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Latest & greatest articles for elderly
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Paramedic Assessment of Older Adults After Falls, Including Community Care Referral Pathway: Cluster Randomized Trial We aim to determine clinical and cost-effectiveness of a paramedic protocol for the care of olderpeople who fall.We undertook a cluster randomized trial in 3 UK ambulance services between March 2011 and June 2012. We included patients aged 65 years or older after an emergency call for a fall, attended by paramedics based at trial stations. Intervention paramedics could refer
Adapting the Vulnerable Elders Survey-13 to Predict Mortality Using Responses to the Medicare Health Outcomes Survey To use items from the Medicare Health Outcomes Survey (HOS) to adapt or validate a simple method for identifying community-dwelling older adults at greater risk of death and to extend the method to identify a very high-risk group.Analysis of longitudinal data.National sample of beneficiaries from Medicare Advantage plans with 500 or more enrollees.Medicare beneficiaries aged 65 (...) and older responding to 2009 baseline and 2011 follow-up HOS (N = 238,687).Bivariate and multivariate analyses of the HOS; adaptation and validation of a previously validated Vulnerable Elders Survey-13 (VES-13) scoring system that uses age and self-reported function to predict mortality.A modified predictive model, that uses substitutes for several items in the previously validated VES-13, predicted 2-year mortality; 10.6% of those scoring 3 or more, and 2.4% of those scoring less than 3 died within 2
Caregiver Integration During Discharge Planning for Older Adults to Reduce Resource Use: A Metaanalysis To determine the effect of integrating informal caregivers into discharge planning on postdischarge cost and resource use in older adults.A systematic review and metaanalysis of randomized controlled trials that examine the effect of discharge planning with caregiver integration begun before discharge on healthcare cost and resource use outcomes. MEDLINE, EMBASE, and the Cochrane Library (...) planning interventions with caregiver integration were associated with a 25% fewer readmissions at 90 days (relative risk (RR) = 0.75, 95% confidence interval (CI) = 0.62-0.91) and 24% fewer readmissions at 180 days (RR = 0.76, 95% CI = 0.64-0.90). The majority of studies reported statistically significant shorter time to readmission, shorter rehospitalization, and lower costs of postdischarge care among discharge planning interventions with caregiver integration.For older adults discharged
A preventative lifestyle intervention for older adults (lifestyle matters): a randomised controlled trial to test whether an occupation-based lifestyle intervention can sustain and improve the mental well-being of adults aged 65 years or over compared to usual care, using an individually randomised controlled trial.288 independently living adults aged 65 years or over, with normal cognition, were recruited from two UK sites between December 2011 and November 2015.lifestyle Matters is a National (...) Institute for Health and Care Excellence recommended multi-component preventive intervention designed to improve the mental well-being of community living olderpeople at risk of decline. It involves weekly group sessions over 4 months and one to one sessions.the primary outcome was mental well-being at 6 months (mental health (MH) dimension of the SF-36). Secondary outcomes included physical health dimensions of the SF-36, extent of depression (PHQ-9), quality of life (EQ-5D) and loneliness (de Jong
of children and young people between 10 to 25 years. Two persons independently read title and summary of 10059 references. Of these, we found 589 potentially relevant publications for age estimation based on dental X-ray and two people independently considered these in full texts. We included 18 studies with results for children and young people that covered the whole or parts of the specified age range with data as mean chronological age with variance within each of Demirjian’s stages on third molar. Two (...) people independently considered the risk of bias in the studies based on the QUADAS-2 checklist and summarized this jointly. Results We found 18 cross-sectional studies using Demirjian’s stages for molars to assess development of wisdom teeth, which presented results as mean age and standard deviation (variance) in tooth stages and provided information about the number of participants. The studies included from 209 to 3510 people with known chronological age. All studies included both boys and girls
