0.198. Meanwhile, the increase in value also occurred in the attitude and skill variables in the control group. So that the results of the independent t-test only showed a significant difference in the attitude score (0.000) with the highest score in the control group. So that there is no significant increase in the ability of the family after the implementation of elderly cadres empowerment.

Astringency is an important sensory characteristic of food and beverages containing polyphenols. However, astringency perception in elderly people has not been documented. The aim of the present work was to evaluate sensitivity to astringency as a function of age and salivary flow. Fifty-four panellists, including 30 elderly people (age=75±4.2 years) and 24 young people (age=29.4±3.8 years), participated in this study. Astringency sensitivity was evaluated by the 2-alternative forced choice (2-AFC) procedure using tannic acid solutions. Whole saliva was collected for 5 min before and after sensory tests. The results showed that the astringency threshold was significantly higher in the elderly group than in the young group. Moreover, a negative correlation between salivary flow and threshold was observed in the young group only. These results showed a difference in oral astringency perception as a function of age for the first time. This difference can be linked to salivary properties that differ as a function of age.

Background: Active ageing is a multidimensional, relative, and context-dependent concept with different paths and outcomes. The purpose of this qualitative study was to explore personal active ageing strategies in a specific context. Method: Following a directed content analyze procedure, we conduct semi structured individual interview with 39 elder (men and women) between the ages of 60-97 years that selected with purposeful sampling .data collection and analysis were concurrent. We analyzed the data from interviews, written narratives, and field notes using directed content analyze. The Reliability of data was fulfilled in accordance Lincoln and Guba criteria. We stopped data collection when no new concept was added and data saturation occurred. Results: Based on the experience of elders, we identified 5 categories: 1) Preventive 2) Coping 3) Internal self-control 4) Coherence maintenance strategies 5) Opportunity exploiting strategies. These described the active ageing strategies when encountering with age related change. Utilizing these strategies, the elder accompanied the life time. Conclusion: The finding suggests that active ageing is a continuous process in confronting age related change. The identified strategies can help to promote active ageing by familiarizing older with opportunities of life and training them in how to use these strategies.

Introduction: Epilepsy is one of the most common neurological diseases. Epilepsy poses a significant burden on the quality of life of affected individuals and their families. The aim of this study was to determine the psychiatric disorders in epileptic patients. Methods and Materials: This descriptive-analytical study was conducted in 2017 with a simple random sampling method on patients with epilepsy who admitted to the neurology department. Results: Among the 150 examined patients, 88 (58.7%) were female and 63(42%) had epilepsy more than 10 years. The most common psychiatric disorder among epileptic patients was depression (68 patients = 45.3%) and anxiety (65 patients = 43.3%) patients. Conclusion: Most of patients had more than 10 years history of epilepsy. Also, Anxiety and depression were the most common symptoms in epileptic patients. It need to more study to determine the psychiatric disorders in epileptic patients.

Primary urethral malignancies are rare in clinical practice and elderly female are prone to suffer. The cause of PUC is unknown and may be related to long-term chronic inflammation, infection, sexual intercourse, pregnancy and irritation of the urethra. Incipient symptom of PUC is not distinctness and can easily lead to misdiagnosis. The final diagnosis relied on transvaginal ultrasound-guided mass biopsy and urethral biopsy. Early tumor treatment is mainly based on surgical resection. For advanced tumors, it is recommended to adopt a comprehensive treatment plan combining surgery, radiotherapy and chemotherapy We report this case with the aim of bringing attention to that primary urethral cancer progresses rapidly and has a poor prognosis, it is urged to call for a need of diagnostic and treatment specification.

Patients with schizophrenia had higher mortality risks and the role of antipsychotic medications remained inconclusive. In an aging society, elderly schizophrenia patients warrant increased attention. In this study, we aimed to explore medication dosage associations with mortality in schizophrenia patients, using Taiwan's national healthcare database from 2010 to 2014, with 102,964 patients with schizophrenia, and a subgroup of 6,433 elderly patients, compared to an age- and gender-matched control group. The findings revealed that schizophrenia patients with no antipsychotic exposure had the highest mortality risk as compared to the control sample—with a 3.61 and 3.37-fold risk for overall and cardiovascular mortality respectively in age and gender-adjusted model, followed by high, low, and moderate exposure groups. A similar pattern was observed in elderly schizophrenia patients but high exposure to antipsychotics was associated with the highest risk in both overall and cardiovascular mortality in elderly patients, with a 3.01, and 2.95-fold risk), respectively. In conclusion, the use of antipsychotics is beneficial to patients with schizophrenia, with recommended exposure levels being low to moderate. In elderly patients, high antipsychotic exposure was associated with the highest mortality risk. We should pay more attention to antipsychotic dosage in elderly schizophrenia patients.

Aging is associated with a decline in immune system functionality. So-called immunosenescence may impair successful vaccination of elderly people. Thus, improved vaccination strategies specifically adapted to an aged immune system are required. We characterized a recombinant MVA expressing a stabilized version of SARS-CoV-2 S protein (MVA-ST) in an aged-hamster model for COVID-19. Intramuscular MVA-ST immunization resulted in protection from disease and severe lung pathology. Importantly, protection correlated with potent activation of SARS-CoV-2 specific T-cells and neutralizing antibodies. Our results suggest that MVA vector vaccines merit further evaluation as clinical candidate vaccines in elderly people to overcome limitations of age-dependent immunosenescence.

It is currently unknown whether thrombin generation is associated with venous thromboembolism (VTE) recurrence, major bleeding, and mortality in the elderly. Therefore, our aim was to prospectively study the association between thrombin generation and VTE recurrence, major bleeding and mortality in elderly patients with acute VTE. Consecutive patients aged ≥65years with acute VTE were followed for 2 years starting from 1 year after the index VTE. Primary outcomes were VTE recurrence, major bleeding and mortality. Thrombin generation was assessed in 565 patients 1 year after the index VTE. At this time, 59% of patients were still anticoagulated. Thrombin generation was discriminatory for VTE recurrence, but not for major bleeding and mortality in non-anticoagulated patients. Moreover, peak ratio (adjusted subhazard ratio 4.09, 95% CI, 1.12-14.92) and normalized peak ratio (adjusted subhazard ratio 2.18, 95% CI, 1.28-3.73) in presence/absence of thrombomodulin were associated with VTE recurrence, but not with major bleeding and mortality after adjustment for potential confounding factors. In elderly patients, thrombin generation was associated with VTE recurrence, but not with major bleeding and/or mortality. Therefore, our study suggests the potential usefulness of thrombin generation measurement after anticoagulation completion for VTE to help identifying among elderly patients those at higher risk of VTE recurrence.

Introduction: Fractures in older individuals are often caused by falls, with approximately 90% of hip fractures resulting from falls. The risk of falling increases with age, and while a significant portion of individuals over 65 fall at least once per year, only a small percentage of these falls result in hip fractures. Factors that influence the likelihood of a fracture occurring include the intensity of the fall and the quality of the bone, with lower bone mineral content increasing the risk of fracture. Older women, particularly those in their 70s, are significantly more prone to hip fractures and any type of fracture. Efforts to reduce the likelihood of falls or mitigate the associated trauma are more complex than treating osteoporosis, due in part to a lack of understanding of the causes and contributing factors of falls in older age.Methods: This study analyzed data from patients admitted to Carmel medical center with upper or lower limb fractures between 2017 and 2019 to determine the side of wrist fractures and compare it to patient age in order to examine whether there was a difference in the distribution of sides in distal radius fractures based on age and test the hypothesis that falls are more likely to occur on the left side due to the assumption that dominant hand gross motor skills are better preserved. The study received approval from the Institutional Helsinki Committee and used statistical analysis with a significance level of 0.05. Potential sources of bias include limited availability of reliable data for many patients and the risk of errors in fracture registration or diagnosis, although the small sample size is expected to minimize these biases.Results: In this analysis of patient data from 2019 to 2017, a binomial test found that the probability of breaking the left wrist is significantly greater than the probability of breaking the right wrist (p < 0.05), while a t-test found no difference in the distribution of fractures between the right and left wrists of the distal radius based on age (p = 0.2774). Discussion: The findings of the study are consistent with previous research, and indicate that there is no change in side preference for fractures with age. Conclusion: The probability of breaking the left wrist is approximately 1.5 times greater than the probability of breaking the right wrist.

Background: Assessment and management of pain in elderly people with cognitive impairment is particularly challenging. Physiological changes due to aging as well as comorbidities and polypharmacy are responsible for a complex clinical approach. Concomitantly, in cognitive impairment, including advanced dementia, changes in central nervous system along with changes in the peripheral nervous system due to aging have a significant impact in pain perception. Often clinicians decide to prescribe opioids in order to relief pain, also without a clear indication. Aim: This review aims to investigate the effect of opioids in elderly patients with cognitive impairment. Methods: A literature search of PubMed/Medline, Scopus, and Cochrane databases was conducted using keyword searches to generate lists of articles which were screened for relevance by title and abstract to give a final list of articles for full-text review. Further articles were identified by snowballing from the reference lists of the full-text articles. Results: This review discuss the complex physiological and pharmacological changes in elderly as well as the neurological changes that affect pain perception in this population. Additionally, it focuses on cognitive impairment and pain in Alzheimer’s disease and other dementias, the pain assessment in the elderly with cognitive impairment as well as the safety of opioid use in elderly. Information regarding opioid prescription in nursing homes as well as recorded indications for opioids use, type and dosing of opioid and compliance of treatment in advanced dementia are also provided. Conclusions: Opioid prescription in elderly population with cognitive impairment is particularly complex. All healthcare professionals involved in the care of such patients, need to be aware of the challenges and strive to ensure analgesic use is guided by appropriate and accurate pain assessment.

This study aimed to characterize the risk of falling in low, moderate and high risk participants from two different geographical locations using a portable force-plate. A sample of 390 older adults from South and North America were matched for age, sex, height and weight. All participants performed a standardized balance assessment using a force plate. Participants were classified in low, moderate and high risk of falling. No differences were observed between South and North American men, nor comparing North American men and women. South American women showed the significantly shorter center of pressure path length compared to other groups. The majority of the sample was categorized as having low risk of falling (male: 65.69 % and female: 61.87 %), with no differences between men and women. Also, no differences were found between North vs. South Americans, nor for falls risk levels when male and female groups were compared separately. In conclusion, South American women had better balance compatible with the status of the 50-59 years’ normative age-range. The prevalence of low falls risk was ~ 61-65 % and the prevalence of moderate to high risk was ~ 16-19 %. The frequency of fall risk did not differ significantly between North and South Americans, nor between males and females.

Purpose: Melanoma’s incidence is increasing, and elderly people could be significantly impacted since the majority occurs in people over 65 years of age. Combined targeted therapies (TT) are current standard regimen for BRAF mutated metastatic melanoma (MM). Except for subgroups of pivotal trials, little data are available for TT in this population. Materials and Methods: Outcomes were explored in real life patients from MelBase, a French multicentric biobank dedicated to the prospective follow-up of unresectable stage III or IV melanoma. Patients treated by BRAF TT and/or MEK TT combined or not, were included from 2013 to 2017 in 2 groups: group 1 <65-year-old (yo), group 2 >65 yo, analyzed for tolerance and efficacy. Results: 353 patients were included: 231 in group 1, 122 in group 2. Median follow-up was 12 months (M). Median time of treatment was 6.9 M. A total of 80% had at least one Adverse Effect (AE). Most frequent AE (all grades) were mainly skin and subcutaneous, general, and gastrointestinal disorders. A total of 31% of AE were grade 3–4: 28% in group 1 and 39% in group 2 (p = 0.05). No differences were observed in all AE grades proportion, dose modifications, interruptions, and discontinuations. For each group, median overall survival was 20.3 M (CI 95%: 15.5–27.9) and 16.3 M (CI: 14.5–26.9), respectively (p = 0.8). Median progression free survival was 7.8 M (6.4–9.9) and 7.7 M (CI: 5.8–11.3) (p = 0.4). Objective response rate was 59% and 50% (p = 0.6). Conclusion: This study on a large multicentric cohort is the first to assess that TT is well tolerated in elderly BRAF-mutated patients such as in patients younger than 65. Efficacy was similar between groups with outcomes reaching those from pivotal studies. There is thus no argument against using TT in elderly people, although an onco-geriatric opinion is welcome for the most vulnerable.

