The sustainability of a quality improvement initiative

Functional decline in seniors admitted to hospital is due in part to lack of mobilization. Many Quality Improvement (QI) initiatives targeting mobilization of the elderly population in acute care exist; however, their long-term effectiveness is not well-documented. Mobilization of Vulnerable Elders (MOVE) was a grant-funded initiative that started in Ontario and spread to Alberta. The primary objective of this project was to ascertain the sustainability of the MOVE project 1 year post implementation at two hospital sites in Alberta, Canada. Qualitative and quantitative cross-sectional data were gathered from multidisciplinary healthcare professionals. Our findings suggest MOVE was not well-sustained one year post implementation. Examination of specific survey questions provided an indication of strengths and weaknesses of the MOVE QI. Sustainable and cost-effective QI targeted at this elderly patient demographic could alleviate some of the demand on the healthcare system. Modifications to improve the sustainability of MOVE are summarized.

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Prevalence of disabilities and non-communicable diseases in an elderly population in the Telangana state, India: a population-based cross-sectional study

BMJ Open ◽

10.1136/bmjopen-2020-041755 ◽

2021 ◽

Vol 11 (2) ◽

pp. e041755

Author(s):

Srinivas Marmamula ◽

Satya Brahmanandam Modepalli ◽

Thirupathi Reddy Kumbham ◽

Rajesh Challa ◽

Jill E Keeffe

Keyword(s):

Elderly Population ◽

Self Care ◽

The Elderly ◽

Population Based ◽

Cross Sectional Study ◽

Communicable Diseases ◽

Self Report ◽

Sectional Study ◽

Cross Sectional ◽

Non Communicable Diseases

ObjectivesTo assess the prevalence of disabilities (vision, hearing, mobility, cognitive, self-care and communication) and non-communicable diseases (NCDs) among the elderly population in two districts in Telangana, India.DesignPopulation-based cross-sectional study using a cluster random sampling method to select the study clusters.SettingElderly population in Khammam and Warangal districts were recruited. Detailed interviews were conducted by trained community health workers. Personal and demographic information such as age, gender, level of education and a self-report of NCDs was collected. The Washington Disability Questionnaire was administered to assess the presence of disabilities.Participants1821 participants aged ≥60 years, 54.5% were women, and 73.3% had no education.Primary outcome measurePrevalence of disabilities and NCDs.ResultsOverall, the prevalence of at least disability was 20.3% (95% CI 16.3 to 24.9). The prevalence of self- reported disabilities were: seeing (5.9%; 95% CI 4.4 to 7.8), mobility (12.8%; 95% CI 9.7 to 16.8), hearing (3.6%; 95% CI 2.7 to 4.8), cognition (4.8%; 95% CI 3.5 to 6.7), self-care (3.3%; 95% CI 2.3 to 4.7) and communication (1.8%; 95% CI 1.2 to 2.6). Overall, the prevalence of at least one NCD was 34.2% (95% CI 30.9 to 37.7). Hypertension was the most common systemic condition (25.4%; 95% CI 22.4 to 28.7), followed by diabetes (9.0%; 95% CI 7.3 to 11.0), and body pains (muscle-skeletal) (9.9%; 95% CI 8.1 to 12.2).ConclusionEvery fifth elderly person in the districts of Khammam and Warangal in Telangana had at least one self-reported disability. Besides, a third of the elderly had at least one NCD. There is a definite need to develop comprehensive public health strategies to address disabilities and NCDs in Telangana.