the method's ability to estimate age. Summary Background Every year, young unaccompanied asylum seekers arrive in Norway, many without knowing how old they are or unable to document their age. To ensure that children receive their rights and that adults are not treated as children, it is necessary to assign a chronological age for these individuals. Evaluation of skeletal maturation of the hand and tooth development has been used for age assessment of asylum seekers in Norway in cases of doubt (...) for studies that used the Greulich and Pyle atlas was updated in January 2017. Two people independently read title and summary for 10640 references. Of these, we found 658 potentially relevant publications for age estimation using x-ray of the hand. Two people independently considered these studies in full text. We included 17 studies with results that present age estimation based on the Greulich & Pyle atlas. We included two different approaches to present the data (in this report referred to as approach
Gestational age at diagnosis of early-onset fetal growth restriction and impact on management and survival: a population-based cohort study To investigate the impact of gestational age (GA) at diagnosis of fetal growth restriction (FGR) on obstetric management and rates of live birth and survival for very preterm infants with early-onset FGR.Population-based cohort study.All maternity units in 25 French regions in 2011.Fetuses diagnosed with FGR before 28 weeks of gestation among singleton (...) to discharge. 50% were live born when diagnosis occurred before 25 weeks, 66% at 25 weeks and >90% at 26 and 27 weeks of gestation. In all, 94.1% of live births were by prelabour caesarean, principally for maternal indications before 26 weeks. Low GA at diagnosis, an estimated fetal weight or abdominal circumference below the third centile and male sex were adversely associated with live birth in adjusted models.Gestational age at FGR diagnosis had an impact on the probability of live birth and survival
Treatment response to sildenafil in men with erectile dysfunction relative to concomitant comorbidities and age To evaluate treatment response in men with erectile dysfunction (ED) and concomitant comorbidities.Data were pooled from 42 placebo-controlled, flexible-dose sildenafil trials. In most trials, the sildenafil dose was 50 mg, taken ~1 hour before sexual activity but not more than once daily, with adjustment to 100 or 25 mg as needed. The overall population (N=9413) was stratified by age (...) with no comorbidity (77% vs 33%), cardiovascular disease/hypertension only (71% vs 27%), diabetes only (63% vs 24%) or depression only (78% vs 29%). Using an IIEF-EF score ≥26, treatment response was significantly greater (P<.0001) with sildenafil vs placebo in men with no comorbidity (49% vs 17%), cardiovascular disease/hypertension only (48% vs 12%), diabetes only (40% vs 12%) or depression only (60% vs 17%). With each definition, the treatment response for each age and comorbidity was significantly greater (P
Association Between HIV Infection and the Risk of Heart Failure With Reduced Ejection Fraction and Preserved Ejection Fraction in the Antiretroviral Therapy Era: Results From the Veterans Aging Cohort Study With improved survival, heart failure (HF) has become a major complication for individuals with human immunodeficiency virus (HIV) infection. It is unclear if this risk extends to different types of HF in the antiretroviral therapy (ART) era. Determining whether HIV infection is associated (...) with HF with reduced ejection fraction (HFrEF), HF with preserved ejection fraction (HFpEF), or both is critical because HF types differ with respect to underlying mechanism, treatment, and prognosis.To investigate whether HIV infection increases the risk of future HFrEF and HFpEF and to assess if this risk varies by sociodemographic and HIV-specific factors.This study evaluated 98 015 participants without baseline cardiovascular disease from the Veterans Aging Cohort Study, an observational cohort
Can Health-care Assistant Training improve the relational care of olderpeople? (CHAT) A development and feasibility study of a complex intervention Can Health-care Assistant Training improve the relational care of olderpeople? (CHAT) A development and feasibility study of a complex intervention Can Health-care Assistant Training improve the relational care of olderpeople? (CHAT) A development and feasibility study of a complex intervention Arthur A, Aldus C, Sarre S, Maben J, Wharrad H (...) , Schneider J, Barton G, Argyle E, Clark A, Nouri F & Nicholson C Record Status This is a bibliographic record of a published health technology assessment from a member of INAHTA. No evaluation of the quality of this assessment has been made for the HTA database. Citation Arthur A, Aldus C, Sarre S, Maben J, Wharrad H, Schneider J, Barton G, Argyle E, Clark A, Nouri F & Nicholson C. Can Health-care Assistant Training improve the relational care of olderpeople? (CHAT) A development and feasibility study
An elderly man with an air-fluid level in the middle ear A 68-year-old Malay man who is a rubber tapper, presented with a large painful right-sided neck swelling for 6 months, which was gradually increasing in size and associated with odynophagia, dysphagia, hoarseness and significant weight loss. He did not complain of any ear symptoms, but on further questioning, he admitted having a 3-week history of occasional tinnitus and reduced hearing on the right ear. Other ear symptoms were negative.