As a growing public interest in social health of elderly, studies focusing on social networks and interpersonal relationships of the elderly are needed. The present study was conducted to de-velop a structured interview to evaluate the interpersonal schema based on Self-Defining Memory of elderly. First, the word cues that the elderly often report on interpersonal events were con-firmed. Next, the indices and scoring rules were prepared, including Relationship frequency (RF), Conflict frequency (CF), Dominance mean (Dm), and Warmth mean (Wm). Healthy elderly peo-ple living alone (mean age = 71.81, SD = 3.95) were interviewed. Finally, the correlation between each index and Short form of Korean Inventory of Interpersonal Problems Circumplex Scales (KIIP-SC) was analyzed for criterion validity. The inter-rater reliability was substantial (Kappa = .61 ~ .66). Based on the analysis of criterion validity, the indices of CF, Dm, and Wm indices showed an appropriate level of criterion validity. This study developed a structural interview based on a novel system of reporting autobiographical memory and established indices with appropriate validity to evaluate interpersonal relationships. The interview is expected to identify the characteristics of interpersonal relationships of the elderly and contribute to the establishment of the elderly community, accordingly.

The human virome is an area of increasing interest with relation to human health and disease. It has been demonstrated to alter in concert with the bacterial microbiome in early life and was also found to be different in patients with certain diseases such as inflammatory bowel disease. However, all virome analyses are hampered by a lack of annotated representative database sequences, often referred to as the ‘viral dark matter’. Here we provide the first description of the gut DNA virome in elderly individuals (>65 years old) as well as the description of novel bacteriophages not present in current reference databases. Diversity analysis comparing elderly persons from different residence locations (community living vs long term care facilities) did not reveal any difference in their virome diversity profiles despite the reported differences at the bacteriome level. An abundance of Microviridae of the subfamily Gokushovirinae were present in the faeces of elderly individuals. Several novel members of the order Caudovirales were also characterized and annotated. Assignment of host bacteria to detected viral genomes was attempted using a combination of CRISPR spacers, tRNA genes and a probabilistic approach. Further characterization of the viral dark matter is necessary for developing tools and expanding databases to study the human virome. This study focused on the virome of an aging human cohort with the goal of illuminating part of the viral dark matter.

Background: This study aimed to develop a highly consumable collagen-containing bar that contributes to enriching the diets of elderly individuals in terms of energy and nutrients. Method: For this purpose, after the development of 5 different bar samples (C, P1, P2, D1, D2) containing different amounts of collagen, date puree, and pumpkin puree, they were evaluated in terms of sensory and nutritional properties. Results: The highest flavor score bars were those with high levels of pumpkin puree (P2) and date puree (D2). By applying the TOPSIS technique, which is used when there are multiple crite-ria among multiple samples, to the snack bar samples with different contents, the most liked sample was found to be the snack bar (D2) with a high level of date puree. One serving of the developed bars contains approximately 300-400 kcal of energy and 6.8-8.8 g of protein. Consid-ering age-related decreased appetite and chewing and swallowing problems in elderly individ-uals, regular consumption of nutrient-rich small meals or snacks with enhanced sensory charac-teristics will contribute to improving their nutritional and functional status.

Aging is associated with muscle atrophy and fatty infiltration of skeletal muscle. The multifidus muscle stabilizes the lumbar spine and undergoes adipose accumulation with age, leading to functional decline in the elderly. Therefore, quantitative assessment of the multifidus muscle can be beneficial for the elderly when formulating treatment strategies and reducing future complications. Fifty-seven patients (mean age, 73.89 ± 6.09; 23 male patients) who underwent lumbar Magnetic resonance imaging (MRI) were prospectively recruited. The cross-sectional area (CSA) of the multifidus from the L2-S1 level and the CSA of the L4-5 level psoas muscle were measured. The functional CSA (fCSA) of the multifidus muscle was measured by excluding the fat infiltration area from the multifidus CSA. The CSA to fCSA ratio was obtained by multiplying 100 by the value obtained by dividing CSA by the fCSA. Pfrrmann classification was used to evaluate the degree of disc degeneration. The functional disability measurements were the Short Physical Performance Battery (SPPB), Berg Balance Scale (BBS), grip strength, and functional reach test (FRT). Pearson's correlation analysis was used to examine the relationship between the functional disability measurements and the multifidus muscle. The CSA to fCSA ratio value was relatively constant at each spine level and showed a significant correlation with the SPPB, grip strength, FRT, and psoas index (p&lt;0.05). However, degree of disc and multifidus muscle degeneration were not statistically significant. So, age-related changes play a significant role in developing back muscle fatty infiltration than disc dgeneration. Moreover, Grip strength showed a stronger relationship with the quality of the multifidus muscle than other functional disability measurements.

The elderly present age-related morphological and histological changes of the oral cavity; Literature displays many studies regarding the specific pathologies of the oral cavity in elderly patients, but no etiologically based classification is available. The aim of this study was to analyze the series of patients over 65 who were treated by our Unit of Pathology between 2020 and 2022 for a suspicion of oral lesion or for preventive dental evaluation (in anticipation of cardiac surgery, anti-resorptive drugs intake, chemotherapy, radiotherapy of the head-neck district or transplantation). The analysis was conducted by dividing oral lesions into 5 groups depending on the etiology: reactive, immunological, traumatic, benign and malignant degenerative. The sixth group consisted of patients undergoing preventive dental evaluation. The study included 435 patients; 91 of them were diagnosed with a reactive origin pathology, 174 with immunological origin pathology, 48 with traumatic pathology and 86 with degenerative pathology (42 benign and 44 malignant). 36 patients went to our Unit for preventive specialist evaluation. Oral health has a major impact on the daily life of the elderly; The examination of oral mucosa in geriatric patients is a fundamental diagnostic moment to report lesions early, thus allowing easier prevention and treatment.

As the world's population ages and the resulting health problems become more serious, medical and health policies in developed countries are focused on how to prevent and treat the diseases of the aging population and how to maintain their quality of life. Typical age-related diseases include deafness, cataracts, osteoarthritis, chronic obstructive pulmonary disease, diabetes mellitus, and dementia. Although the mechanisms by which these diseases develop differ, they are all caused by the accumulation of molecular and cellular damage over time. In addition, age-related diseases can cause a decline in physical and mental functions and the ability to perform activities of daily living, as well as the loss of roles in society and a sense of fulfillment in life. Therefore, there is a need for treatment and measures to accurately grasp and maintain their quality of life.

Older adults (age ≥65) are at high risk of influenza morbidity and mortality. This study evaluated the impact of a hypothetical two-dose influenza vaccine regimen per season to reduce symptomatic flu cases by providing preseason (first dose) and mid-season (second dose) protection to offset waning vaccine effectiveness (VE). The Framework for Reconstructing Epidemiological Dynamics (FRED), an agent-based modeling platform, was used to compare typical one-dose vaccination to a two-dose vaccination strategy. Primary models incorporated waning VE of 10% per month and varied influenza season timing (December through March) to estimate cases and hospitalizations in older adults. Additional scenarios modeled reductions in uptake and VE of the second dose, and overall waning. In seasons with later peaks, two vaccine doses had the largest potential to reduce cases (14.4% with February peak, 18.7% with March peak) and hospitalizations (13.1% with February peak, 16.8% with March peak). Reductions in cases and hospitalizations still resulted but decreased when 30% of individuals failed to receive a second dose, second dose VE was reduced, or overall waning was reduced to 7% per month. Agent-based modeling indicates that two influenza vaccine doses could decrease cases and hospitalizations in older individuals. The highest impact occurred in the more frequently observed late-peak seasons. The beneficial impact of the two-dose regimen persisted despite model scenarios of reduced uptake of the second dose, decreased VE of the second dose, or overall VE waning.

This article presents an overview of the philosophical and theoretical foundations of the Family Resilience, The Resiliency Model of Family Stress, the Adjustment, and Adaptation Model in families caring for the elderly, The Concept of Religious Coping and its application in order to strengthen family resilience. It is based on the phenomenon the increasing elderly population worldwide has become a global problem, along with the fact that the extension of life expectancy in a person is also accompanied by a decrease in function due to degenerative processes, that require complex health care services. So far, the family is still the primary care setting of choice in the care of the elderly. However, as an informal caregiver, the family also has many limitations that cause the burden of caring for the elderly to become a source of stress in itself. Hence, it impacts the quality of care and the quality of life of the elderly themselves. Meanwhile, from various sources, it is known that religious coping is one of the sources of overcoming stress. So that a strategy is needed to strengthen family resilience in accepting the responsibility of health care for the elderly with a religious coping approach.

Over the past decade, Thailand has experienced a rapid increase in its elderly population. Many unfavorable health outcomes among elderly people are associated with nutrition. Nutrition in elderly people is affected by physical, mental, and social factors. This study explored the food choices and dietary practices among community-dwelling elderly people in Thailand from the perspective of both caregivers and the elderly people themselves. Six focus group discussions and six semi-structured interviews were conducted in the Samut Sakhon Province of Thailand. A combination of deductive and inductive thematic analyses was adopted, and the results show that physical and mental factors and societal factors are important determinants of food choices. Moreover, a changing food environment and economic factors were found to affect food choices. Issues of trust in food safety and food markets were highlighted as growing issues. Therefore, fostering healthy food choice interventions that consider both environmental and societal aspects is necessary.

Thoracotomy is one of the most painful types of incision a patient can experience. Pain is a very complex pathophysiological entity. Neuronal pathophysiological mechanisms are integrated with the immunological response, which amplify inflammation and pain. Prolonged inflammation induces a pathological response of the immune-system and constantly stimulate the nociceptive pathways generating chronic pain. The mechanisms are particularly altered in lymphomas, where pain following chest surgery often becomes chronic and reduces the quality of life. In this study 51 elderly patients who had undergone a transthoracic biopsy to verify the suspect of mediastinal lymphoma were examined for pain reduction with oral opioids, effect of epidural analgesia and paravertebral block. Subsequently, patients underwent tensed torsion exercises, progressively intensified. After the first few days, patients walked progressively for 20 minutes a day. Once discharged a program of patients started aerobic exercises to increase muscle endurance and to strengthen the extensor muscles of the legs and of the upper limbs. The systemic administration of opioids is the simplest and most common method of providing analgesia for postoperative pain, but early mobilization, respiratory rehabilitation, and muscle toning exercises are excellent support devices both for physical and psychological recovery.

The incidence of post transplantation lymphoproliferative disorders (PTLDs) and other neoplasms in organ transplant patients is higher than in the non-transplanted population. This event is more frequent in older subjects, due, at least in part, to the immune dysfunction induced by immunosuppressants administered to prevent rejection. Alterations of the immune system mechanisms of protection against carcinogenesis appear to be the key role in the in the pathogenesis of these neoplasms. The data of our study on the incidence of neoplasms occurred during a long-term follow-up in an elderly population after they underwent cardiac transplantation. This study gives, also evidence of the favorable effect of physical activity programs on cardiorespiratory and psychomotor function.