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Health risk assessment and countermeasure analysis of the elderly population exposed to PM2.5 microenvironment

Work ◽

10.3233/wor-205361 ◽

2021 ◽

pp. 1-11

Author(s):

Yan Xu ◽

Wantian Cui

Keyword(s):

Mental Health ◽

Health Risk ◽

Elderly Population ◽

Mental Health Problems ◽

Negative Impact ◽

The Elderly ◽

Exposure Concentration ◽

Physical Diseases ◽

The Impact

BACKGROUND: China’s atmospheric PM2.5 pollution is serious, and PM2.5 exerts a negative impact on the human respiratory system, cardiovascular, and mental health, and even more serious health risk for the elderly with weak immunity. OBJECTIVE: This work aims to analyse the impacts of PM2.5 microenvironment exposure on the health of the elderly and provide corresponding countermeasures. METHODS: The survey subjects are 118 retired elderly people in the community. PM2.5 exposure concentrations are monitored in summer (June 10 ∼ July 10, 2019) and winter (November 25 ∼ December 25, 2019). RESULTS: The exposure concentration in winter is higher than that in summer, with statistical difference (P < 0.05). Under the impact of PM2.5 microenvironment exposure, smoking in the elderly can increase the concentration of PM2.5, and long-term exposure to PM2.5 in the elderly can cause mental health problems. CONCLUSION: Long-term exposure of the elderly to the PM2.5 microenvironment leads to physical diseases and even psychological problems, which requires attention.

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Cardiovascular and musculoskeletal health disorders associate with greater decreases in physical capability in older women

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04056-4 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Juopperi Samuli ◽

Sund Reijo ◽

Rikkonen Toni ◽

Kröger Heikki ◽

Sirola Joonas

Keyword(s):

Chronic Diseases ◽

Musculoskeletal Disorders ◽

Population Sample ◽

The Elderly ◽

Primary Objective ◽

Baseline Body Mass Index ◽

Functional Tests ◽

Physical Capability ◽

Study Population

Abstract Background Good physical capability is an important part of healthy biological ageing. Several factors influencing physical capability have previously been reported. Long-term reports on physical capability and the onset of clinical disorders and chronic diseases are lacking. Decrease in physical capacity has been shown to increase mortality. This study focuses on the prevalence of chronic diseases. The primary objective of the study was to reveal the association between physical capability and morbidity. Secondary objectives included the validity of self-reported physical capability and the association between baseline physical capability and mortality. Methods The OSTPRE (Kuopio Osteoporosis Risk Factor and Prevention Study) prospective cohort involved all women aged 47–56 years residing in the Kuopio Province, Finland in 1989. Follow-up questionnaires were mailed at five-year intervals. Physical capability questions were first presented in 1994. From these women, we included only completely physically capable subjects at our baseline, in 1994. Physical capability was evaluated with five scale self-reports at baseline and in 2014 as follows: completely physically capable, able to walk but not run, can walk up to 1000 m, can walk up to 100 m and temporarily severely incapable. The prevalences of selected chronic diseases, with a minimum prevalence of 10% in 2014, were compared with the change in self-reported physical capability. Additionally, associations between long-term mortality and baseline physical capability of the whole 1994 study population sample were examined with logistic regression. The correlation of self-reported physical capability with functional tests was studied cross-sectionally at the baseline for a random subsample. Results Our study population consisted of 6219 Finnish women with a mean baseline age of 57.0 years. Self-reported physical capability showed statistically significant correlation with functional tests. Cardiovascular diseases and musculoskeletal disorders show the greatest correlation with decrease of physical capability. Prevalence of hypertension increased from 48.7% in the full physical capability group to 74.5% in the “able to walk up to 100 metres” group (p < 0.001). Rheumatoid arthritis showed a similar increase from 2.1 to 7.4% between these groups. Higher baseline body mass index (BMI) decreases long-term capability (P < 0.001). Women reporting full physical capability at baseline had a mortality rate of 15.1%, in comparison to 48.5% in women within the “able to walk up to 100 m” group (p = 0.357). Mortality increased steadily with worsening baseline physical capability. Conclusions The results of this study show that chronic diseases, particularly cardiovascular and musculoskeletal disorders, correlate with faster degradation of physical capability in the elderly. Similar results are shown for increase in BMI. We also demonstrate that the risk of mortality over a 20-year period is higher in individuals with poor baseline physical capability.