Diffuse large B-cell lymphoma in very elderly patients over 80 years old: Incorporating consolidative radiation therapy into management decisions The population of patients aged 80 years or older who are diagnosed with diffuse large B-cell lymphoma (DLBCL) continues to increase, but an optimal treatment strategy has not been established. We sought to examine the influence of consolidative radiation therapy (RT) on outcome and toxicity among the very elderly diagnosed with stage I-IV DLBCL.We (...) more frequently among ES patients who received 6 to 8 cycles of chemotherapy alone. Among advanced-stage patients with bulky disease (n = 35), consolidative RT to sites of bulky disease may have improved local control (3-year local control, 100% vs 60.3%, P = .160).Among patients aged 80 years or older who have with ES DLBCL, 3 to 4 cycles of chemotherapy followed by RT is at least equivalent in efficacy to chemotherapy alone and is associated with lower levels of toxicity, which suggests
Opposing activities of oncogenic MIR17HG and tumor suppressive MIR100HG clusters and their gene targets regulate replicative senescence in human adult stem cells Growing evidence suggests that many diseases of aging, including diseases associated with robust changes and adipose deports, may be caused by resident adult stem cell exhaustion due to the process called cellular senescence. Understanding how microRNA pathways can regulate cellular senescence is crucial for the development of novel (...) diagnostic and therapeutic strategies to combat these pathologies. Herein, using integrated transcriptomic and semi-quantitative proteomic analysis, we provide a system level view of the regulation of human adipose-derived stem cell senescence by a subset of mature microRNAs (termed senescence-associated-microRNAs) produced by biogenesis of oncogenic MIR17HG and tumor-suppressive MIR100HG clusters. We demonstrate functional significance of these mature senescence-associated-microRNAs in the process
Racial Differences in Associations of Blood Pressure Components in Young Adulthood With Incident Cardiovascular Disease by Middle Age: Coronary Artery Risk Development in Young Adults (CARDIA) Study Data are sparse regarding which blood pressure (BP) components in young adulthood optimally determine cardiovascular disease (CVD) by middle age.To assess which BP components best determine incident CVD events in young adults and determine whether these associations vary by race and age at BP (...) measurement.Using data from the Coronary Artery Risk Development in Young Adults (CARDIA) study, this study assessed the longitudinal race-stratified associations between BP and cardiovascular outcomes. CARDIA is a community-based cohort that recruited black and white individuals (age range, 18-30 years) from March 26, 1985, through June 7, 1986. CARDIA followed up participants for up to 28 years, and 94% of the surviving cohort completed at least 1 telephone interview or examination from August 2009 through
Association of Coronary Artery Calcium in Adults Aged 32 to 46 Years With Incident Coronary Heart Disease and Death Coronary artery calcium (CAC) is associated with coronary heart disease (CHD) and cardiovascular disease (CVD); however, prognostic data on CAC are limited in younger adults.To determine if CAC in adults aged 32 to 46 years is associated with incident clinical CHD, CVD, and all-cause mortality during 12.5 years of follow-up.The Coronary Artery Risk Development in Young Adults (...) (CARDIA) Study is a prospective community-based study that recruited 5115 black and white participants aged 18 to 30 years from March 25, 1985, to June 7, 1986. The cohort has been under surveillance for 30 years, with CAC measured 15 (n = 3043), 20 (n = 3141), and 25 (n = 3189) years after recruitment. The mean follow-up period for incident events was 12.5 years, from the year 15 computed tomographic scan through August 31, 2014.Incident CHD included fatal or nonfatal myocardial infarction, acute