Endoscopic retrograde cholangiopancreatography (ERCP) is a routinely used therapeutic procedure for the biliary and pancreatic diseases. Population aging may increase the typical indications of ERCP and come with more complexity and difficulties, especially in cannulation. This study aimed to evaluate the incidence, causes, and management of difficult biliary cannulation during ERCP in super-aged patients and the role of difficult cannulation as a risk factor for adverse events. A total of 614 patients, underwent ERCP, were prospectively studied as a cohort and divided into two groups based on their age. There were 146 patients aged 80 years or older in group A and 468 patients aged less than 80 years in group B. The primary outcome measures were the difficulty grade of papilla cannulation, clinical outcomes, and ERCP-related complications in the two groups. The adverse events were analyzed using logistic regression for patient age, co-morbidities, indications, and cannulation difficulty grade variables. There was no difference in the incidence of difficult cannulation between the two groups (32.9% vs. 34.4%, p=0.765) though, as expected, super-aged Group A had a higher prevalence of periampullary diverticulum (29.5% vs. 16.7%, p=0.001). The technical cannulation success rate was (96.6% vs. 96.8%, p= 0.54). All used cannulation techniques in the elderly group were efficient and safe. Logistic regression showed that age ≥80 was not associated with increased adverse events; however, difficult cannulation (adjusted odds ratio [AOR]=3.478; 95% confidence interval [CI]=1.877, 6.442; p<0.001) and CCI ≥2 (AOR=1.824; 95% CI=0.993, 3.349; p=0.045) were more likely to have adverse events. Age ≤65 (AOR=3.460; 95% CI=1.511, 7.922; p=0.003), female gender (AOR=2.362; 95% CI=1.089, 5.124; p=0.030), difficult cannulation (AOR=4.527; 95% CI=2.078, 9.860; p<0.001), and patients with cholangitis (AOR=3.261; 95% CI=1.204, 8.832; p=0.020) were strongly associated with increasing Post-ERCP Pancreatitis (PEP). Advanced age has not proved to be a risk factor of difficult cannulation, and secondary cannulation techniques can be safely and efficaciously utilized for this group. CCI ≥2 and difficult cannulation are associated with increased overall adverse events rate while age ≥80 factor is not.

Background: Malnutrition is a frequent condition in the elderly and is associated with prolonged hospitalization and increased mortality. However, the impact of malnutrition among elderly patients with acute myocardial infarction has not been clarified yet. Methods and Results: We have enrolled 174 patients aged 65 years and over, admitted with the diagnosis of acute myocardial infarction (AMI) who underwent to the evaluation of nutritional status by Mini Nutritional Assessment (MNA) and of mortality risk by Grace score 2.0. All-cause mortality was the outcome considered for this study. Over a mean follow-up of 24.5 ± 18.2 months, 43 deaths have been registered (24.3%). Non-survivors were more likely to be older, with worse GFR, lower SBP, lower albumin and MNA score, higher prevalence of Killip classification III-IV grade, and higher Troponin I levels. Multivariate Cox proportional analysis revealed that Grace score and MNA showed a significant and independent impact on mortality, (HR = 1.76, 95% CI = 1.34–2.32 and HR = 0.56, 95% CI = 0.42–0.73, respectively). Moreover, the clinical decision curve revealed a higher clinical net benefit when the MNA was included compared to the partial models without MNA. Conclusions: Nutritional status is an independent predictor of long-term mortality among elderly patients with AMI. MNA score in elderly patients with AMI may help prognostic stratification and identification of patients with/at risk of malnutrition in order to apply interventions to improve nutritional status and maybe survival in this population.

Objective: To assess the effects of chronic walnut consumption on body weight and adiposity in elderly individuals. Methods: The Walnuts And Healthy Aging study is a dual-center (Barcelona, Spain and Loma Linda University [LLU]), 2-year randomized parallel trial. This report concerns only the LLU cohort. Healthy elders (mean age 69 y, 67% women) were randomly assigned to walnut (n = 183) or control diets (n = 173). Subjects in the walnut group received packaged walnuts (28–56 g/d), equivalent to ≈15% of daily energy requirements, to incorporate into their habitual diet, while those in the control group abstained from walnuts. Adiposity was measured periodically, and data were adjusted for in-trial changes in self-reported physical activity. Results: After 2 years, body weight significantly decreased (P = 0.031), while body fat significantly increased (P = 0.0001). However, no significant differences were observed between the control and walnut groups regarding body weight (−0.6 kg and −0.4 kg, respectively, P = 0.67) or body fat (+0.9% and +1.3%, respectively, P = 0.53). Lean body mass, waist circumference and waist-to-hip ratio remained essentially unchanged. Sensitivity analyses were consistent with the findings of primary analysis. Conclusion: Our findings indicate that walnuts can be incorporated into the daily diet of healthy elders without concern for adverse effects on body weight or body composition.

The processes of an ageing population are becoming a challenge in the context of social, technological, and research policy. Also, according to the perspective 2080, Poland belongs to the group of counties with the prognosticated number of citizens over 65 to account for one-third of the population. Different strategies aimed at dealing with the mentioned demographic challenges include widespread use of humanoids in care for older people. As the research of such nature was the first in Poland, this article aimed to identify the factors and their interlinks that determine the attitude and the future use of humanoids by older people of the Polish society. Based on the specific attributes of humanoid technology, the model hypothesises that an attitude to technology can be directly predicted by four perceived technology attributes, namely an impact on the quality of life, technological impact, ethical and social problems, while user attitude towards humanoid technology is predicted to have an indirect influence on the future intention of use. A survey method was used to collect research data. An electronic questionnaire was used to conduct confidential interviews. Finally, 643 filled questionnaires were received. Results received via a regression analysis confirmed that the most important factor influencing human attitudes was a positive social impact achieved using humanoids in the care of lonely people and improving the safety of older people. Another important factor was a technological impact from the use of humanoids performing functions desired by respondents. The technology in question could be useful for reminding older people about taking medication, informing family members about the health condition of their older people and calling for help on their behalf.

The human virome is an area of increasing interest with relation to human health and disease. It has been demonstrated to alter in concert with the bacterial microbiome in early life and was also found to be different in patients with certain diseases such as inflammatory bowel disease. However, all virome analyses are hampered by a lack of annotated representative database sequences, often referred to as the ‘viral dark matter’. Here we provide the first description of the gut DNA virome in elderly individuals (>65 years old) as well as the description of novel bacteriophages not present in current reference databases. Diversity analysis comparing elderly persons from different residence locations (community living vs long term care facilities) did not reveal any difference in their virome diversity profiles despite the reported differences at the bacteriome level. An abundance of Microviridae of the subfamily Gokushovirinae were present in the faeces of elderly individuals. Several novel members of the order Caudovirales were also characterized and annotated. Assignment of host bacteria to detected viral genomes was attempted using a combination of CRISPR spacers, tRNA genes and a probabilistic approach. Further characterization of the viral dark matter is necessary for developing tools and expanding databases to study the human virome. This study focused on the virome of an aging human cohort with the goal of illuminating part of the viral dark matter.

Understanding the spatial distribution pattern and evolution characteristics of the elderly population in urban areas is of great significance for the development of urban planning and the implementation of public management policies in the context of rapid aging. Accurately identifying the spatial distribution and evolution characteristics of the elderly population in the city requires a comprehensive analysis of multiple indicators and large-scale data. Taking Wuhan city as an example, this article measures the spatial distribution characteristics and evolution trend of the elderly population from 2000 to 2020 at the street/township level, based on the fifth, sixth, and seventh census data, using methods such as kernel density hotspot detection, spatial clustering analysis, and standard deviation ellipse analysis. The results show that: ① there are significant differences in the aging spatial pattern between the central area and the suburban areas of Wuhan; ② overall, Wuhan's aging rate shows a typical "core-periphery" growth mode in space, while the density of the elderly population has significant spatial aggregation characteristics and shows an evolution trend of "centralized concentration, peripheral outliers, axial development, and near-field growth"; ③the center of gravity of the elderly population remains relatively stable over time.

To assess the clinical efficacy of a novel organic olive oil-based denture adhesive and its effect on Candida Albicans growth in maxillary edentulous individuals wearing complete dentures. Individuals were selected from two Dental Schools in Portugal and Spain. Twenty-eight complete dentures were relined, following a standardized protocol. The novel product (Test) was compared with a commercialized adhesive (Control) and Vaseline (Placebo) randomly assigned in a cross-study design. The retention resistance was measured with a Gnathometer and a dynamometer, the patient related outcome evaluations with a 5-points questionnaire and the Candida albicans growth in a Sabouraud dextrose agar (SDA) medium in order to evaluate differences between the placebo and experimental product. Twenty-three participants were included. Dynamometer evaluation showed significant differences between not using a denture adhesive and using either (experimental, p = .03; control, p = .04), no significant differences between the two adhesives (p &gt; .05). In the subjective analysis, the experimental adhesive showed a significantly longer effectiveness (p = .001); the control reported better results at taste (p = .03) in chewing (p = .001). The test adhesive showed better (p &lt; .001) Candida albicans growth inhibition. The experimental adhesive showed longer effectiveness than the control and placebo with a better inhibition capacity for the growth of Candida albicans, patients reported better abilities for speech, chewing, taste and retirement in the control adhesive.

Nonpharmacological therapeutic interventions in elderly may lead to the reduction of cognitive and depressive symptoms. The aim of the study was to evaluate changes in cognitive functions and mood er or not. in older adults participating in therapy, conducted in the community day-care center (CD-CC). 46 elderly adults (21 M, 25 W) (SG) were examined. The control group (CG) included 45 adults (12 M, 33 W), who participated in the activities of the University of the Third Age (U3A). The following measuring tools were used: Mini-Mental State Examination (MMSE), Clock-Drawing Test (CDT), Verbal Fluency Test (VFT), Digit Span Test (DST), Stroop Color and Word Test (SCWT), Beck's Depression Inventory (BDI), and Hospital Anxiety and Depression Scale (HADS). The intervention consisted of CD-CC 6-month complex therapy. In the SG, compared to the CG, the scores on the: MMSE, CDT, VFT, DST, and SCWT were significantly lower (p<0,05), and BDI was significantly higher (p<0,05). After intervention, the SG and the CG, did not show substantial differences in their scores on the: MMSE, CDT, and BDI. In the SG, a significant improvement (p<0,05) was reported on the: VFT, BDI, and HADS scores. The CD-CC complex therapy can be helpful for the cognitive and emotional elderly functioning.

Background: This study aimed to describe the frequency and duration of sedentary bouts and assess the bidirectional cross-sectional associations between these characteristics and adiposity in elderly women. Methods: Data from 314 elderly community-dwelling women (mean age 66.6±6.5 years) from Czech Republic, Poland, and Slovakia were analyzed. Measures were collected in 2008–2017. Fat mass percentage (FM%) was used as an indicator of adiposity. The patterns of sedentary behaviour were monitored using an accelerometer, and ≥5, ≥10, ≥20, ≥30, ≥40, and ≥60 minute bouts were analyzed. The exponent alpha was also calculated to express the accumulation of sedentary time in bouts. We performed a multiple linear regression analysis to assess the bidirectional causal association between variables. Results: There was a significant association of FM% with time spent in bouts with a duration ≥5, ≥10, ≥20min (β ranging 0.11–0.28, p≤0.01) and the frequency of bouts with a length ≥5, ≥10, ≥20, and ≥30min (β ranging 0.03–0.74, p≤0.05) in fully-adjusted models. In contrast, a strong negative association was observed between FM% and alpha (bout distribution) in both directions (p≤0.001). Conclusions: Our results suggest that the sedentary characteristics such as bout duration, bout frequency, and distribution (alpha) are bidirectionally associated with adiposity and they should be considered in further research in older adults.

