Hospital-treated deliberate self-poisoning in the older adult: Identifying specific clinical assessment needs

2020 ◽  
Vol 54 (6) ◽  
pp. 591-601
Author(s):  
Mariann Jackson ◽  
Katie McGill ◽  
Terry J Lewin ◽  
Jenifer Bryant ◽  
Ian Whyte ◽  
...  
Keyword(s):  
Older Adults ◽  
Clinical Assessment ◽  
Older Age ◽  
Middle Aged ◽  
Aged Patients ◽  
Psychiatric Hospitalisation ◽  
Aged Group ◽  
Targeted Interventions ◽  
Middle Aged Adults ◽  
Prospective Longitudinal

Background: Hospital-treated deliberate self-poisoning is common, with a median patient age of around 33 years. Clinicians are less familiar with assessing older adults with self-poisoning and little is known about their specific clinical requirements. Objective: To identify clinically important factors in the older-age population by comparing older adults (65+ years) with middle-aged adults (45–64 years) during an index episode of hospital-treated deliberate self-poisoning. Methods: A prospective, longitudinal, cohort study of people presenting to a regional referral centre for deliberate self-poisoning (Calvary Mater Newcastle, Australia) over a 10-year period (2003–2013). We compared older-aged adults with middle-aged adults on demographic, toxicological and psychiatric variables and modelled independent predictors of referral for psychiatric hospitalisation on discharge with logistic regression. Results: There were ( n = 157) older-aged and ( n = 925) middle-aged adults. The older-aged group was similar to the middle-aged group in several ways: proportion living alone, reporting suicidal ideation/planning, prescribed antidepressant and antipsychotic drugs, and with a psychiatric diagnosis. However, the older-aged group were also different in several ways: greater proportion with cognitive impairment, higher medical morbidity, longer length of stay, and greater prescription and ingestion of benzodiazepines in the deliberate self-poisoning event. Older age was not a predictor of referral for psychiatric hospitalisation in the multivariate model. Conclusion: Older-aged patients treated for deliberate self-poisoning have a range of clinical needs including ones that are both similar to and different from middle-aged patients. Individual clinical assessment to identify these needs should be followed by targeted interventions, including reduced exposure to benzodiazepines.

Frailty in Young and Middle-Aged Adults: An Integrative Review

2021 ◽  
pp. 1-7
Author(s):  
C. Loecker ◽  
M. Schmaderer ◽  
L. Zimmerman
Keyword(s):  
Older Adults ◽  
Assessment Tool ◽  
Later Life ◽  
Integrative Review ◽  
Future Research ◽  
Middle Aged ◽  
Targeted Interventions ◽  
Definition Of ◽  
Middle Aged Adults ◽  
Study Designs

Background: Frailty is a public health priority resulting in poor health outcomes and early mortality in older adults. Early identification, management, and prevention of frailty may reduce frailty trajectory into later life. However, little is known about frailty in younger adults. Objective: Describe frailty prevalence, definitions, study designs, and components contributing to multidimensional frailty in 18 to 65-year-olds and impart guidance for future research, practice, and policies with potential to positively impact frail individuals. Methods: Integrative review approach was selected to explore frailty allowing for inclusion of diverse methodologies and varied persepectives while maintaining rigor and applicability to evidence-based practice initiatives. CINAHL, Embase, PsycInfo, PubMed databases were searched for studies describing frailty in adults age 18 to 65. Articles were excluded if published prior to 2010, not in English, lacked frailty focus, or non-Western culture. Results: Twelve descriptive correlational studies were included. No intervention or qualitative studies were identified. No standard conceptual definition of frailty was discovered. Studied in participants with health disparities (n=3) and chronic conditions (n=8); HIV was most common (n=4). Frailty prevalence ranged from 3.9% (313 of 8095) to 63% (24 of 38). Many factors associated with frailty were identified among physical (18) and social (14), and fewer among psychological (11) domains. Conclusions: Universal frailty definition and multidimensional assessment tool is needed to generate generalizable results in future studies describing frailty in young and middle-aged adults. Early frailty identification by clinicians has potential to facilitate development and implementation of targeted interventions to prevent or mitigate frailty progression, but additional research is needed because risk factors in younger populations may be different than older adults.

