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database to investigate the relationship between age and DNAR. All 10 studies fulfilling our inclusion criteria found that "do not attempt resuscitation" orders were more prevalent in older patients; eight demonstrated that this was independent of other mediating factors such as illness severity and likely outcome. In studies comparing age groups, the adjusted odds of having a DNAR order were greater in patients aged 75 to 84 and ≥85 years (adjusted odds ratio [AOR] 1.70, 95% confidence interval [CI (...) End of Life Care and Do Not Resuscitate Orders: How Much Does Age Influence Decision Making? A Systematic Review and Meta-Analysis. With population aging, "do not resuscitate" (DNAR) decisions, pertaining to the appropriateness of attempting resuscitation following a cardiac arrest, are becoming commoner. It is unclear from the literature whether using age to make these decisions represents "ageism." We undertook a systematic review of the literature using CINAHL, Medline, and the Cochrane
years. The median age of participants was 10 years old and the median BMI z score was 2.2.Primary analyses demonstrated that behaviour-changing interventions compared to no treatment/usual care control at longest follow-up reduced BMI, BMI z score and weight. Mean difference (MD) in BMI was -0.53 kg/m2 (95% confidence interval (CI) -0.82 to -0.24); P < 0.00001; 24 trials; 2785 participants; low-quality evidence. MD in BMI z score was -0.06 units (95% CI -0.10 to -0.02); P = 0.001; 37 trials; 4019 (...) Diet, physical activity and behavioural interventions for the treatment of overweight or obese children from the age of 6 to 11 years. Child and adolescent overweight and obesity has increased globally, and can be associated with significant short- and long-term health consequences. This is an update of a Cochrane review published first in 2003, and updated previously in 2009. However, the update has now been split into six reviews addressing different childhood obesity treatments at different
Diet, physical activity and behavioural interventions for the treatment of overweight or obese adolescents aged 12 to 17 years. Adolescent overweight and obesity has increased globally, and can be associated with short- and long-term health consequences. Modifying known dietary and behavioural risk factors through behaviour changing interventions (BCI) may help to reduce childhood overweight and obesity. This is an update of a review published in 2009.To assess the effects of diet, physical (...) activity and behavioural interventions for the treatment of overweight or obese adolescents aged 12 to 17 years.We performed a systematic literature search in: CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL, LILACS, and the trial registers ClinicalTrials.gov and ICTRP Search Portal. We checked references of identified studies and systematic reviews. There were no language restrictions. The date of the last search was July 2016 for all databases.We selected randomised controlled trials (RCTs) of diet
Outcomes after observation stays among older adult Medicare beneficiaries in the USA: retrospective cohort study. Objective To characterize rates and trends over time of emergency department treatment-and-discharge stays, repeat observation stays, inpatient stays, any hospital revisit, and death within 30 days of discharge from observation stays.Design Retrospective cohort study.Setting 4750 hospitals in the USA.Participants Nationally representative sample of Medicare fee for service (...) beneficiaries aged 65 or over discharged after 363 037 index observation stays, 2 540 000 index emergency department treatment-and-discharge stays, and 2 667 525 index inpatient stays from 2006-11.Main outcome measures Rates of emergency department treatment-and-discharge stays, observation stays, inpatient stays, any hospital revisit, and death within 30 days of discharge from index observation stays. Rates were compared with corresponding outcomes within 30 days of discharge from both index emergency
care providers, among community-dwelling older adults who were discharged home after presenting to an ED with a fall-related injury.We enrolled English speaking patients, aged ≥ 65 years, who presented to the ED of an urban level one trauma center with a fall or fall related injury and discharged home. During subjects' initial visits to the ED, we screened and enrolled patients, gathered patient demographics and provided them with a flyer for a Matter of Balance course. Sixty-days post enrollment (...) , we conducted a phone follow-up interview to collect information on post-fall behaviors including information regarding the efforts to engage family and the primary care provider, enroll in a falls prevention program, assess patients' attitudes towards falling and experiences with any subsequent falls.Eighty-seven community-dwelling people between the ages of 65 and 90 were recruited, the majority (76%) being women. Seventy-one percent of subjects reported talking to their provider regarding
Use of Antipsychotic Drugs by Elderly Primary Care Patients and the Effects of Medication Reviews: A Cross-Sectional Study in Sweden Antipsychotics form a class of drugs that should be used with caution among elderlypeople because of a high risk of adverse events. Despite the risks and modest effects, their use is estimated to be high, especially in nursing homes.The aim was to explore the effects of medication reviews on antipsychotic drug use for elderly primary care patients and describe (...) the extent of, and reasons for, the prescription of antipsychotics.In this cross-sectional study in primary care in Skåne, Sweden, patients aged ≥75 years living in nursing homes or in their own homes with home care were included. The effects of medication reviews were documented, as were the use of antipsychotics and the differences in characteristics between patients receiving or not receiving antipsychotics.A total of 1683 patients aged 87.6 (±5.7) years were included in the analysis. Medication