The research is carried out to assess factor affecting the health condition of the elderly people in the slum areas in Sylhet City. This research was quantitative type. In Quantitative approach, primary data were collected and used from the randomly selected elderly people in the Sylhet City slum areas. The secondary data were collected from many articles, documents, newspaper, magazine etc. By analyzing the survey data, it is illustrated that the slum dwellers are deprived from the basic needs. Meanwhile, elderly people can‟t fulfill their medical treatment due to their financial condition because of their work incompatibility. This study identifies the factor affecting health condition such as financial condition, lack of knowledge about proper medical facilities, communication gap between the authority and patient, unemployment, and so on. These factors also affect their health situation. Many diseases like asthma, heart disease are occurred. This study also mentions about the livelihood of slum people are so poor in condition. Due to financial condition, aged people can‟t take their proper treatment and their family member can‟t afford it. This study also understands that the people from slum areas are getting concerned about their medical care. They are easily going to the hospital and take their service because of low pricing. On the other hand, people are meanwhile stopped their treatment of financial situation. This study finds the health situation of elderly people at slum areas in metropolitan city and their consciousness.

Controversy exists on whether animal and plant proteins influence obesity differently. The purpose of this study was to evaluate the association between total, animal, and plant protein intake with the obesity index and renal function in Korean adults. Study participants included Korean adults aged 60 years or older from the Korean National Health and Nutrition Examination Survey in 2013-2014. Height, weight, and waist circumference (WC) were measured and the body mass index (BMI) was calculated. One-day 24-hour recall data were used to estimate the daily total, animal, and plant protein intake. Glomerular filtration rate (GFR) was calculated by using the Modification of Diet in Renal Disease (MDRD) equation. General linear modellings were used to assess the relationships between protein intake, BMI and WC. The mean age was 69.2 ± 0.2 years, 44.2% were male. The total daily protein intake was 1.1 ± 0.02 g/kg/d and 0.9 ± 0.02 g/kg/d for males and females, respectively. Only one third of protein intake was from animal sources. In males, BMI (p < 0.001, p = 0.016, p < 0.001 respectively) and WC (p < 0.001, p = 0.010, p < 0.001, respectively) decreased as daily intake of plant protein (g/kg/d), animal protein (g/kg/d) and total protein (g/kg/d) increased. Similar associations were shown in Korean female. GFR was not associated with protein intake regardless of protein source in both sexes. In Korean adults aged 60 years or older, the protein intake was associated with a favorable obesity index without decrease in renal function. The effect was similar in both male and females, with both animal and plant proteins.

This study tests the utilization of Bluetooth noise-canceling headphones in improving the quality of eye exams in patients with hearing loss. University of Texas Medical Branch patients above 55 years of age were screened for hearing loss using SoundCheck audiometry. All 29 subjects (18 red-zone and 11 yellow-zone) answered pre-recorded Amsler grid and patient education questions that solicited precise responses. As controls, subjects were randomly administered half of the questions via headphones and half via a smartphone at normal speech volume (60 decibels). Points were awarded for responses demonstrating comprehension, and a post-exam survey was collected. Collectively, the mean score was 1.79 with headphones versus 0.96 with control on the Amsler grid segment and 1.90 with headphones versus 0.97 with control on education questions (p=0.001). Between the red and yellow zone hearing loss patients, the red-zone group answered significantly better in both Amsler (1.78 versus 0.50; p=0.0003) and education questions (1.88 versus 0.44; p&lt;0.0001) with headphones. The yellow zone group answered better with headphones overall but failed to reach significance. Post-exam survey indicated that 28 of 29 patients (97%) preferred the headphones during ophthalmic exams. Patients with severe hearing loss demonstrated better comprehension with the noise-canceling headphones; thus these devices show great promise in improving effective, compassionate communication between providers and hearing-loss patients.

A promoting work for the elderly is an important way of empowering the participation of the elderly in society for economic development, which will lead to the well-being of the elderly. This is presented the policy proposal for elderly government officials employment in public sector organizations landscape study by policy research on EDFR which combines MACR, especially, elderly civil servants in public sector organizations of 56 - 60 years, and aged of 60 years to over, include the experts into the data. Comparing the employment forms elderly civil servants in public sector organizations of flexible employment and new employment models to differences at statistical significance level of 0.01, 0.05, respectively. Significance the policy proposal for elderly government officials employment at “Key” factors of the strategies, goals, measures, and operational guidelines to effectiveness.

Background and Objectives: There is a need to effectively manage the healthy aging of the rapidly increasing number of elderly people in an ultra-elderly society. The purpose of this study was to analyze the mediating effects of social networks and wisdom on the relationship between lifestyle habits and healthy aging in older adults with chronic diseases. Materials and Methods: Participants were 120 community-dwelling older adults aged 65 and older with at least one chronic disease. Data were collected from elderly people who met the criteria by visiting nursing care worker training centers, senior centers, social gatherings, and home welfare centers in D, G, and S cities from May 24 to June 23, 2023, with a questionnaire consisting of lifestyle habits, social networks, wisdom and healthy aging, and general characteristics. Results: The degree of healthy aging of the subjects was 3.56 out of 5, and there were differences in the degree of healthy aging according to age (F=3.76, p=0.026), spousal relationship (t=3.11, p=0.002), education (F=9.08, p&lt;0.001), number of diseases (F=8.65, p&lt;0.001), and economic level (t=-2.45, p=0.016). The most common diseases among the subjects were hypertension, hyperlipidemia, joint diseases and diabetes mellitus. Healthy aging was highly correlated with lifestyle habits (r=0.63, p&lt;0.001), social networks (r=0.65, p&lt;0.001), and wisdom (r=0.73, p&lt;0.001). Social networks (β=0.46, p&lt;0.001) and wisdom (β=0.55, p&lt;0.001) had partial mediating effects (z=4.15, p&lt;0.001; z=5.11, p&lt;0.001) on the relationship between subjects' lifestyle habits and healthy aging. Conclusions: In order to increase the degree of healthy aging of the subjects, it is necessary to establish a mediating intervention program that manages to have a good lifestyle habits in daily life, increase social networks, and become wise.

Thermoregulation is important for maintaining homeostasis of our body. It can be easily broken under anesthesia. An appropriate method to measure the core body temperature is needed, especially for elderly patients because the efficiency of thermoregulation gradually decreases with age. The aim of this study was to examine the accuracy and feasibility of using of SpotOn® sensor in lower extremity orthopedic surgery in elderly patients aged over 80 years by comparing a SpotOn® sensor with two other reliable minimal-invasive methods: a tympanic membrane thermometer and a bladder thermometer. This study enrolled 45 patients aged over 80 years who were scheduled to undergo a lower extremity surgery. Body temperature was measured using a SpotOn® sensor, tympanic membrane thermometer and bladder thermometer. Agreements between the SpotOn® sensor and the other two methods were assessed using Bland and Altman plots for repeated measures adjusted for unequal numbers of measurements per patient. Compared with TempBladder, bias and limits of agreement for TempZHF were 0.07℃ ± 0.58℃. Compared with TempTympanic, bias and limits of agreement for TempZHF were -0.28℃ ± 0.61℃. 3M SpotOn® sensor using ZHF method for patients aged over 80 years undergoing lower extremity surgery shows feasible measurement value and sensitivity.

Surgeons are increasingly faced with a challenging, ageing and frail patient population. A significant absence of biomarkers to stratify outcomes of patients undergoing emergency laparotomy exists. Inflammageing describes a state of chronic inflammation associated with ageing and frailty and may predict worse outcomes. This retrospective observational study evaluated pre-morbid inflammatory markers in the prognostication of elderly patients undergoing emergency laparotomy. Patients aged ≥65 years undergoing surgery between 01/04/2017 – 01/04/2022 were identified. Pre-admission and acute C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), total white cell count (WCC), neutrophil count (NC) and lymphocyte count (LC) data points were captured. Pre-operative risk stratification scores and postoperative outcomes were recorded using the National Emergency Laparotomy Audit (NELA) database. A cohort of 196 patients was included: 57.7% were female, median age of 74.5 years. High-risk (NELA risk of mortality ≥5%) and frail (clinical frailty scale ≥4) patients experienced a significantly longer hospital and critical care stay (p<0.05). Pre-admission ESR ≥16 and LC ≥4.1 were significantly associated with a longer critical care stay (p<0.05), however, no statistical significance was observed with CRP, WCC and NC in predicting adverse outcomes. We found an elevated pre-morbid ESR and LC identifies a potential inflammageing cohort that demonstrate worse outcomes following emergency laparotomy. The prognostication of elderly surgical patients remains a challenge and represents an area of research deserving of future attention.

Background: dementia is a significant health issue worldwide. Mild cognitive impairment (MCI) can transform into dementia over time. General practitioners may be the first to notice the cognitive deficit, so they may need a screening test in the event of suspicion, which they must be able to use under great time pressure. We examined the usability of the Hungarian Test Your Memory (TYM-Hun) self-administered dementia test in general practice, and with the results of the received tests, we tried to draw conclusions regarding the population. Methods: In the four Hungarian cities with medical universities, general practitioners filled out 368 questionnaires with their clients over 50 years of age. Results: the total scores of the test showed a significant correlation with education and the type of occupation, while a significant negative correlation with age. We found the clock drawing test and recall indicates cognitive decline the earliest. Based on the TYM-Hun results, the prevalence levels for MCI and dementia are slightly higher in Hungary than globally. Conclusion: the test can sensitively indicate MCI and early-stage dementia as a screening test, and two of its subtests can raise the possibility of cognitive impairment at an earlier age than the others.

Background: COVID-19 is a disease of the elderly as 95% of deaths related to COVID-19 occur in people over 60 years of age. Despite the urgent need for a preventive treatment there are currently no serious leads, other than the vaccination. Objective: To find a preventive treatment of COVID-19 in elderly patients. Design: Retrospective case-control study. Setting: Robertsau Geriatric Hospital of the University Hospitals of Strasbourg, France. Patients: 179 elderly patients who had been in contact with the SARS-CoV-2, of whom 89 had tested RT-PCR-positive (COVID-pos) for the virus and 90 had tested RT-PCR-negative (COVID-neg). Measurements: Treatments within 15 days prior to RT-PCR (including antihypertensive drugs, antipsychotics, antibiotics, nonsteroidal anti-inflammatory drugs, proton pump inhibitors (PPIs), paracetamol, anticoagulant, oral antidiabetics (OADs), corticosteroids, immunosuppressants), comorbidities, symptoms, laboratory values, and clinical outcome were all collected using the electronic patient record. Results: COVID-pos patients more frequently had a history of diabetes (P=.016) and alcoholism (P=.023), a lower leukocyte count (P=.014) and a higher mortality rate– 29.2% versus 14.4% – (P=.014) when compared to COVID-neg patients. Patients on PPIs were 2.3 times less likely (odds ratio [OR] = 0.4381, 95% confidence interval [CI] [0.2331, 0.8175], P=.0053) to develop COVID-19 infection, compared to those not on PPIs. No other treatment decreased or increased this risk. COVID-19 patients on antipsychotics (P=.0013) and OADs (P=.0166) were less likely to die. Limitations: retrospective study. Conclusion: PPIs treatment lowered the risk of development of COVID-19 infection, and antipsychotics and OADs decreased the risk of mortality in geriatric patients. If further studies confirm this finding, PPIs could be used preventatively in the elderly in this pandemic context. Moreover, OADS and antipsychotics should be tested in clinical trials.

