Medicine in old age

Author(s):  
Gordon Wilcock ◽  
Kenneth Rockwood

Frailty occurs in a mainly older or geriatric population, is linked to the accumulation of a number of different health-related problems, and may influence disease presentation. A frequently used clinical definition recognizes presentations comprising weight loss, exhaustion, slow movement, a low level of physical activity, and weakness. It can also be graded by degree of disability: (1) very mild frailty describes someone who has given up complex hobbies; (2) mild frailty implies some dependence on ‘instrumental activities of daily living’; (3) moderate frailty involves intermediate self-care activities; and (4) severe frailty requires personal-care dependence. The complexity of frailty underlies the difficulties that often arise when managing the care of an older person. Understanding the concept and consequences of frailty is essential to the problems of and successful management of many older people....

Author(s):  
Carlos Albuquerque ◽  
Carla Correia ◽  
Sara Oliveira Albuquerque

Objectives: To determine the adherence to physical activity among people with type 2 diabetes Methods: Quantitative, cross-sectional, nonexperimental, descriptive, and correlational study, with a sample of 102 people suffering from type 2 diabetes whose age ranged between 40 and 85 years. Most of the participants were male (51.96%). The evaluation protocol included a sociodemographic and clinical questionnaire, Diabetes Self-Care Scale(1) and the Diabetes Knowledge Questionnaire(2). The HbA1c clinical parameter was used to directly assess adherence. Results: The self-care activity in which respondents showed higher level of involvement was glucose monitoring that had an average participation of 5.73 days per week. Inversely, participants did not seem interested in physical activity. In this sort of activity participation amounted to 1 mere day per week on average. The study also showed that people with type 2 diabetes show minimal knowledge of areas related to the identity of the illness, its causes, complications, and treatment. 53.9% of the respondents did not recognise the role played by physical exercise in the treatment of their condition. Conclusion: Reducing the incidence of this disease is an imperative and preventive measure must be implemented to prevent the appearance of the problem, especially for people at higher risk. Among all the possible measures to be implemented, special focus will have to be placed on physical activity and weight loss. Physical activity has a direct impact on the control of the disease through the reduction of HbA1c levels, but its influence is also evident in other parameters, like weight loss, prevention of risk factors for cardiovascular diseases and it also plays a crucial role in increasing quality of life.


2013 ◽  
Vol 18 (1) ◽  
Author(s):  
Sofia Von Humboldt ◽  
Isabel Leal ◽  
Filipa Pimenta

In an ageing world, the potential for ageing well in older people is still relatively unexplored. Literature has suggested that a sense of coherence (SOC) is an important factor with regard to retaining a good quality of life in old age. To explore whether satisfaction with life (SWL), as well as sociodemographic, health- and lifestyle-related variables, are predictors of SOC in a community-dwelling sample of older adults and to assess significant differences in SOC amongst the four nationalities studied. Cross-national research encompassing a community-dwelling sample of 454 older adults aged 75 years and above was undertaken. Sense of coherence was assessed using the Orientation to Life Questionnaire and Satisfaction with Life (SWL) was measured using the Satisfaction with Life Scale. Structural equation modelling was used to investigate a structural model of the self-reported SOC, comprising sociodemographic variables (age, gender, marital status, professional status, educational level, family’s annual income and standard of living arrangements), as well as SWL, lifestyle and health-related (physical activity and recent disease) characteristics. Significant predictors were physical activity (β = 0.804; p < 0.001), recent disease (β = 0.501;p < 0.001) and SWL (β = 0.07; p = 0.004). These variables accounted for approximately 57.5% of the variability of SOC. Moreover, differences with regard to SOC were also found amongst the four nationality groups (F(3) = 5.204; p = 0.002). Physical activity is the strongest predictor of self-reported SOC. Other predictors are the absence of a recent disease and SWL. The four nationalities presented significant differences with regard to SOC. This study highlighted the need for understanding the potential factors (in particular physical activity and further health-related characteristics) that impact on older adults’ SOC.In ’n wêreld wat aan die verouder is, is die potensiaal van bejaardes om goed te verouder steeds relatief onbekend. ’n Toenemende literatuurbasis stel voor dat koherensiesin belangrik is om ’n goeie lewensgehalte vir bejaardes te verseker. Om te verken of lewenstevredenheid, sosio-demografiese, gesondheids- en lewenstylverwante veranderlikes voorspellers is van die koherensiesin in ’n steekproef van bejaardes wat nie in tehuise woon nie, asook om die beduidende verskille tussen die vier nasionaliteite met betrekking tot die koherensiesin te evalueer. Kruis-nasionale navorsing bestaande uit ’n steekproef van 454 volwassenes, 75 jaar of ouer, wat nie in tehuise woon nie. Koherensiesin is met behulp van die lewensoriëntasievraelys beoordeel en lewenstevredenheid is met behulp van die lewenstevredenheidskaal gemeet. Strukturele vergelykingsmodellering is gebruik om ’n strukturele model van die self-gerapporteerde koherensiesin te ondersoek. Die model bestaan uit sosio-demografiese veranderlikes (ouderdom, geslag, huwelikstatus, professionele status, opvoedkundige vlak, gesin se jaarlikse inkomste en lewensomstandighede), asook lewenstevredenheid, lewenstyl- en gesondheidsverwante (fisiese aktiwiteitsvlak en onlangse siekte) eienskappe. Beduidende voorspellers is fisiese aktiwiteitsvlak (β = .804; p < 0.001), onlangse siekte (β = .501; p < 0.001) en lewenstevredenheid (β = .07; p = 0.004). Die veranderlikes verklaar onderskeidelik 57.5% van die wisselvalligheid van die koherensiesin. Verder is daar ook verskille tussen die vier nasionaliteite met betrekking tot koherensiesin (F(3) = 5.204; p = 0.002) gevind. Fisiese aktiwiteitsvlak is die sterkste voorspeller van self-gerapporteerde koherensiesin. Ander voorspellers is lewenstevredenheid en die afwesigheid van onlangse siekte. Die vier nasionaliteite het duidelike verskille ten opsigte van koherensiesin getoon. Hierdie studie beklemtoon die noodsaaklikheid om die potensiële faktore − veral fisiese aktiwiteitsvlak en verdere gesondheidsverwante eienskappe − wat bejaardes se koherensiesin beïnvloed, te verstaan.