Longitudinal Assessment of PTH in Community-Dwelling Older Womenâ€”Elevations Are Not Associated With Mortality In older women, the magnitude of elevated parathyroid hormone (PTH) and its consequence is unclear.To describe normal PTH profiles over time and the association with mortality.There were 1044 community-dwelling women in the Malmö Osteoporosis Prospective Risk Assessment cohort (OPRA) who attended baseline (age 75 years). Follow-ups were attended by 715 (age 80 years) and 382 (age 85 (...) years).PTH, estimated glomerular filtration rate (eGFR), 25-hydroxyvitamin D (25OHD) and mortality.At age 75 years, PTH levels for most (n = 877, 88%) were within the normal reference range (NRR) (i.e., <6.9 pmol/L). Longitudinally, between ages 75 and 80 years, PTH increased in 60% of all women (n = 390) but increases of up to 50% above baseline values (64%; n=250) still resulted in PTH levels within the NRR. These women had lower 25OHD levels (74 vs 83 nmol/L, P = 0.001). Only when increases were
Low back pain in older adults: risk factors, management options and future directions Low back pain (LBP) is one of the major disabling health conditions among older adults aged 60 years or older. While most causes of LBP among older adults are non-specific and self-limiting, seniors are prone to develop certain LBP pathologies and/or chronic LBP given their age-related physical and psychosocial changes. Unfortunately, no review has previously summarized/discussed various factors that may (...) affect the effective LBP management among older adults. Accordingly, the objectives of the current narrative review were to comprehensively summarize common causes and risk factors (modifiable and non-modifiable) of developing severe/chronic LBP in older adults, to highlight specific issues in assessing and treating seniors with LBP, and to discuss future research directions. Existing evidence suggests that prevalence rates of severe and chronic LBP increase with olderage. As compared to working-age
Associations of Maternal Antidepressant Use During the First Trimester of Pregnancy With Preterm Birth, Small for Gestational Age, Autism Spectrum Disorder, and Attention-Deficit/Hyperactivity Disorder in Offspring. Prenatal antidepressant exposure has been associated with adverse outcomes. Previous studies, however, may not have adequately accounted for confounding.To evaluate alternative hypotheses for associations between first-trimester antidepressant exposure and birth (...) weeks), small for gestational age (birth weight <2 SDs below the mean for gestational age), and first inpatient or outpatient clinical diagnosis of autism spectrum disorder and attention-deficit/hyperactivity disorder in offspring.Among 1 580 629 offspring (mean gestational age, 279 days; 48.6% female; 1.4% [n = 22 544] with maternal first-trimester self-reported antidepressant use) born to 943 776 mothers (mean age at childbirth, 30 years), 6.98% of exposed vs 4.78% of unexposed offspring were
Immune dysfunctionality of replicative senescent mesenchymal stromal cells is corrected by IFNÎ³ priming Industrial-scale expansion of mesenchymal stromal cells (MSCs) is often used in clinical trials, and the effect of replicative senescence on MSC functionality is of mechanistic interest. Senescent MSCs exhibit cell-cycle arrest, cellular hypertrophy, and express the senescent marker β-galactosidase. Although both fit and senescent MSCs display intact lung-homing properties in vivo, senescent (...) MSCs acquire a significant defect in inhibiting T-cell proliferation and cytokine secretion in vitro. IFNγ does not upregulate HLA-DR on senescent MSCs, whereas its silencing did not reverse fit MSCs' immunosuppressive properties. Secretome analysis of MSC and activated peripheral blood mononuclear cell coculture demonstrate that senescent MSCs are significantly defective in up (vascular endothelial growth factor [VEGF], granulocyte colony-stimulating factor [GCSF], CXCL10, CCL2) or down (IL-1ra
Links between primary occupation and functional limitations among older adults in Mexico Social inequalities in health and disability are often attributed to differences in childhood adversity, access to care, health behavior, residential environments, stress, and the psychosocial aspects of work environments. Yet, disadvantaged people are also more likely to hold jobs requiring heavy physical labor, repetitive movement, ergonomic strain, and safety hazards. We investigate the role of physical (...) work conditions in contributing to social inequality in mobility among older adults in Mexico, using data from the Mexican Health and Aging Survey (MHAS) and an innovative statistical modeling approach. We use data on categories of primary adult occupation to serve as proxies for jobs with more or less demanding physical work requirements. Our results show that more physically demanding jobs are associated with mobility limitations at olderages, even when we control for age and sex. Inclusion