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Implications for health services

Philosophical Transactions of the Royal Society B Biological Sciences ◽

10.1098/rstb.1997.0175 ◽

1997 ◽

Vol 352 (1363) ◽

pp. 1887-1893 ◽

Cited By ~ 3

Author(s):

John Grimley Evans

Keyword(s):

Health Services ◽

Political Thought ◽

Elderly Population ◽

Average Duration ◽

Later Life ◽

The Elderly ◽

Services Research ◽

Extrinsic Factors ◽

Progressive Loss

Health services for older people in the NHS have developed pragmatically, and reflect the nature of disease in later life and the need to agree objectives of care with patients. Although services are likely to be able to cope with the immediate future, the growth of the elderly population anticipated from 2030 calls for long–term planning and research. The issue of funding requires immediate political thought and action. Scientifically the focus needs to be on maximizing the efficiency of services by health services research and reducing the incidence of disability in later life through research on its biological and social determinants. Senescence is a progressive loss of adaptability due to an interaction between intrinsic (genetic) processes with extrinsic factors in environment and lifestyle. There are grounds for postulating that a policy of postponement of the onset of disability, by modifications of lifestyle and environment, could reduce the average duration of disability before death. The new political structures of Europe offer underexploited–unexploited opportunities for the necessary research.

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Abstract WMP57: Declining Blood Pressure is Associated with Subcortical Microinfarcts in Older Adults

Stroke ◽

10.1161/str.48.suppl_1.wmp57 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Mekala R Raman ◽

Jonathan Graff-Radford ◽

Scott A Przybelski ◽

Timothy G Lesnick ◽

Michelle M Mielke ◽

...

Keyword(s):

Blood Pressure ◽

Older Adults ◽

Elderly Population ◽

Adult Population ◽

Blood Pressure Measurement ◽

The Elderly ◽

Pressure Measurements ◽

Autopsy Study ◽

Cross Sectional ◽

Blood Pressures

Hypertension is highly prevalent in the elderly population and microinfarcts are the most common vascular brain pathology identified in older adults at autopsy. We investigated the associations between systolic and diastolic blood pressures measured antemortem and the presence of microinfarcts at autopsy. Study subjects (n=302; age range=71-95) were participants in the population-based Mayo Clinic Study of Aging autopsy study, who had blood pressure measurements recorded during life. We investigated both cross-sectional systolic and diastolic blood pressure measurements at the baseline visit and the change in blood pressure (slope). Presence and location (subcortical or cortical) of chronic microinfarcts was abstracted from the autopsy reports. Of the 302 study subjects, 47 (16%) had cerebral microinfarcts, and, of those, 18 (38%) had subcortical microinfarcts and 29 (62%) had only cortical microinfarcts. The baseline blood pressures were not different between subjects with no microinfarcts, subcortical microinfarcts, and only cortical microinfarcts. In a logistic regression model including time between last blood pressure measurement and death, a greater decline in systolic [OR= 1.06 (1.01, 1.11); p=0.02]) and greater decline in diastolic [OR= 1.11 (1.02, 1.20); p=0.01] blood pressures were predictors of the presence of subcortical microinfarcts at autopsy. However, these variables were not associated with the presence of cortical microinfarcts. In conclusion, microinfarcts are common in the older adult population, and most of them are located in the cortex. A greater decline in both systolic and diastolic blood pressures and their association with subcortical microinfarcts, but not with cortical microinfarcts, may have implications for aggressive lowering of blood pressure in the elderly population.

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METABOLIC SYNDROME PREVALENCE IS NOT ASSOCIATED WITH DIET QUALITY IN THE CHILEAN ELDERLY POPULATION: A CROSS SECTIONAL ANALYSIS FROM THE NATIONAL HEALTH SURVEY 2009-2010

Journal of Aging Research and Lifestyle ◽

10.14283/jarcp.2016.104 ◽

2016 ◽

pp. 1-7

Author(s):

C. Dussaillant ◽

G. Echeverría ◽

L. Villarroel ◽

C.B. Yu ◽

A. Rigotti ◽

...