2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 840-840
Author(s):  
Steven Albert ◽  
Elizabeth Venditti ◽  
Barbara Nicklas

Abstract The high prevalence of overweight or obesity in older adults is a public health concern because obesity is associated with risk of mobility disability. The benefits of brief community-based lifestyle interventions that promote modest weight loss and increased physical activity are unclear. We assessed the impact of a 13-month lifestyle intervention, the Mobility and Vitality Lifestyle Program (MOVE UP), delivered by community health workers (CHW), on a variety of outcomes, including weight loss, performance-based lower extremity function (Short Physical Performance Battery, SPPB), activity, diet, and health-related quality of life (CDC U48 DP005001). The 32-session behavioral weight management intervention enrolled 303 community-dwelling adults (90.4% of those eligible), who were followed for 12 months (2015-19). Participants completed the program at 26 sites led by 22 CHWs. Participants were age (sd) 67.7 (4.1) and were mostly female (87%). 22.7% were racial minorities. The mean (sd) BMI at baseline was 34.7 (4.7). Median weight loss in the sample was 5% of baseline body weight. SPPB total scores improved by +0.31 units (p &lt; .006), gait speed by +0.04 m/sec (p &lt; .0001), and time to complete chair stands by -0.95 sec (p &lt; .0001). Presenters will assess the effect of MOVE UP on activity, diet, fatigue, and health-related quality of life. A final paper examines implementation of MOVE UP and how site and CHW factors affected outcomes. Findings suggest that promoting healthier eating, weight loss, and physical activity in a community setting is an effective strategy for reducing risk of disability in older adults.


2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Hui Jie Wong ◽  
Pei Lin Lua ◽  
Sakinah Harith ◽  
Khairul Azmi Ibrahim

Abstract Background Apart from maximizing functional abilities and independence after stroke, improving overall health-related quality of life (HRQoL) should also become part of the stroke treatment and rehabilitation process goals. This study aimed to assess the HRQoL profiles and explore the dimension-specific associated factors of HRQoL among stroke survivors. Methods This was a cross-sectional study of stroke survivors attending post-stroke care clinics in three public hospitals in the states of Pahang and Terengganu, Malaysia. The HRQoL was assessed by EuroQol-5 dimension-5 levels. Data on socio-demographic, clinical profiles, malnutrition risk, and physical activity level were collected through an interviewer-administered survey. Descriptive analyses for HRQoL profiles and multiple logistic regression analyses for its associated factors were performed. Crude and adjusted odds ratios were reported. Results A total of 366 stroke survivors were recruited with a mean age of 59 ± 11 years. The most -commonly reported health problems were mobility (85%), followed by usual activities (82%), pain/discomfort (63%), anxiety/depression (51%) and self-care (41%). The mean of the EQ visual analogue scale and the median of the EQ5D summary index was reported at 60.3 ± 14.2 and 0.67 ± 0.37, respectively. Malnutrition risk (mobility, usual activities, and self-care), wheelchair users (self-care and usual activities), speech impairment (usual activities and pain/discomfort), number of stroke episodes (self-care and pain/discomfort), body mass index, physical activity level and types of strokes (usual activities), age and use of a proxy (anxiety/depression), working and smoking status (mobility), were factors associated with either single or multiple dimensions of HRQoL. Conclusion Routine malnutrition screening, tailored program for speech therapy, prevention of recurrent stroke, and physical activity promotion should be addressed and further reinforced in current rehabilitation interventions to improve the HRQoL among stroke survivors in Malaysia.