Age differences in everyday problem solving

2012 ◽  
Vol 37 (1) ◽  
pp. 13-20 ◽  
Author(s):  
Wendy Loken Thornton ◽  
Theone S. E. Paterson ◽  
Sophie E. Yeung
Keyword(s):  
Older Adults ◽  
Problem Solving ◽  
Older Age ◽  
Relative Performance ◽  
Middle Aged ◽  
Problem Context ◽  
Everyday Problem Solving ◽  
Everyday Problem ◽  
Middle Aged Adults ◽  
The Impact

Reductions in everyday problem solving (EPS) are often reported in older age, although it has been suggested that problem context may modify this effect. We evaluated the impact of two aspects of problem context: age appropriateness (age-neutral vs. older-age content) and problem type (interpersonal vs. practical) on EPS performance in 175 adults aged 18–87. Older adults generated fewer solutions to ill-structured EPS vignettes than younger and middle-aged adults. Middle-aged adults demonstrated an advantage on practical problems. While all age groups demonstrated a relative performance advantage for interpersonal content on older age problems, older adults showed the least relative benefit in this condition. Thus older adults do not exhibit relative performance gains on EPS problems designed to be most salient and relevant to this age group.

scholarly journals Factors associated with sarcopenia screened by finger-circle test among middle-aged and older adults: a population-based multisite cross-sectional survey in Japan

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Daiki Watanabe ◽  
Tsukasa Yoshida ◽  
Takashi Nakagata ◽  
Naomi Sawada ◽  
Yosuke Yamada ◽  
...  
Keyword(s):  
Older Adults ◽  
Smoking Status ◽  
Multiple Logistic Regression Analysis ◽  
Population Based ◽  
Middle Aged ◽  
Cross Sectional ◽  
Factors Associated ◽  
Mail Surveys ◽  
Osaka Prefecture ◽  
Middle Aged Adults

AbstractBackgroundPrevious epidemiological studies have demonstrated the prevalence and relationship of various factors associated with sarcopenia in older adults; however, few have examined the status of sarcopenia in middle-aged adults. In this study, we aimed to, 1) evaluate the validity of the finger-circle test, which is potentially a useful screening tool for sarcopenia, and 2) determine the prevalence and factors associated with sarcopenia in middle-aged and older adults.MethodsWe conducted face-to-face surveys of 525 adults, who were aged 40–91 years and resided in Settsu City, Osaka Prefecture, Japan to evaluate the validity of finger-circle test. The finger-circle test evaluated calf circumference by referring to an illustration printed on the survey form. The area under the receiver operating characteristic curves (AUROC) was plotted to evaluate the validity of the finger-circle test for screening sarcopenia and compared to that evaluated by skeletal muscle mass index (SMI) measured using bioimpedance. We also conducted multisite population-based cross-sectional anonymous mail surveys of 9337 adults, who were aged 40–97 years and resided in Settsu and Hannan Cities, Osaka Prefecture, Japan. Participants were selected through stratified random sampling by sex and age in the elementary school zones of their respective cities. We performed multiple logistic regression analysis to explore associations between characteristics and prevalence of sarcopenia.ResultsSarcopenia, defined by SMI, was moderately predicted by a finger-circle test response showing that the subject’s calf was smaller than their finger-circle (AUROC: 0.729, < 65 years; 0.653, ≥65 years); such subjects were considered to have sarcopenia. In mail surveys, prevalence of sarcopenia screened by finger-circle test was higher in older subjects (approximately 16%) than in middle-aged subjects (approximately 8–9%). In a multiple regression model, the factors associated with sarcopenia were age, body mass index, smoking status, self-reported health, and number of meals in all the participants.ConclusionsSarcopenia, screened by the finger-circle test, was present not only among older adults but also among middle-aged adults. These results may provide useful indications for developing public health programs, not only for the prevention, but especially for the management of sarcopenia.Trial registrationUMIN000036880, registered prospectively May 29, 2019, https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000042027