Global rise of potential health hazards caused by blue light-induced circadian disruption in modern aging societies Mammals receive light information through the eyes, which perform two major functions: image forming vision to see objects and non-image forming adaptation of physiology and behavior to light. Cone and rod photoreceptors form images and send the information via retinal ganglion cells to the brain for image reconstruction. In contrast, nonimage-forming photoresponses vary widely (...) . Understanding melanopsin function lets us recognize considerable physiological effects of blue light, which is increasingly important in our modern society that uses light-emitting diode. Misalignment of circadian rhythmicity is observed in numerous conditions, including aging, and is thought to be involved in the development of age-related disorders, such as depression, diabetes, hypertension, obesity, and cancer. The appropriate regulation of circadian rhythmicity by proper lighting is therefore essential
Health-promotion theories in nutritional interventions for community-dwelling older adults: a systematic review. To identify theories applied in interventions promoting healthy nutrition among community-dwelling older adults and determine the efficacy of theories in changing knowledge, attitudes, and behaviors.The PubMed, PsycINFO, Embase, and ERIC databases were searched for English articles from January 1990 to December 2015. Mono or multicomponent randomized controlled trial studies were
Guidelines for the prevention of travel-associated illness in older adults International travel to the developing world is becoming more common in elderly patients (defined here as individuals greater than 65 years old). When providing pre-travel counseling, providers must appreciate the changing physiology, comorbidities, immunity and pharmacokinetics associated with the aging process to prepare elderly patients for the stressors of international travel. These guidelines present an evidence (...) -based approach to pre-travel counseling, immunization, and pharmacology concerns unique to elderly patients seeking care in a travel clinic setting.
Geometric morphometric analysis reveals age-related differences in the distal femur of Europeans Few studies have looked into age-related variations in femur shape. We hypothesized that three-dimensional (3D) geometric morphometric analysis of the distal femur would reveal age-related differences. The purpose of this study was to show that differences in distal femur shape related to age could be identified, visualized, and quantified using three-dimensional (3D) geometric morphometric (...) analysis.Geometric morphometric analysis was carried out on CT scans of the distal femur of 256 subjects living in the south of France. Ten landmarks were defined on 3D reconstructions of the distal femur. Both traditional metric and geometric morphometric analyses were carried out on these bone reconstructions. These analyses were used to identify trends in bone shape in various age-based subgroups (<40, 40-60, >60).Only the average bone shape of the < 40-year subgroup was statistically different from
Computer-Aided Systematic Review Screening Comes of Age. 28605802 2017 12 11 2018 12 02 1539-3704 167 3 2017 08 01 Annals of internal medicine Ann. Intern. Med. Computer-Aided Systematic Review Screening Comes of Age. 210-211 10.7326/M17-1295 Hemens Brian J BJ From McMaster University, Hamilton, Ontario, Canada. Iorio Alfonso A From McMaster University, Hamilton, Ontario, Canada. eng Journal Article Comment 2017 06 13 United States Ann Intern Med 0372351 0003-4819 AIM IM Ann Intern Med. 2017
Community-Based Hip Fracture Rehabilitation Interventions for Older Adults With Cognitive Impairment: A Systematic Review. A hip fracture in older adulthood can result in function and mobility decline. The consequences are debilitating and place a great burden on patients, caregivers, and the health care system. Although inpatient rehabilitation programs have proven effective, the best practices for community-based rehabilitation required to maintain the gains in function and mobility post (...) hospital discharge are currently unknown.The aim of this systematic review is to identify and evaluate the evidence on the effectiveness of community-based rehabilitation post hospital discharge interventions for older adults with cognitive impairment (CI) following a hip fracture, and to identify the physical recovery outcomes and measures used in previous studies.The methods outlined in the Cochrane Handbook for Systematic Reviews of Intervention were followed and findings were reported using