The rapid growth rate of the elderly population is a serious current issue in most countries, affecting them economically through needed medical treatment and healthcare planning. The priority concern is how to reduce the number of elderly people requiring long-term healthcare and raise the number who are able to live independently. This study executed a behavior assessment of elderly person’s self-reported use of electric scooters and analyzed their degree of acceptance of these assisted living tools, partly through a related factor analysis of our survey instrument. We used this questionnaire survey as our research method, applying SPSS22 software for factor analysis that revealed five survey facets.

The present study examines the long-term care service awareness, needs, and usage intention of elderly male homosexuals in Taiwan and their ideal long-term care service model. This study of five elderly male homosexual subjects aged 66 to 73 years was intended as a preliminary exploration. Interviews were used to collect data. The study determined that the five subjects had high awareness of long-term care services, as they had actual experience of long-term care services or even participated in care service staff training to obtain certificates. Some even had experience in applying for home care services and experienced problems during use. The subjects perceived that they were very likely to require long-term care services in the future and tended to use home care services if they required long-term care services. Due to their personal experiences, the subjects had negative awareness of long-term care services and worried that long-term care service staff had poor attitudes toward homosexuals. The subjects considered the most important aspects of long-term care to be basic medical care and lifestyle care. However, they worried that long-term care staff would delay or refuse to provide such services due to the subjects’ sexual orientation or stereotypes, and they were concerned above all about the “friendly attitude” of long-term care staff. They hoped that long-term care staff were friendly toward homosexuals and did not discriminate against them, and they felt that it would be more appropriate for homosexual long-term care staff to provide assistance. In terms of vision, while preferring organizations with homosexual employees, the subjects worried that they would be stigmatized and discriminated against . With regard to ideal long-term care services, while considering institutions with homosexual staff to be ideal, the subjects also worried that these would be labeled as institutions that were dedicated to homosexuals, potentially resulting in discrimination. Therefore, they hoped that the sexuality sensitivity of long-term care staff could be improved and that they would undergo professional continuing education to learn about homosexuals, the situation and care needs of homosexuals, and care techniques for homosexuals.

Poor medication adherence among older adults is a widespread problem worldwide. As the population ages, the design of smartphone medication management apps is critical to improving medication adherence among older adults. Taking the design of an elderly medication reminder APP as an example, this study proposes a sustainable design research method that integrates the KANO model, Analytic Hierarchy Process (AHP), Quality Function Deployment (QFD), and PUGH decision matrix. The method collects user demands through in-depth interviews, and applies the KANO model to classify these demands. The hierarchical structure of user needs is established by using AHP, and the priority is sorted according to the weight and importance determined by the judgment matrix. QFD is used to translate user needs into design requirements, and the house of quality matrix identifies key design requirements. Finally, design alternatives are evaluated using Pugh's concept selection method. The results of this study demonstrate that the integration of KANO-AHP-QFD-PUGH can be effective as a sustainable optimal design approach for the user experience of a medication reminder application for the elderly. This integrated method not only facilitates innovative optimization and sustainability of application design methods but also provides valuable theoretical and practical insights for future drug-assisted design for elderly users.

This research is aimed at the knowledge of the effectiveness of the material resources in the sensa-tions of exploratory procedures in 365 older people who take part in the physical activity that the Sport Municipal Institute (SMI) offers in the different sports centers assigned to it in the city of Se-ville, using a descriptive design and with a questionnaire developed and validated previously by the Delphi method; showing the relationship between the basic emotions that seniors experience when handling sport, and the materials. So it is claimed that exist a relation between older people, which practice exercise with the materials that they use on it.

Background: While several drugs are in the pipeline for treatment of various grades of COVID-19 disease, none of them have shown promise until now. Medicinal plants are crucial in developing and developed countries for their primary and basic health needs owing to better tolerability, superior compatibility with human body and having lesser side effects. AEV01 , a speciality extract of kutki (Picrorhiza kurroa), is one potential medicinal herb which can be effective for mild COVID19 in elderly patients at risk of complications and aging immunity. Purpose: The efficacy and safety of AEV01 for mild COVID-19 in elderly patients at risk of complications was investigated in this study. Study design: A prospective, phase 3, randomized, multicentric, placebo controlled double blinded parallel group interventional trial. Methods: This study was conducted in elderly patients diagnosed as COVID-19 with mild symptoms. 70 patients were randomized into two groups to receive AEV01 capsule (100mg) and placebo respectively thrice daily for 30 days along with standard care of treatment as per national WHO/ICMR guidelines. Clinical improvement timelines and corresponding scores using 8-point ordinal scale and NEWS were assessed for efficacy and safety of AEV01 in COVID-19 patients. Results: AEV01 group showed a significant improvement (P=0.0001) in the normalization of the SpO₂ rate and relief from cough. There was also significant difference in time to recovery, with patients in the AEV01 drugtreated group recovering in 4.5 days as compared to Placebo in 9.1 days. ESR, LDH, serum ferritin, Neutrophil-Lymphocyte ratio (NLR), TNF- alpha, IL-6 and CD4 cell counts, which are considered as prognostic markers in COVID19 infected patients, showed a significant improvement in patients treated with AEV01. The AEV01 drug treated group showed significant clinical improvement in the 8-point ordinal scale severity rating and NEW Score from day 3 onwards which continued up to end of study. Conclusion: AEV01 has shown a significant improvement in clinical and laboratory parameters. There was also reduction in the progression of the COVID-19 disease in unvaccinated elderly patients from mild to moderate when treated at an earlier stage.

The irritable bowel syndrome (IBS) is functional gastrointestinal tract disease, include abnormal defecation and abdominal pain. The Rome IV criteria define fecal incontinence as "recurrent and uncontrolled stool leakage that lasts more than 3 months." Fecal incontinence is common in patients with IBS and can have a significant negative impact on daily life and reduce the patient's quality of life. Diet and lifestyle guidance are needed to prevent fecal incontinence. Fecal incontinence can be reduced by ingesting dietary fiber, which can improve stool properties, and avoiding foods with stool-softening properties. Additionally, defecation habit guidance is important for preventing fecal incontinence. If rectal sensation is normal, it is recommended to go to the bathroom as soon as there is a desire to defecate. In elderly people, if there is stool in the rectum due to decreased rectal sensation and it continues to accumulate in the rectum without triggering the urge to defecate, overflowing leaky fecal incontinence may occur. For such patients, defecation habit training teaching them to defecate even if they do not have the desire to defecate may be effective. Education and advice on defecation reduces fecal incontinence and is beneficial to caregivers.

Coronavirus disease 2019 (COVID-19) is associated with high risk of malnutrition, primarily in elderly people; assessing nutritional risk using appropriate screening tools is critical. This systematic review identified applicable tools and assessed their measurement properties. Literature was searched in the MEDLINE, Embase, and LILACS databases. Four studies conducted in China met the eligibility criteria. Sample sizes ranged from six to 182, and participants’ ages from 65 to 87 years. Seven nutritional screening and assessment tools were used: the Nutritional Risk Screening 2002 (NRS-2002), Mini Nutritional Assessment (MNA), MNA-short form (MNA-sf), Malnutrition Universal Screening Tool (MUST), Nutritional Risk Index (NRI), Geriatric NRI (GNRI), and modified Nutrition Risk in the Critically ill (mNUTRIC) score. Nutritional risk was identified in 27.5% to 100% of participants. The NRS-2002, MNA, MNA-sf, NRI, and MUST demonstrated high sensitivity; the MUST had better specificity. The MNA and MUST demonstrated better criterion validity. The MNA-sf demonstrated better predictive validity for poor appetite and weight loss; the NRS-2002 demonstrated better predictive validity for prolonged hospitalization. mNUTRIC score demonstrated good predictive validity for hospital mortality. Most instruments demonstrate high sensitivity for identifying nutritional risk, but none are acknowledged as the best for nutritional screening in elderly COVID-19 patients.

The purpose of this study was to determine the effects of aerobic exercise on carotid to femoral pulse wave velocity (cf-PWV), cell adhesion molecules (intracellular adhesion molecules (ICAM-1), vascular cell adhesion molecules (VCAM-1), and endothelial selectin (E-selectin), and oxidized-LDL in elderly women aged 70–85 years, and to identify the effect of and correlation with vascular stiffness. Forty participants were recruited and divided into three groups; vascular stiffness (VSG, n=14), obesity (OG, n=14), and normal (NG, n=12). All groups were given a 16-week intervention of aerobic exercise, and the data collected before and after exercise were analyzed using SPSS Ver. 23.0. Two-way repeated-measures ANOVA was used to evaluate between-group and time-dependent interaction effects. One-way ANOVA was used to evaluate between-group variations. In addition, the significance was tested using a post-hoc test (Scheffe). The within-group variations by time before and after exercise were examined using a paired t-test, and correlation analysis was performed using Pearson correlation coefficients. Simple regression analysis was performed for variables showing significant differences. The results indicated interaction effects for cf-PWV (p<.001), VCAM-1 (p<.01), E-selectin (p<.05) and oxidized LDL (p<.001). The rate of change of cf-PWV was positively correlated with that of VCAM-1 (r=.352, p<.05) and that of oxidized-LDL (r=.325, p<.05) with statistical significance. To determine the effect of the rate of change of cf-PWV on the rate of change of VCAM-1, the variables were tested, and the coefficient of determination in the regression analysis was .124, indicating that 12.4% of the tested variables fit the standard regression line. The variables for the effect of the rate of change of cf-PWV on the rate of change of oxidized LDL were also tested, and the coefficient of determination in the regression analysis was .106, indicating that 10.6% of the tested variables fit the standard regression line. Thus, the 16-week regular and consistent aerobic exercise program had significant effects on the cf-PWV, ICAM-1, VCAM-1, E-selectin, and oxidized-LDL in elderly Korean women with vascular stiffness, suggesting improvements in vascular stiffness, based on which the intervention is predicted to contribute to the prevention of vascular dysfunction by lowering the risk of cardiovascular disease due to atherosclerosis, as well as having a positive effect in the prevention of impairment of vascular endothelial cells.

Background. There is limited evidence on the relationship between chronic kidney disease (CKD) and frailty in older people in Vietnam. This study aimed to examine the prevalence of frailty and its impact on mortality in older patients with end-stage renal disease. Method. This is a prospective, observational study at two large Dialysis Centres in Vietnam from November 2020 to June 2021. Consecutive older patients diagnosed with end-stage renal disease and on dialysis were recruited. Participants’ frailty status was defined by the Clinical Frailty Scale (CFS). The study outcome was all-cause mortality at 6th month. Results. A total of 175 participants were recruited (mean age 72.4 years, 58.9% female). Using the cut-point of CFS ≥4, 87.4% of the participants were frail. Mortality at 6th month was 14.9%, 31.9% in participants with CFS ≥7, 12.8% in participants with CFS=6, 7.5% in participants with CFS from 4 to 5, and 4.5% in participants with CFS ≤3 (p=0.001). Cox regression analysis showed that compared to the non-frail participants, the probability of death over 6 months was nearly 2-fold higher in the mildly frail, 3-fold higher in the moderately frail, and 9-fold higher in the severely frail participants. Conclusion. This study demonstrated a very high prevalence of frailty in older patients with end-stage renal disease and dialysis and the significant impact of frailty severity on mortality. Healthcare providers should consider incorporating frailty screening into routine care for older patients with end-stage renal disease and dialysis.