Educational Differences in Self-Rated Health Trends Among Middle-Aged and Older Adults Living Alone, 1972–2018

2022 ◽  
pp. 089826432110527
Author(s):  
Esther O. Lamidi
Keyword(s):  
Older Adults ◽  
Living Arrangements ◽  
Living Arrangement ◽  
Living Alone ◽  
Middle Aged ◽  
Older Americans ◽  
Health Trends ◽  
Self Rated Health ◽  
Educational Differences ◽  
Middle Aged Adults

Objectives: This study examines educational differences in living alone and in self-rated health trends among middle-aged and older adults. Methods: We used logistic regression to analyze data from the 1972–2018 National Health Interview Survey ( n = 795,239 aged 40–64; n = 357,974 aged 65–84). Results: Between 1972–1974 and 2015–2018, living alone became more prevalent, particularly among men and at lower levels of education. Self-rated health trends varied by living arrangement and education. We found self-rated health declines among middle-aged adults having no college degree and living alone, but trends in self-rated health were mostly stable or even improved among middle-aged adults living with others. Among older adults, self-rated health improved over time, but for the least-educated older Americans living alone, the probability of reporting fair or poor health increased between 1972–1974 and 2015–2018. Discussion: The findings suggest growing disparities by social class, in living arrangements and in self-rated health.

scholarly journals The Role of Delay of Care in Depression among US Middle-Aged and Older Adults during the COVID-19 Pandemic:: A Secondary Data Analysis (Preprint)

2021 ◽  
Author(s):  
Yan Luo
Keyword(s):  
Mental Health ◽  
Older Adults ◽  
Dental Care ◽  
Age Groups ◽  
Binary Logistic Regression ◽  
Middle Aged ◽  
Delay Of Care ◽  
Middle Aged Adults ◽  
Univariate Analyses

BACKGROUND The depression level among US adults significantly increased during the Coronavirus Disease 2019 (COVID-19) pandemic and age disparity in depression during the pandemic were reported in recent studies. Delay or avoidance of medical care is one of the collateral damages caused by the COVID-19 pandemic and it can lead to increased morbidity and mortality. OBJECTIVE The present study aims to assess the prevalence of depression and delay of care among US middle-aged adults and older adults during the pandemic, as well as investigate the role of delay of care in depression among those two age groups. METHODS This cross-sectional study used the 2020 Health and Retirement Study (HRS) COVID-19 Project (Early, Version 1.0) data. Univariate analyses, bivariate analyses, and binary logistic regression were applied. US adults older than 46 years old were included. Depression was measured by Composite International Diagnostic Interview Short Form (CIDI-SF). Delay of care were measured by four items: delay of surgery, delay of seeing a doctor, delay of dental care, and delay of other care. Univariate analyses, bivariate analyses, and binary logistic regression were conducted. RESULTS More than half of participants were older than 65 years old (58.23%) and 274 participants (8.75%) had depression during the pandemic. Delay of dental care was positively associated with depression among both middle-aged adults (OR=2.05, 95%CI=1.04-4.03, P<0.05) and older adults (OR=3.08, 95%CI=1.07-8.87, P<0.05). Delay of surgery was positively associated with depression among older adults (OR=3.69, 95%CI=1.06-12.90, P<0.05). Self-reported pain was positively related to depression among both age groups. Middle-aged adults who reported higher education level (some college of above) or worse self-reported health had higher likelihood to have depression. While perceived more loneliness was positively associated with depression among older adults, financial difficulty was positively associated with depression among middle-aged adults. CONCLUSIONS This study found that depression among middle-aged and older adults during the pandemic was also prevalent. The study highlighted the collateral damage of the COVID-19 pandemic by identifying the effect of delay of surgery and dental care on depression during the pandemic. Although surgery and dental care cannot be delivered by telehealth, telehealth services can still be provided to address patients’ concern on delay of surgery and dental care. Moreover, the implementation of tele-mental health services is also needed to address mental health symptoms among US middle-aged and older adults during the pandemic. Future research that uses more comprehensive CLINICALTRIAL N/A