Information and Communication Technologies in the Care of the Elderly: Systematic Review of Applications Aimed at Patients With Dementia and Caregivers. The interest in applying information and communications technology (ICT) in older adult health care is frequently promoted by the increasing and unsustainable costs of health care services. In turn, the unprecedented growth of the elderly population around the globe has urged institutions, companies, industries, and governments to respond (...) to older adults' medical needs.The aim of this review is to systematically identify the opportunities that ICT offers to health services, specifically for patients with dementia and their families.A systematic review of the literature about ICT applications that have been developed to assist patients with Alzheimer's disease (AD) and their primary caregivers was conducted. The bibliographic search included works published between January 2005 and July 2015 in the databases Springer Link, Scopus
Temperature as a Circadian Marker in Older Human Subjects: Relationship to Metabolic Syndrome and Diabetes Circadian rhythms are characterized by approximate 24-hour oscillations in physiological and behavioral processes. Disruptions in these endogenous rhythms, most commonly associated with shift work and/or lifestyle, are recognized to be detrimental to health. Several studies have demonstrated a high correlation between disrupted circadian rhythms and metabolic disease. The aim of this study (...) was to determine which metabolic parameters correlate with physiological measures of circadian temperature amplitude (TempAmp) and stability (TempStab).Wrist skin temperature was measured in 34 subjects (ages 50 to 70, including lean, obese, and diabetic subjects) every 10 minutes for 7 consecutive days. Anthropometric measures and fasting blood draws were conducted to obtain data on metabolic parameters: body mass index, hemoglobin A1C, triglycerides, cholesterol, high-density lipoprotein, and low-density
Heterogeneity in Blood Pressure Transitions Over the Life Course: Age-Specific Emergence of Racial/Ethnic and Sex Disparities in the United States Many studies have assessed racial/ethnic and sex disparities in the prevalence of elevated blood pressure (BP) from childhood to adulthood, yet few have examined differences in age-specific transitions between categories of BP over the life course in contemporary, multiracial/multiethnic populations.To estimate age, racial/ethnic, and sex-specific (...) annual net transition probabilities between categories of BP using Markov modeling of cross-sectional data from the National Health and Nutrition Examination Survey.National probability sample (National Health and Nutrition Examination Survey in 2007-2008, 2009-2010, and 2011-2012) of 17 747 African American, white American, and Mexican American participants aged 8 to 80 years. The data were analyzed from September 2014 to November 2015.Age-specific American Heart Association-defined BP
CHA2DS2-VASc Score (Congestive Heart Failure, Hypertension, Age >/=75 [Doubled], Diabetes Mellitus, Prior Stroke or Transient Ischemic Attack [Doubled], Vascular Disease, Age 65-74, Female) for Stroke in Asian Patients With Atrial Fibrillation: A Korean N The CHA2DS2-VASc stroke score (congestive heart failure, hypertension, age ≥75 (doubled), diabetes mellitus, prior stroke or transient ischemic attack (doubled), vascular disease, age 65-74, female) is used in most guidelines for risk (...) stratification in atrial fibrillation (AF), but most data for this score have been derived in Western populations. Ethnic differences in stroke risk may be present. Our objective was to investigate risk factors for stroke in AF and application of the CHA2DS2-VASc score in an Asian AF population from Korea.A total of 5855 oral anticoagulant-naive nonvalvular AF patients aged ≥20 years were enrolled from Korea National Health Insurance Service Sample cohort from 2002 to 2008 and were followed up until December
Ethnicity and age as factors in sildenafil treatment of erectile dysfunction Sildenafil has been evaluated in >16 000 men with erectile dysfunction (ED) in double-blind, placebo-controlled trials.To assess efficacy and safety of sildenafil in ED by ethnicity (white, black Asian) and age (≤45, 46-60, ≥61 years).Data were pooled from 38 double-blind, placebo-controlled, flexible-dose trials. Most had starting sildenafil doses of 50 mg once daily, ~1 hour before sexual activity, with adjustment (...) for IIEF-EF domain and GAQ were significant for each ethnic and age group (P<.0001); significant treatment-by-ethnicity and treatment-by-age interactions were also observed for change in IIEF-EF domain scores (P<.05), with differences significantly greater for White vs. Black (P<.0001), White vs. Asian (P=.0163), and Asian vs. Black (P=.0036) men. A significant treatment-by-ethnicity interaction was observed for GAQ (P=.0004). The OR comparison for GAQ was significantly greater (P=.0001
Interventions to prevent age-related cognitive decline, mild cognitive impairment, and clinical Alzheimer's-type dementia Interventions to prevent age-related cognitive decline, mild cognitive impairment, and clinical Alzheimer's-type dementia Interventions to prevent age-related cognitive decline, mild cognitive impairment, and clinical Alzheimer's-type dementia Kane RL, Butler M, Fink HA, Brasure M, Davila H, Desai P, Jutkowitz E, McCreedy E, Nelson VA, McCarten JR, Calvert C, Ratner E, Hemmy (...) LS, Barclay T Record Status This is a bibliographic record of a published health technology assessment. No evaluation of the quality of this assessment has been made for the HTA database. Citation Kane RL, Butler M, Fink HA, Brasure M, Davila H, Desai P, Jutkowitz E, McCreedy E, Nelson VA, McCarten JR, Calvert C, Ratner E, Hemmy LS, Barclay T. Interventions to prevent age-related cognitive decline, mild cognitive impairment, and clinical Alzheimer's-type dementia. Rockville: Agency for Healthcare