Green public space immensely provides ecological soundness (ES), social resilience, social inclusiveness, mental health, self-esteem, and cultural prosperity from privileged class to lower ones. This research aims at estimating the effect of social services, safety, and infrastructural amenity in green space (parks) on mental health building self-esteem for elderly population. Data were collected from four parks out of 21 in Dhaka selected by systematic random sampling. Two-hundred and three elderly participants were picked up for survey using snowball sampling. The survey was conducted in a pre-structured questionnaire consisted of 40 close-ended questions. Data was analyzed applying ordinal logistic model, multivariate regression analysis, and Partial Least Square (PLS) -Path Modeling. The study explored several key findings-1) Infrastructural amenities impacted social services of parks; 2) Social services contributed positively to mental health boosting up self-esteem for elderly population. 3) Likewise, mental health for elderly population was affected by safety measure of green space. Dhaka requires constructing age-friendly parks to promote elderly mental health.

PcALCL mainly concerns elderly patients. It is a large CD30+ T-cell neoplasm composed of large cells with anaplastic, pleomorphic or immunoblastic morphology, with exclusively cutaneous onset and localization. The clinical course of pcALCL is predominantly indolent. Most elderly patients with lymphoma tend to have a sedentary lifestyle, which has a negative effect on their quality of life (QoL) and on their survival. Several studies indicate that exercise has a positive impact on QoL because it reduces peak oxygen consumption, improves physical capacity, increases self-esteem, reduces accumulated stress and promotes relaxation. Therefore, particularly in indolent lymphomas, it is necessary to indicate a program of physical activity to be practiced systematically. The complete surgical excision and local radiotherapy are the first line gold standard in pcALCL with solitary lesion.

The aim of this study was to identify the differences in functional fitness and quality of life among women over 60 years of age depending on their level of objectively measured physical activity (PA) according to Global Recommendations on Physical Activity for health. The study used cross-sectional design with 213 volunteered women over 60 years of age. Physical activity was monitored for 7 days of the week using Actigraph Gt3x monitor. The Senior Fitness Test battery and Hand-grip strength tests were performed to assess functional fitness. Quality of life was self-reported using short version of WHOQOL-brief questionnaire. Women who met the PA recommendations achieved slightly better results in most functional tests and all domain of quality of life. The significant differences were found in upper body strength, dynamic balance and social relationships domain of quality of life. Physical activity programs developed on the basis of WHO recommendations have the potential to improve functional capacity and quality of life. However, further experimental studies in this area are required.

Background: While outcomes of chronic phase chronic myeloid leukemia (CP-CML) patients aged over 65 years have been extensively evaluated in real-life experiences, limited data exist for the very elderly population (i.e., aged ≥ 75 years), especially for next-generation tyrosine kinase inhibitors (TKIs). In this retrospective study, we sought to evaluate the safety and efficacy of TKIs in this particular setting of patients. Methods: We conducted a retrospective analysis of a multicenter cohort of 123 newly diagnosed CP-CML very elderly patients. Results: The median age at diagnosis was 80 years (range: 75-96). In the first-line, 86.1% of patients received imatinib, 7.1% dasatinib, 5.6% nilotinib, and 0.81% received bosutinib. A total of 31 patients (25.2%) switched to second-line therapy, nine patients to a third-line and one patient to a fourth line of therapy. Resistance to treatment was the primary reason for switching therapy in both the first (64.5%) and second lines (77.7%). At diagnosis, reduced doses were administered in 36.5% of patients, in 61.2% in the second line, and in all patients in subsequent lines of therapy. In first-line setting, 71.9% of patients achieved an early molecular response (EMR, i.e. 3-month BCR::ABL1 IS <10%); at 6, 12, and 24 months, MR3 was reached by 35.7%, 55.7%, and 75.0% of patients, with 16.6%, 35.7%, and 51.7% achieving DMR at the same timepoints. Treatment-free remission (TFR) was successfully attempted in 11 patients. During the follow-up period, adverse events (AEs) were observed in 78.8% of patients, including 22 cases of cardiovascular AEs. Toxicity grade ≥ 3 was more commonly observed in patients treated with standard doses of TKIs compared to reduced doses (p=0.033). Overall, median follow-up was 46.62 months (range: 1.8-206.2), and 43 patients died due to non CML related causes. Three patients died due to disease progression to advanced (n=1) and blastic (n=2) phases. The 5-year overall survival (OS) for the entire cohort was 71.9% (95% CI: 0.63-0.81), with no significant difference between patients treated with standard doses of TKI compared to those treated with reduced doses (p=0.35). Conclusions: TKIs appear to be safe and effective even in very elderly CML patients, and dose optimization strategies yield satisfactory molecular responses for adequate disease control with an improved safety profile.

This rapid review aims to present a comprehensive overview of barriers and facilitators or factors, and, effective interventions that promote immunisation uptake by older people in the Asia-Pacific region. Rapid review methodology was applied using two databases (PubMed, Embase). Articles were included if studies were conduced in Australia, Singapore, Indonesia and the Philippines, included human population ≥50 years old, used original data, adopted quantitative, qualitative, and mixed-method designs, and published from 2016 to August 2022. The study selection yielded 1424 articles. A total 23 papers met the inclusion criteria, of which 19 reported on barriers and facilitators, while, 4 articles reported on effective interventions to promote vaccination uptake. Among the 19 studies that identified barriers and facilitators to vaccination uptake, the more common factors were social influences (n=8/19), perceived benefits of vaccine (n=7/19), and perceived vaccine safety (n=6/19). Strategies that focussed on supporting clinicians were found to be effective in leading them to recommend vaccinations among older adults such as creating awareness on the low baseline vaccination rates among older adults, provision of structured health assessment, and nurse reminders. More studies are needed ascertain the factors, and effective interventions influencing vaccine uptake among older people in the Asia-Pacific region.

Adult human thymus degenerates into adipose tissue (TAT). In contrast to subcutaneous adipose tissue (SAT), TAT has been reported to exhibit enhanced angiogenic properties in elderly people. We have previously shown that vascular endothelial growth factor A (VEGFA) is the most abundant angiogenic growth factor in TAT of patients with ischemic cardiomyopathy (IC), and that VEGFA levels are increased in elderly (&gt;70 years) compared with middle-aged patients. This makes TAT a promising candidate for angiogenic therapies and the regeneration of ischemic tissues following coronary surgery. MicroRNAs (miRNAs) have emerged as attractive therapeutic targets, especially those that regulate angiogenic processes. The study's purpose is to determine the miRNA network associated with both VEGFA pathway regulation and enrichment of age-linked angiogenesis in the TAT.

The rapid ageing of populations around the World is creating complex challenges for national governments. The establishment of sustainable and equitable long-term care systems for old and dependent people is one of the main issues of social policy in developed countries. The aim of this work is to define a cost model for residential and day care centres for dependent persons in Cantabria (Spain). The cost model will make it possible to establish the theoretical cost of attending to the needs of the different types of dependent persons in the different types of care centres, and the methodology used could be extrapolated to other regions. The daily cost per user for elderly residential care is €53.72. The cost per user in elderly day centres (5 days) is 32.56 euros. In residential centres for people with disabilities, the values range between €47.41 and €75.25 depending on the category of the centre. In three categories of centres the public price is not enough to cover the cost (physical disability, intellectual disability, mental illness – low care), and therefore the administration should reconsider their public prices for these kind of centres if they want to really contribute to the sustainability of these residential care centres. This research will have important implications for policy-makers in a context of fulfilment of SDGs and where better support for old and disabled people and their carers, as well as fair and efficient financing of social care services, are essential to address the current and future challenges of dependency.

Fragility scales are intended to help in therapeutic decisions. Here we asked if the fragility as-sessment in MM patients ≥75 years old qualified for treatment by the local physician correlates with the choice of treatment: a 2- or 3-drug regimen. Between 7/2018 to 12/2019 we prospectively enrolled 197 MM patients at the start of treatment from the 13 Polish Myeloma Group centers. The data to assess fragility were prospectively collected, but centrally assessed fragility was not disclosed to the local center. The activity of daily living (ADL) could be assessed in 192 (97.5%) and was independent in 158 (80.2%), moderately impaired in 23 (11.7%), and 11 (5.6%) in com-pletely dependent. Patients with more than 3 comorbidities were 26.9% (53 patients). Thus, ac-cording to the Palumbo calculator, 43 patients were in the intermediate-fitness group (21.8%), and the rest belonged to the frailty group (153, 77.7%). Overall, 79.7% of patients (157) received 3-drug regimens and 20.3% (40) received 2-drug regimens. In each ECOG group, more than 3/4 of patients received 3-drug regimens. According to the ADL scale, 82.3% of the independent 65.2% of moderately impaired, and 81.8% of the dependent received 3-drug regimens. Out of 53 pa-tients with at least 4 comorbidities, 71.7% received 3-drug regimens, and the rest 2-drug regi-mens. Three-drugs regimens received 34 patients from the intermediate-fit group (79.0%), and 123 (79.9%) from the frail group. Early mortality occurred in 25 patients (12.7%). No one discon-tinued treatment due to toxicity. To conclude, MM patients over 75 are mainly treated with tri-ple-drug regimens, not only in reduced doses, regardless of their frailty scores. However, the absence of prospective fragility assessment did not negatively affect early mortality and the number of treatment discontinuations which questions the clinical utility of current fragility scales in everyday practice.

Background: The incidence of traumatic acute subdural hematomas (ASDH) in elderly is increasing. Despite surgical evacuation, these patients have poor survival and low rate of functional outcome, and surgical timing plays a no clear role as predictor. We investigated if the timing of surgery has a major role in influencing outcome in these patients.Methods: We retrospectively retrieved clinical and radiological data of all patients ≥70 years operated on for post-traumatic ASDH in a 3 years period in 5 Italian Hospitals. Patients were divided in 3 surgical timing groups from hospital arrival: ultra-early (within 6h); early (6-24h); delayed (after 24h). Outcome was measured at discharge using two endpoints: survival (alive/dead) and functional outcome at Glasgow Outcome Scale (GOS). Univariate and multivariate predictor models were constructed.Results: We included 136 patients. About 33% died for consequences of ASDH and among the survivors only 24% were in good functional outcome at discharge. Surgical timing groups appeared different according to presenting GCS, which was on average lower in ultra-early surgery group, and radiological findings, which appeared worse in the same group. Delayed surgery was more frequent in patients with subacute clinical deterioration. Surgical timing appeared associated neither with survival nor with functional outcome also after stratification for preoperative GCS. Preoperative midline shift was the strongest outcome predictor. Conclusions: An earlier surgery was offered to patients with worse clinical-radiological findings. Also after stratification for GCS it was not associated with better outcome. Among the radiological markers, preoperative midline shift was the strongest outcome predictor.

Urinary and fecal incontinence as well as skin pressure injury are common healthcare problems in nursing home; however, these prevalence and related risk factors were not well understood in the Japanese special elderly nursing home settings. We surveyed the prevalence of urinary, fecal and double incontinence, and skin pressure injury among the elderly living in special elderly nursing home in Japan. A nationwide cross-sectional epidemiological survey was conducted with a total of 4,881 residents. The prevalence of urinary, fecal and double incontinence was 82.9%, 68.9% and 64.9%, respectively. Skin pressure injury was found in 283 residents (283/4881, 5.8%). Age, Care-Needs level, loss of voiding desire, and fecal incontinence were significant risk factors for urinary incontinence. Residential period, Care-Needs level, loss of voiding and defecation desires, and urinary incontinence were significant risk factors for fecal incontinence. Only male sex was a significant risk factor for skin pressure injury. Our study revealed continence status and the prevalence of pressure skin injury among older adult residents who receive an end-of-life care in special nursing homes in Japan. Further studies should be conducted to examine whether recovery of urinary and fecal sensations improves continence status.