Abstract 18787: Hypertension Treatment and Control Rates in United States Adults by Risk Group

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Kunal N Karmali ◽  
Hongyan Ning ◽  
Donald M Lloyd-Jones
Keyword(s):  
Older Adults ◽  
High Risk ◽  
Kidney Disease ◽  
Risk Group ◽  
Intensive Therapy ◽  
Risk Groups ◽  
Middle Aged ◽  
Ascvd Risk ◽  
Middle Aged Adults ◽  
And Control

Introduction: Ten-year cardiovascular disease (CVD) risk and absolute benefit from antihypertensive therapy vary at any given BP based on associated risk factor levels. Thus, implications of treatment and control rates at a particular BP vary substantially in different risk groups. Objectives: We examined the prevalence, treatment, and control of hypertension (HTN) by risk group in US adults without prevalent CVD. Methods: We used data from the National Health and Nutrition Examination Survey 2005 to 2010 for adults age 40-79 years without prevalent CVD (n=4,066). We estimated 10-year risk for an atherosclerotic CVD (ASCVD) event using the ACC/AHA 2013 Pooled Cohort risk equations. We examined HTN treatment and control rates according to current guidelines in middle-aged (40-59 years) and older (60-79 years) adults with: 10-year ASCVD risk <7.5% (no diabetes/kidney disease); 10-year ASCVD risk ≥7.5% (no diabetes/kidney disease); and either diabetes or kidney disease. Results: The proportion of adults with treatment-eligible HTN was 39.3% for those with 10-year ASCVD risk <7.5%, 32.2% for those with 10-year ASCVD risk ≥7.5%, and 28.4% for those with either diabetes or kidney disease (see Table 1). Treatment rates across the risk groups varied from 51.5% to 79.0% for middle-aged adults and 81.8% to 90.2% for older adults. HTN control rates were highest (87.7%) in older adults with 10-year ASCVD risk <7.5% but were lowest (29.3%) in middle-aged individuals with 10-year ASCVD risk ≥7.5%. Conclusions: US HTN guidelines, based solely on BP thresholds, identify a higher proportion of low-risk adults and a lower proportion of high-risk adults as being eligible for treatment. Control rates remain suboptimal in high-risk individuals, particularly middle-aged adults. Future guidelines should consider pre-treatment risk stratification to identify those at increased pretreatment ASCVD risk who would benefit most from more intensive therapy.

Age Differences in the Malleability of Attitudes toward Automated Shared Mobility

2021 ◽  
Vol 65 (1) ◽  
pp. 128-128
Author(s):  
Kathryn Baringer ◽  
Dustin J. Souders ◽  
Jeremy Lopez
Keyword(s):  
Older Adults ◽  
Older Adult ◽  
Age Groups ◽  
Educational Video ◽  
Middle Aged ◽  
Automated Vehicles ◽  
Younger Adults ◽  
Difference Scores ◽  
Video Condition ◽  
Middle Aged Adults