2019 ◽  
Vol 33 (3) ◽  
pp. 39-56
Author(s):  
Aske Juul Lassen ◽  
Tiago Moreira

In the last 15 years, STS has established a research programme focused on the sociotechnical reconfiguration of later life, particularly as new political programmes aim to deploy ‘active ageing’ in contemporary societies. In Denmark, the bicycle is a key technology in this aim, because of how it articulates sustainable living, health and social participation. Thus, two new ‘inclusive cycling’ initiatives for older people have been developed. Drawing on ethnographic data, we explore the ways the bikes differ, and how they explicitly mobilise active ageing as a form of ‘good old age’ in different ways. We argue that whereas ‘Cycling without Age’ rickshaws attempt to assemble social participation for older people, ‘Duo-Bikes’ aim to enable capacities through physical activity in later life. We further explore what happens when these two schemes meet, and suggest how searching for a compromise will be necessary to enhance opportunities to cycle in later life.  


Living Data ◽  
2019 ◽  
pp. 125-150
Author(s):  
Celia Roberts ◽  
Adrian Mackenzie ◽  
Maggie Mort ◽  
Theresa Atkinson ◽  
Mette Kragh-Furbo ◽  
...  

How does biosensing reach into the lives of older people living at home? Here we examine care monitoring systems for older people, or telecare, as this has become known. We focus in particular on the wearable falls detector, an alarm device which triggers, it is claimed, when a person trips or falls. We explore findings from ethnographies of home telecare and from citizens’ panel debates on how individuals and families live with such systems, and how falls detectors are constructed as workable. Following individuals' interactions with telecare we question the notion of self-tracking, preferring the term dys-tracking as better reflecting their relationship with automated devices. Falls detectors are technically highly complex, collecting data difficult to interpret. Ageing bodies are invariably assessed as low functioning and intrinsically at risk. Views from our citizens’ panels however, show a more active and imaginative constituency where practices of self-care exist alongside remote-care systems.


2021 ◽  
Author(s):  
Alessio Bricca ◽  
Madalina Jäger ◽  
Marie Johnston ◽  
Graziella Zangger ◽  
Lasse K. Harris ◽  
...  

Abstract Background To investigate the effect of behavioural interventions targeting lifestyle behaviours on physical activity, weight loss, physical function, health-related quality of life and depression in people with multimorbidity and to investigate which Behaviour Change Techniques (BCTs) are associated with better outcomes.Methods Systematic review of randomised controlled trials targeting lifestyle behaviours in people with multimorbidity following the Cochrane recommendations. Data sources included MEDLINE, EMBASE, CENTRAL and CINAHL up to June 19th, 2020 and screening reference list of Cochrane reviews including people with multimorbidity, ongoing systematic reviews of the MOBILIZE project, the WHO registry and citation tracking of included studies. Meta-analyses using random-effects model to assess the effect of behavioural interventions on physical activity, weight loss, physical function and health-related quality of life and depression. Meta-regression analyses and effectiveness ratios to investigate the impact of pre-specified mediators of effect estimates. Cochrane ‘Risk of Bias Tool’ 2.0 and the GRADE assessment to evaluate the overall quality of evidence.Results Fourteen papers involving 1,378 people. Behavioural interventions had little to no effect on physical activity (standardised mean difference 0.38, 95%CI -0.12 to 0.61 – very low certainty) and the effect on weight loss is uncertain (BMI mean difference -0.17, 95%CI -1.17 to 0.83 – very low certainty) at the end-treatment follow-up (mean duration 23 weeks, SD 15). Small improvements were seen in health-related quality of life (SMD 0.29, 95% CI 0.17 to 0.42 – moderate certainty) and physical function (SMD 0.42, 95% CI 0.12 to 0.73 – low certainty), and moderate improvements were seen for depression symptoms (SMD -0.70, 95%CI -0.98 to -0.42 – moderate certainty). Studies using the BCTs ‘action planning’ and ‘social support (practical)’ reported greater physical activity and weight loss. The effects of behavioural interventions diminished for all the outcomes at long-term follow-ups (mean duration of 36 weeks, SD 15).Conclusions Behavioural interventions targeting lifestyle behaviours improve health-related quality of life and physical function, and reduce depression symptoms, whereas little to no effect was achieved on physical activity and weight loss in people with multimorbidity. However, the evidence for physical activity and weight loss were of low quality and the end-treatment benefits diminished over time.Systematic review protocol Open Science Framework: https://osf.io/r7pm5/


2019 ◽  
Vol 29 (11) ◽  
pp. 1797-1804 ◽  
Author(s):  
Hanna Jantunen ◽  
Niko Wasenius ◽  
Minna K. Salonen ◽  
Hannu Kautiainen ◽  
Mikaela B. von Bonsdorff ◽  
...  

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