Technology advancements are evident in the healthcare field; numerous new opportunities and applications have emerged during the last years based on embedded intelligence and related to real-time diagnosis of medical issues, tele-care and telemedicine, remote monitoring of patients, computer-assisted “smart” transportation in case of emergencies, as well as new types of remotely controlled surgical operations. This paper aims to provide an overview of the application of embedded intelligence in the field of healthcare; it gathers the main critical requirements, related technologies and research advancements up to date, and it presents the most important challenges that are yet to be faced. The main focus is given in the development and optimization of Body Area Networks (BANs) based on advanced embedded sensing devices, the optimization of smart gateways in such networks, and the provision of holistic scalable and secure solutions in the healthcare domain. In addition, the paper presents two principal use cases that stem from the combination of novel information and communication technologies with classic healthcare practices, explaining the functional and non-functional requirements, as well as the mixed criticality characteristics of the associated systems.

As medical care aiming to maintain the quality of life for elderly patients is increases, implant treatment for elderly patients is increasing worldwide. Therefore, we aimed to investigate implant stability and the reliability of different measuring devices according to implant placement site and duration in patients aged over 65 years. The study evaluated 60 implants in 60 patients aged ≥ 65 years. The implant placement sites were divided into six evenly distributed sections (n=10) i.e., maxillary right- posterior, A; maxillary anterior, B; maxillary left-posterior, C; mandibular right-posterior, D; mandibular anterior, E; mandibular left-posterior, F. Participants visited the hospital seven times: preoperatively, 1V; implant surgery, 2V; stitch removal, 3V; 1-month follow-up, 4V; 2-months follow-up, 5V; before final-restoration delivery, 6V; and after final-restoration delivery, 7V. The implant stability was evaluated with the Osstell Mentor (ISQ), Periotest M (PTV), and Anycheck (IST). The mean values of ISQ, PTV, and IST were analyzed (α=.05). ISQ, PTV, and IST results of 5V and 6V were significantly higher than those of 2V (P<.05). The lowest ISQ results occurred in E location at 5V and 6V (P<.05). In all mandibular locations, IST results of 7V were significantly higher than those of 2V, 3V, 4V, and 5V (P<.05). ISQ results were negatively correlated with PTV and positively correlated with IST, and PTV was negatively correlated with IST. By considering various factors that affect implant stability, the appropriate implant load application time was determined. This could help increase the implant success rate in elderly patients. And as a diagnostic device for implant stability for evaluation of osseointegration in elderly patients, Anycheck was also able to prove its relative reliability compared to Osstell ISQ Mentor and Periotest M.

Background: It is unclear why certain countries have been more severely affected by COVID-19 than other countries. Methods: In this ecological study we compared COVID-19 mortality and incidence/100,000 as well as 4 putative explanatory factors by WHO world region. Linear regression was then used to assess the country-level predictors of COVID-19 mortality/100,000 and incidence/100,000 in 204 countries with available data. Results: COVID-19 incidence and mortality/capita were greater in Europe than other regions. This was despite a higher testing rate in Europe than other regions. Europe had an older population than all other regions and a higher prevalence of obesity than Africa, South East Asia and the Eastern Mediterranean. Country level multiple linear regression revealed positive associations between mortality/capita and testing rate, percent of the population 65 years or older, and Europe compared to Western Pacific and South East Asia (all P<0.005). Results for the analyses with cases/100,000 as outcome variable were similar. Conclusion: Our results suggest that older populations as well as other undefined regional and national factors, possibly related to efficacy of control efforts, are responsible for differences in national severity COVID-19 epidemics.

Aim: this scoping review was designed to identify studies that assess the adverse drug reactions (ADRs) for older people in Australian aged-care facilities. This review critically evaluated each published study to identify the risk of, or actual adverse drug events in older people. Inclusion criteria: This review considered any clinical studies that examined the adverse effects of medications in older people who were living in aged-care facilities. This review considered qualitative studies, analytical studies, RCTs, descriptive cross-sectional studies, and analytic observational studies that explored the use of medications and their adverse effects on older people in clinical settings (including aged care facilities). Methods: An initial search of the PubMed, OvidSP, EBSCOHost, MEDLINE, ScienceDirect, Wiley Online, SAGE, and SCOPUS databases, with full text was performed, followed by an analysis of the article’s title and abstract. Additionally, MeSH was used to describe the article. The initial round of the database search was based on inclusion criteria from studies that assessed tools or protocols aiming to identify the adverse effects of medications on the elderly population suffering chronic conditions or multiple co-morbidities. Two reviewers screened the retrieved papers for inclusion. The data presented in this review are in tabular forms and a narrative summary which aligns with the review’s objectives. Results: Seven studies were identified, and the extracted data from these studies were grouped according their characteristics and the auditing results of each study. Conclusion: There was no comprehensive or broadly adverse drug reaction assessment tool derived from Australian data that has been used on the elderly in an Australian healthcare setting.

This study aimed to investigate the efficacy of probiotics in elderly hospitalized tube-fed patients undergoing antibiotic therapy for Clostridium difficile-associated diarrhea (CDAD). Probiotics were administered to 29 patients, with twice-daily doses for 7 days following the completion of antibiotic treatment. In the probiotic group, while stool form showed no significant change, there was a significant decrease in stool frequency. Conversely, the control group exhibited improved stool form but not frequency. The probiotic group maintained a significant difference in stool form during the follow-up period. Additionally, the control group showed a positive correlation between stool form, frequency, antibiotic therapy, and intensive care unit admission, which was not observed in the probiotic group. These findings suggest that supplementing with probiotics can effectively normalize stool form in elderly hospitalized tube-fed patients undergoing antibiotic treatment for CDAD, highlighting the potential benefits of probiotic intervention in this specific population.

Background: Frail elderly patients are exposed to suffering the consequences of heart diseases that are not managed timely such as receiving anticoagulation to prevent stroke associated to atrial fibrillation (AF). Referral to the cardiological outpatient department can be cumbersome as it often requires repeated visits. The aim of this project was to use AF as a showcase to develop and implement CardioShare, a shared-care model where primary care leads patient management, using an easy-to-use compact Holter monitor device with asynchronous remote support from cardiologists. Methods: This complex intervention has been developed during a feasibility phase, tested in a pragmatic cluster-randomization trial (primary care clinic as clusters) and its implementation potential evaluated with an escalation test. Mixed methods were used to evaluate the impact of the intervention, comprising quantitative observations, semi-structured interviews, and workshops. Results: Between February 2020 and December 2021, 314 patients (30% frail) were included of whom 75% had AF diagnosed/not found within 13 days. More than 80% in both groups avoided referral to cardiologists. Patients felt safe and primary care clinicians satisfied. In the escalation test, 58 primary-care doctors used CardioShare to manage 93 patients over three months with remote support from four hospitals in the Capital Region of Denmark. Conclusions: CardioShare was successfully implemented for AF evaluation in primary care.

Alzheimer’s disease and related dementias (ADRD) remain a public health challenge in developing counties. We developed a needs-based essential care service package (ECSP) for care planning of persons living with dementia (PLWD) using a cross-sectional survey among PLWD in institutions in six cities in China (n= 1,299). Face-to-face interviews were conducted with caregivers of PLWD by trained staff between 2018 and 2019. Care service needs and utilization by the level of cognitive impairment were summarized. The average age of PLWD was 80.7 years. 76% of participants had severe cognitive impairment. The needs-based ECSP with 30 service items would be sufficient in supporting care services of PLWD in China, of which seven items are core care. The selection plan for ECSP at different levels is designed as “General Care Services + Selective Care Services”, in which service items for low-, mid-and high-level care for PLWD are 7+3, 7+6, and 7+10, respectively. The findings provide the first large-scale data on service needs and utilization of PLWD in mainland China. The ECSP for PLWD advanced in the paper was a practicable and effective quantitative management means. It is deserved to application in a large scale.

Diabetes mellitus (DM) and chronic kidney disease (CKD) are common in middle aged and elderly individuals. DM may accelerate the aging process, and the age-related declines in the estimated Glomerular Filtration Rate (eGFR), can pose a challenge to diagnose diabetic kidney disease (DKD) using standard diagnostic criteria especially with absence of severe albuminuria among the elderly. In the presence of CKD and DM, elderly patients may need multidisciplinary care due to susceptibility to various health issues e.g., cognitive decline, auditory or visual impairment, various comorbidities, complex medical regimens, and increased sensitivity to medication adverse effects. As a result, it can be challenging to apply recent therapeutic advancements for the general population to the elderly. We review the evidence that the benefits from these newer therapies apply equally to elderly and non-elderly patients and propose a framework for the management of DKD by discussing the nonpharmacological measures and pharmacological management with renin angiotensin system inhibitors (RASi), Sodium Glucose Co-Transporter two inhibitors (SGLT2i), non-steroidal mineralocorticoids receptor antagonists (MRAs), and Glucagon Like Peptide 1 Receptor Agonists (GLP1-RAs).

Mild Cognitive Impairment (MCI) is a clinical syndrome characterized by a moderate decline in one or more cognitive functions with a preserved autonomy in daily life activities [1]. MCI exhibits cognitive, behavioral, psychological symptoms [2]. The executive functions (EFs) are a set of key functions for everyday life and physical and mental health; and allow adapting the behavior to external changes [3-5]. Higher-level executive functions develop from basic EFs (inhibition, working memory, attentional control, and cognitive flexibility). They are planning, reasoning, problem- solving, and fluid intelligence (Gf) [3]. This systematic review investigates the relationship between higher-level executive functions and healthy and pathological aging, assuming the role of executive functions deficits as a predictor of cognitive decline. The systematic review was conducted according to the PRISMA Statement [6-7]. A total of 73 studies were identified. The results indicate that 65.8% of the studies confirm significant EFs alterations in MCI (100% problem solving, 71.4% fluid intelligence, 56.8% planning, 50% reasoning). These results seem to highlight a strong prevalence of higher-level executive functions deficits in MCI elderly than in healthy elderly.

Abstract: The objective of this meta-analysis was to evaluate the factors associated with mortality of elderly Italians diagnosed with the new coronavirus who resided in institutions or who were hospitalized as a result of the disease. Methods: A systematic review following the recommenda-tions of The Joanna Briggs Institute (JBI), where the PEO strategy was utilized - Population, Exposure and Outcome. P, being the elderly over 65 years old. E, the SARS-CoV_2 pandemic. O, mortality. The NCBI / PubMed, LILACS, EMBASE and CINAHL databases were used until July 31, 2020.; Results: Five Italian studies were included in the meta-analysis, with the number of elderly people varying between 18 and 1591 patients. The main morbidities presented by the elderly in the studies were: dementia, diabetes, chronic kidney disease and hypertension. Conclusions: The factors as-sociated with the mortality of elderly Italian people diagnosed with SARS-CoV-2 who lived in in-stitutions or who were hospitalized because of the disease were evaluated. It was found that de-mentia, diabetes, chronic kidney disease and hypertension are the main the main diagnosed dis-eases for mortality in elderly people with Covid-19.