Keyword(s):

Blood Pressure ◽

Metabolic Syndrome ◽

Waist Circumference ◽

Food Intake ◽

Diet Quality ◽

Elderly Population ◽

The Elderly ◽

National Health Survey ◽

Cross Sectional ◽

Sectional Analysis

Objectives: To analyze the relationship between the prevalence of metabolic syndrome, food intake, and diet quality in elderly (≥65 years old) Chilean population. Design: Cross sectional analysis based on the last national health survey performed in the years 2009 and 2010 (ChNHS 2009-2010). Setting: Non-institutionalized individuals of 65 years or older were selected and visited at home. Participants: A subsample of 505 elderly adults from the ChNHS 2009-2010 who answered a food questionnaire and had appropriate information to diagnose metabolic syndrome following the ATPIII-NCEP guidelines. Measurements: Fasting blood samples were obtained in order to measure blood lipids and fasting blood glucose. Blood pressure, waist circumference, and body mass index (BMI) were also measured. A 5-item food frequency questionnaire was applied to all the participants of NHS 2009-2010. Results: The overall prevalence of metabolic syndrome in the Chilean adult population was 37.7%, increasing in frequency with advancing age. Among the elderly (≥65 years old), metabolic syndrome was found in 57.2% of the sample. Elevated blood pressure and increased waist circumference were the most prevalent metabolic syndrome components among this group (88% and 80%, respectively). Low intake of fruits, vegetables, whole cereals, fish, and dairy was seen among the elderly, and no association was found between food intake nor diet quality and metabolic syndrome prevalence. Conclusion: Metabolic syndrome is highly prevalent among the Chilean elderly population and its prevalence is not associated with food intake or diet quality in this age group.

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Cerebrovascular diseases mortality in the elderly in the state of São Paulo

10.5327/1516-3180.417 ◽

2021 ◽

Author(s):

Isaac Rêgo Purificação ◽

Allêh Kauãn Santos Nogueira ◽

Matheus Araújo de Souza ◽

Camila de Almeida Costa Alencar ◽

Sancha Mohana Brito Goes Rios

Keyword(s):

Age Groups ◽

The Elderly ◽

Cross Sectional Study ◽

Cerebrovascular Diseases ◽

Sao Paulo ◽

Primary Objective ◽

The State ◽

São Paulo ◽

Cross Sectional ◽

Lack Of Information

Background: Cerebrovascular disease (CVD) is the world 2nd death cause and the main cause of disability. Nevertheless, there is a lack of information regarding the mortality profile for this etiology in the last decade. Objective and Methods: Using prospectively collected data available in TabNet (DataSUS) platform, a descriptive and cross-sectional study was conducted. The primary objective is to access the demographic information most associated with DCV mortality in individuals older than 50 years-old, in São Paulo (SP), from 2010 to 2019. Results: The highest mortality in the state of SP was in 2019 (16,945 deaths), according to the growing trend; in the 2010-2019 period, the annual mean by city of deaths (± standard deviation [SD]) was 14,885 (± 1,341). During these years, the number of deaths was higher in the municipality of São Paulo (57,013; 31%). The annual mean deaths (± SD) in the capital and in the interior cities were, respectively: 4,684 (± 269) and 31 (± 58). The age groups from 70 to 79 years and over 80 years were the most affected. Caucasian race represents 71% of deaths. Individuals with 1 to 3 years of school were more affected (38%). The ratio of male deaths to female deaths was 1.02. Conclusion: In the last decade, there was an increasing mortality by CVD among the elderly population, and the city of São Paulo leads the number of cases.