Introduction: The use of shared automated vehicles (SAVs) should lead to several societal and individual benefits, including reduced greenhouse gas emissions, reduced traffic, and improved mobility for persons who cannot safely drive themselves. We define SAVs as on-demand, fully automated vehicles in which passengers are paired with other riders traveling along a similar route. Previous research has shown that younger adults are more likely to report using conventional ridesharing services and are more accepting of new technologies including automated vehicles (AVs). However, older adults, particularly those who may be close to retiring from driving, stand to greatly benefit from SAV services. In order for SAVs to deliver on their aforementioned benefits, they must be viewed favorably and utilized. We sought to investigate how short educational and/or experiential videos might impact younger, middle-aged, and older adult respondents’ anticipated acceptance and attitudes toward SAVs. Knowing what types of introductory experiences improve different age groups’ perceptions of SAVs will be beneficial for tailoring campaigns aiming to promote SAV usage. Methods: We deployed an online survey using the platform Prolific for middle-aged and older respondents, and our departmental participant pool for younger adults, collecting 585 total responses that resulted in 448 valid responses. Respondents answered questions regarding their demographic attributes, their ridesharing history, preconceptions of technology, as well as their anticipated acceptance attitudes towards SAVs as measured by the dimensions of the Automated Vehicle User Perception Survey (AVUPS). After this, respondents were randomly assigned to an intervention condition where they either watched 1) an educational video about how SAVs work and their potential benefits, 2) an experiential video showing a AV navigating traffic, 3) both the experiential and educational videos, or 4) a control video explaining how ridesharing works. Anticipated acceptance attitudes towards SAVs were measured again after this intervention and difference scores calculated to investigate the effect of the intervention conditions. Prolific respondents were paid at a rate of $9.50/hour and younger adults received course credit. Results: Controlling for preconceptions of technology and ridesharing experience, a MANOVA was run on the difference scores of the dimensions of the AVUPS (intention to use, trust/reliability, perceived usefulness (PU), perceived ease of use (PEOU), safety, control/driving-efficacy, cost, authority, media, and social influence). Both older and middle-aged adults expressed significantly greater increases in PEOU and PU of SAVs than younger adults. We also observed an interaction between age and condition for both PU and PEOU. For PU, older adults’ difference scores were found to be significantly greater than younger adults’ for the control video condition. With PEOU, older adults’ difference scores were significantly greater than both younger adults’ for the control video condition, and middle-aged adults had greater difference scores for the educational-only video condition than younger or older adults. Discussion: The increases in PU observed for older adults in the control condition suggests that educating them on how to use currently available ridesharing services might transfer to and/or highlight the benefits that automated ridesharing might provide. The PEOU interactions also suggest that middle-aged adults might respond more positively than younger or older adults to an educational introduction to SAVs. Conclusion: The positive findings pertaining to PU and PEOU show that exposure to information related to SAVs has a positive impact on these attitudes. PU’s and PEOU’s positive relationship to behavioral intentions (BI) in the Technology Acceptance Model, coupled with the findings from this study, bode well for higher fidelity interventions seeking to inform and/or give individuals experience with SAVs. Providing information on how currently available ridesharing services work helped our older adult respondents recognize the potential usefulness of SAVs. Knowing that different age groups may respond better to educational versus experiential interventions, for example middle-aged adults in this study responding more positively to the educational video condition than younger or older adults, may be useful for targeted promotional campaigns.

Benefits of volunteerism for middle-aged and older adults: comparisons between types of volunteering activities

2021 ◽  
pp. 1-20
Author(s):  
Alfred H. K. Lam ◽  
Dannii Y. Yeung ◽  
Edwin K. H. Chung
Keyword(s):  
Older Adults ◽  
Life Satisfaction ◽  
Depressive Symptoms ◽  
Cross Sectional Study ◽  
Middle Aged ◽  
Cross Sectional ◽  
Health And Wellbeing ◽  
Hand Grip ◽  
Middle Aged Adults ◽  
Main Effects

Abstract Volunteering is a popular activity among middle-aged and older adults as means to contribute to the society and to maintain personal health and wellbeing. While the benefits of volunteering have been well-documented in the current literature, it does not tend to distinguish between various types of volunteering activities. This cross-sectional study aims to compare the effects of instrumental (e.g. food preparation, fundraising) and cognitively demanding volunteering activities (e.g. befriending, mentoring) in a sample of 487 middle-aged and older Hong Kong Chinese adults. Participation in instrumental and cognitively demanding volunteering, life satisfaction, depressive symptoms, cognitive functioning and hand-grip strength were measured. The results of two-way between-subject robust analyses of variance demonstrated significant main effects of volunteering type and their interaction effect with age on life satisfaction and depressive symptoms. Comparisons among four volunteering groups (no volunteering, instrumental volunteering, cognitively demanding volunteering and both types) revealed that individuals engaging in instrumental volunteering exhibited lower life satisfaction and more depressive symptoms compared to those who engaged in cognitively demanding volunteering and those who did not volunteer at all. This detrimental pattern of instrumental volunteering was only seen in middle-aged adults, but not in older adults. Findings of this study revealed distinctive effects of two volunteering types, and provide valuable directions for designing future volunteering programmes.

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