Background: Animal-assisted therapy has positive effects on cognitive function, depression, performance ability, and social functioning in elderly patients. The aim of this study was to evaluate the effects of rearing pet insects on the cognitive function of healthy elderly participants, with fMRI (functional magnetic resonance imaging) being used for this purpose. Methods: Community-dwelling elderly women (≥60 years) with normal cognitive function were enrolled during April 2015. They were randomized at a 1:1 ratio into two groups: insect-rearing and control (n=16) groups, with the insect-rearing group being further classified into two groups for analysis according to the subjects’ scores in the Wisconsin Card Sorting Test, WCST) at the first fMRI: insect-rearing group I with a relatively high score (n=13), and insect-rearing group II with a relatively low score (n=6). All subjects were educated on a healthy lifestyle for better cognitive function at every visit, and the insect-rearing groups received and reared crickets as pet insects. The fMRI was performed at baseline and after 8 weeks using the WCST as a stimulus. The WCST consisted of two variations, a high level baseline (HLB) and semi-WCST version. Results: There were no significant differences in the baseline characteristics among the three groups. There was a significant difference accuracy of the HLB–semi-WCST (p<0.05) in insect-rearing group II after 8 weeks from the baseline test. In the fMRI analysis involving the WCST reaction test, increased activation was observed in the right dorsal lateral prefrontal cortex and parietal cortex in insect-rearing group II when the semi-WCST, rather than the HLB, was performed. There were no significant differences in the other groups. Conclusion: The rearing of pet insects as an animal-assisted therapy is cost-effective, easy, and occupies little space. In this study, it showed positive effects on executive functions and performance improvement in elderly women. Further larger studies on the effects of pet insects on cognitive function are warranted.

The TeNDER project aims to improve the Quality of Life (QoL) of chronic patients through an integrated care ecosystem. This study evaluates the Health Recommender System (HRS) developed for the project, which offers personalized recommendations based on data collected from a set of monitoring devices. The list of notifications covered different areas of daily-life such as physical activity, nutrition, and sleep. We conducted this case of study to evaluate the effectiveness and usability of the HRS in providing accurate and relevant recommendations to users. Evaluation process consisted on survey administration for QoL assessment, and the satisfaction and usability of the HRS. The four-week pilot study involved several patients and caregivers, and demonstrated that the HRS was perceived as user-friendly, consistent, and helpful, with a positive impact on patients’ QoL. However, the study highlights the need for improvement in terms of personalization of recommendations.

The 3D/3D+ multidimensional geriatric assessment tool provides an optimal model of emergency care for patients aged 75 and over who attend the Emergency Department (ED). The baseline, or static, component (3D) stratifies the degree of frailty prior to the acute illness, while the current, or dynamic, component (3D+) assesses the multidimensional impact caused by the acute illness and helps to guide the choice of care facility for patients upon their discharge from the ED. The objective of this study was to evaluate the prognostic value of the 3D/3D+ to predict short- and long-term adverse outcomes in ED patients aged 75 years and older. Multivariable logistic regression models were used to identify the predictors of mortality 30 days after 3D/3D+ assessment. Two hundred and seventy-eight patients (59.7% women) with a median age of 86 years (interquartile range: 83-90) were analysed. According to the baseline component (3D), 83.1% (95%CI: 78.2-87.3) presented some degree of frailty. The current component (3D+) presented alterations in 60.1% (95%CI: 54.1-65.9). The choice of care facility at ED discharge indicated by the 3D/3D+ was considered appropriate in 96.4% (95%CI: 93.0-98.0). Thirty-day all-cause mortality was 19.4%. Delirium and functional decline were the dimensions on the 3D/3D+ that were independently associated with 30-day mortality. These two dimensions had an area under receiver operating characteristic of 0.80 (95%CI: 0.73-0.86) for predicting 30-day mortality. 3D/3D+ enhances the provision of comprehensive care by ED professionals, guides them in the choice of patients’ discharge destination, and has a prognostic validity that serves to establish future therapeutic objectives.

Many countries are facing the advent of super-aging societies, where sarcopenia and frailty will become emerging problems. Elderly people suffer from various diseases, such as diabetes, heart failure, chronic kidney disease and dementia. The prevalence of comorbidities is a major problem in countries with aged populations. Underlying diseases, such as diabetes, heart failure, chronic kidney disease and also dementia are associated with sarcopenia and frailty, and they are frequent causes of falls, fractures, and a decline in activities of daily living. Fractures in the elderly people are associated with bone fragility, which is influenced by diabetes and chronic kidney disease. Nutritional support for chronic disease patients and sarcopenic individuals with adequate energy and protein intake, vitamin D supplementation, blood-glucose-level management for individuals with diabetes, obesity prevention, nutritional education for healthy individuals, and the enlightenment of society could be crucial to solving the problems in super-aging societies.

Many countries are facing the advent of super-aging societies, where sarcopenia and frailty will become emerging problems. Elderly people suffer from various diseases, such as diabetes, heart failure, chronic kidney disease and dementia. The prevalence of comorbidities is a major problem in countries with aged populations. Underlying diseases, such as diabetes, heart failure, chronic kidney disease and also dementia are associated with sarcopenia and frailty, and they are frequent causes of falls, fractures, and a decline in ADL. Fractures in the elderly people are associated with bone fragility. Diabetes and chronic kidney disease are associated with bone fragility. Nutritional support for chronic disease patients and sarcopenic individuals with adequate energy and protein intake, vitamin D supplementation, blood-glucose-level management for individuals with diabetes, obesity prevention, nutritional education for healthy individuals, and the enlightenment of society could be crucial to solving the problems in super-aging societies.

Falls, highly common in the constantly increasing global aging population, can have a variety of negative effects on their health, well-being, and quality of life, including restricting their capabilities to conduct Activities of Daily Living (ADLs), which are crucial for one’s sustenance. Timely assistance during falls is highly necessary, which involves tracking the indoor location of the elderly during their diverse navigational patterns associated with ADLs to detect the precise location of a fall. With the decreasing caregiver population on a global scale, it is important that the future of intelligent living environments can detect falls during ADL.s while being able to track the indoor location of the elderly in the real world. Prior works in these fields have several limitations, such as – the lack of functionalities to detect both falls and indoor locations, high cost of implementation, complicated design, the requirement of multiple hardware components for deployment, and the necessity to develop new hardware for implementation, which make the wide-scale deployment of such technologies challenging. To address these challenges, this work proposes a cost-effective and simplistic design paradigm for an Ambient Assisted Living system that can capture multimodal components of user behaviors during ADLs that are necessary for performing fall detection and indoor localization in a simultaneous manner in the real world. Proof of concept results from real-world experiments are presented to uphold the effective working of the system. The findings from two comparison studies with prior works in this field are also presented to uphold the novelty of this work. The first comparison study shows how the proposed system outperforms prior works in the areas of indoor localization and fall detection in terms of the effectiveness of its software design and hardware design. The second comparison study shows that the cost for the development of this system is the least as compared to prior works in these fields, which involved real-world development of the underlining systems, thereby upholding its cost-effective nature.

The research is devoted to the acute problem of cinema influence on the young audience. With the continuous development of mass media, cinema is still one of the most popular leisure activities, remaining an influential tool on the picture of the world, values, stereotypes, the behavior of viewers, etc. The paper studies the effects of the cinema on young viewers in relation to their ideas about the elderly. Using a psychosemantic technique that includes 25 scales designed specifically to identify the content of representation of older people, respondents evaluated their various characteristics before and after watching the film. It should be noted that after watching a film about the elderly, the respondents changed their representations of motivational and regulatory, cognitive and emotional characteristics of the older people. However, the changes were not similar in different groups of young people: students seemed to have more negative representation, graduate students’ assessment, on the contrary, changed for a better one. The discovered opposite effects of the cinema influence can be explained by a number of reasons starting from age, personal experience of the respondents, the formation of ideas to the special features of the film itself. In this regard, the contribution of individual factors to the efficiency of the cinema impact and the prediction of its specific effects requires further study.

Hand gestures may play an important role in medical applications for health care of elderly people, where providing a natural interaction for different requests can be executed by making specific gestures. In this study we explored three different scenarios using a Microsoft Kinect V2 depth sensor then evaluated the effectiveness of the outcomes. The first scenario utilized the default system embedded in the Kinect V2 sensor, which depth metadata gives 11 parameters related to the tracked body with five gestures for each hand. The second scenario used joint tracking provided by Kinect depth metadata and depth threshold together to enhance hand segmentation and efficiently recognize the number of fingers extended. The third scenario used a simple convolutional neural network with joint tracking by depth metadata to recognize five categories of gestures. In this study, deaf-mute elderly people execute five different hand gestures to indicate a specific request, such as needing water, meal, toilet, help and medicine. Then, the requests were sent to the care provider’s smartphone because elderly people could not execute any activity independently. The system transferred these requests as a message through the global system for mobile communication (GSM) using a microcontroller.

Background and objectives: Only a few studies analyzed the physical activity level of elderly people living alone in local communities and evaluated the relationship between it and mental health. The purpose of this study was to investigate the relationship between physical activity and depression in the elderly living alone and to provide basic data for the prevention of depression in the elderly. Materials and Methods: We analyzed 256 elderly people living alone aged 65 years or older who completed the 2014 Korea National Health and Nutrition Examination Survey. Depression was defined as a score of 10 or higher using Patient Health Questionnaire-10(PHQ-9). This study investigated walking per week, days of muscular strength exercise performance in the past one week, days of flexibility exercise in the past one week, mean hours in a sitting position per day, the numbers of days and hours conducting a high intensity physical activity in the past one week, and numbers of days and hours conducting a medium intensity physical activity in the past one week to define physical activity. Our study presented prevalence odds ratios (pOR) and 95% confidence interval (CI) by using complex sample logistic regression analysis in order to identify the relationship between physical activity and depression. Results: The results of complex sample logistic regression analysis showed that flexibility exercise was significantly related to depression (p <0.05). On the other hand, the mean hours in a sitting position per day, aerobic physical activity, walking, and muscular strength exercise were not significantly related to geriatric depression. Conclusions: The results of our study implied that persistent flexibility exercise might be more effective to maintain a healthy mental status than muscular strength exercise. A longitudinal study is required to prove the causal relationship between physical activity and depression in the old age.

We consider the financial planning problem of a retiree wishing to enter a retirement village at a future uncertain date. The date of entry is determined by the retiree's utility and bequest maximisation problem within the context of uncertain future health states. In addition, the retiree must choose optimal consumption, investment, bequest and purchase of insurance products prior to her full annuitisation on entry to the retirement village. A hyperbolic absolute risk-aversion (HARA) utility function is used to allow necessary consumption for basic living and medical costs. The retirement village will typically require an initial deposit upon entry. This threshold wealth requirement leads to exercising the replication of an American put option at the uncertain stopping time. From our numerical results, active insurance and annuity markets are shown to be a critical aspect in retirement planning.

Dementia patients express a set of problematic and deteriorating symptoms, along self-care dependency. Overtime, the mental health of family caregivers of persons with dementia may suffer, putting them at a high risk for psychopathology, which may be associated with endangered wellbeing of demented people. This cross-sectional study examined the psychometric properties of the Depression Anxiety Stress Scale 8-items (DASS-8), DASS-12, DASS-21 in a convenient sample of 571 caregivers from northern Italy and southern Switzerland (Mean age = 53, SD = 12, range = 24–89 years). A bifactor structure of the three measures had the best fit; some items of the DASS-12/DASS-21 failed to load on their domain-specific factors. The three-factor structure was invariant across various groups (e.g., gender, education, etc.), expressed adequate reliability and convergent validity, and had strong positive correlation with the 3-item UCLA Loneliness Scale (UCLALS3). Dementia type had no effect on distress scores, which were higher among females, adult children caregivers, those caring for dependent patients, and those who received help with care. For 54.9 and 38.8% of the latter, care was provided by relatives and health professionals, respectively. Since the DASS-8 expresses adequate psychometrics comparable with the DASS-21, it may be used as a brief measure of distress in this population.