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Changes in the Human Vocal Tract Due to Aging and the Acoustic Correlates of Speech Production

Journal of Speech Language and Hearing Research ◽

10.1044/1092-4388(2003/054) ◽

2003 ◽

Vol 46 (3) ◽

pp. 689-701 ◽

Cited By ~ 79

Author(s):

Steve An Xue ◽

Grace Jianping Hao

Keyword(s):

Speech Production ◽

Vocal Tract ◽

Cost Effective ◽

The Elderly ◽

Cross Sectional ◽

Men And Women ◽

Acoustic Reflection ◽

Dimensional Changes ◽

Formant Frequencies ◽

Age Related

This investigation used a derivation of acoustic reflection (AR) technology to make cross-sectional measurements of changes due to aging in the oral and pharyngeal lumina of male and female speakers. The purpose of the study was to establish preliminary normative data for such changes and to obtain acoustic measurements of changes due to aging in the formant frequencies of selected spoken vowels and their long-term average spectra (LTAS) analysis. Thirty- eight young men and women and 38 elderly men and women were involved in the study. The oral and pharyngeal lumina of the participants were measured with AR technology, and their formant frequencies were analyzed using the Kay Elemetrics Computerized Speech Lab. The findings have delineated specific and similar patterns of aging changes in human vocal tract configurations in speakers of both genders. Namely, the oral cavity length and volume of elderly speakers increased significantly compared to their young cohorts. The total vocal tract volume of elderly speakers also showed a significant increment, whereas the total vocal tract length of elderly speakers did not differ significantly from their young cohorts. Elderly speakers of both genders also showed similar patterns of acoustic changes of speech production, that is, consistent lowering of formant frequencies (especially F1) across selected vowel productions. Although new research models are still needed to succinctly account for the speech acoustic changes of the elderly, especially for their specific patterns of human vocal tract dimensional changes, this study has innovatively applied the noninvasive and cost-effective AR technology to monitor age-related human oral and pharyngeal lumina changes that have direct consequences for speech production.

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Prevalência de hiperglicemia em idosos: um estudo de base populacional

Scientia Medica ◽

10.15448/1980-6108.2016.4.25246 ◽

2016 ◽

Vol 26 (4) ◽

pp. 25246

Author(s):

Felipe Zancan Espanhol ◽

Rita de Cássia S. M. De Oliveira ◽

Gustavo Paes Silvano ◽

André Luciano Manoel ◽

Laise Rodrigues Silveira ◽

...

Keyword(s):

Skin Color ◽

Elderly Population ◽

Fasting Glucose ◽

Fasting Blood Glucose ◽

Simple Random Sampling ◽

The Elderly ◽

Population Based ◽

Blood Collection ◽

Cross Sectional ◽

Family History Of Diabetes

Aims: To evaluate the prevalence of hyperglycemia and associated factors in the elderly population of a municipality in southern Brazil.Methods: Cross-sectional population-based study, carried out with the elderly (≥60 years) living in the city of Tubarão, state of Santa Catarina, Brazil, from September 2010 to May 2011. Participants were selected by simple random sampling. The elderly were registered by the Community Health Agents of the Family's Health Strategy Program. Sociodemographic data (age, gender, skin color, marital status, employment status and education), behavioral data (physical activity, alcohol use and smoking) and clinical data (obesity, drug use and family history of diabetes) were recorded. After answering these questions the participants were scheduled to attend the clinic for blood collection and anthropometric measurements. The prevalence of hyperglycemia was assessed from fasting blood glucose tests, and individuals with values ≥126 mg/dL or use of hypoglycemic drugs were considered hyperglycemic. To assess the association between the variables of interest, the chi-square test was applied. The pre-determined confidence interval was of 95% and the error α of 5%.Results: Eight hundred thirty-three elderly patients were included, and 220 were considered hyperglycemic according to the methodology criteria (prevalence of 26.4%). Of the patients included in the hyperglycemia group, 190 were using oral hypoglycemic drugs, and of these, 112 had also fasting glucose ≥126 mg/dL, while in 78 fasting glucose was <126 mg/dL. Also in the hyperglycemia group, 30 patients had fasting glucose ≥126 mg/dL and were not on hypoglycemic treatment. Having parents diagnosed with diabetes and being obese were associated with the presence of hyperglycemia.Conclusions: This study suggests that a large portion of the elderly population have fasting hyperglycemia, requiring a wider evaluation for diabetes mellitus.

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