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Geriatrics, Volume 2, Issue 1 (March 2017) – 13 articles

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265 KiB  
Review
Healthcare and End-of-Life Needs of Lesbian, Gay, Bisexual, and Transgender (LGBT) Older Adults: A Scoping Review
by Arne Stinchcombe, Jeffrey Smallbone, Kimberley Wilson and Katherine Kortes-Miller
Geriatrics 2017, 2(1), 13; https://doi.org/10.3390/geriatrics2010013 - 16 Mar 2017
Cited by 49 | Viewed by 14373
Abstract
Lesbian, gay, bisexual, and transgender (LGBT) older adults face a number of challenges with respect to access to healthcare especially towards end-of-life. Through a systematic search and scoping review of the literature, we sought to answer two related research questions. In particular, the [...] Read more.
Lesbian, gay, bisexual, and transgender (LGBT) older adults face a number of challenges with respect to access to healthcare especially towards end-of-life. Through a systematic search and scoping review of the literature, we sought to answer two related research questions. In particular, the purpose of this scoping review was to determine the healthcare needs of LGBT older adults nearing end-of-life as well as the factors that contribute to a good death experience among older adults who identify as LGBT. A systematic search of electronic databases for articles published between 2005 and 2016 as well as screening for relevance resulted in 25 results. The data were charted and grouped according to the themes of: social support and chosen family, intimacy, health status, fear of discrimination and lack of trust, lack of knowledge and preparedness, and cultural competence in the healthcare system. The results suggest a role for health and social service workers in contributing to a positive care experience for LGBT older adults by becoming knowledgeable about the unique needs of this population and being unassuming and accepting of individuals’ sexuality. Many of the articles reviewed collected data outside of Canada, limiting generalizability and highlighting a need for Canadian data on LGBT aging and end-of-life. Full article
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Article
Muscle Strength and Functional Ability in Recreational Female Golfers and Less Active Non-Golfers over the Age of 80 Years
by Alison Stockdale, Nicholas Webb, Jessica Wootton, Jonathan Drennan, Simon Brown and Maria Stokes
Geriatrics 2017, 2(1), 12; https://doi.org/10.3390/geriatrics2010012 - 04 Mar 2017
Cited by 4 | Viewed by 7283
Abstract
Muscle strength and functional ability decline with age. Physical activity can slow the decline but whether recreational golf is associated with slower decline is unknown. This cross-sectional, observational study aimed to examine the feasibility of testing muscle strength and functional ability in older [...] Read more.
Muscle strength and functional ability decline with age. Physical activity can slow the decline but whether recreational golf is associated with slower decline is unknown. This cross-sectional, observational study aimed to examine the feasibility of testing muscle strength and functional ability in older female golfers and non-golfers in community settings. Thirty-one females over aged 80, living independently (golfers n = 21, mean age 83, standard deviation (±) 2.1 years); non-golfers, n = 10 (80.8 ± 1.03 years) were studied. Maximal isometric contractions of handgrip and quadriceps were tested on the dominant side. Functional ability was assessed using the Timed Up and Go (TUG) and health-related quality of life using the Short Form-36 questionnaire. Grip strength, normalised to body mass, was greater in golfers (0.33 ± 0.06 kgF/kg) than non-golfers (0.29 ± 0.06), however, the difference was not statistically significant (p = 0.051). Quadriceps strength did not differ (golfers 2.78 ± 0.74 N/kg; non-golfers 2.69 ± 0.83; p = 0.774). TUG times were significantly faster (p = 0.027) in golfers (10.4 ± 1.9 s) than non-golfers (12.6 ± 3.21 s; within sarcopenic category). Quality of life was significantly higher in golfers for the physical categories (Physical Function p < 0.001; Physical p = 0.033; Bodily pain p = 0.028; Vitality p = 0.047) but psychosocial categories did not differ. These findings indicated that the assessment techniques were feasible in both groups and sensitive enough to detect some differences between groups. The indication that golf was associated with better physical function than non-golfers in females over 80 needs to be examined by prospective randomised controlled trials to determine whether golf can help to achieve the recommended guidelines for strengthening exercise to protect against sarcopenia. Full article
(This article belongs to the Special Issue Frailty and Sarcopenia in Old Age)
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Article
Intramuscular Adipose Tissue and the Functional Components of Sarcopenia in Hospitalized Geriatric Patients
by Stany Perkisas, Anne-Marie De Cock, Veronique Verhoeven and Maurits Vandewoude
Geriatrics 2017, 2(1), 11; https://doi.org/10.3390/geriatrics2010011 - 22 Feb 2017
Cited by 25 | Viewed by 7753
Abstract
Intramuscular adipose tissue (IMAT) could be an important missing value in the assessment of sarcopenia. This study tries to determine the relation between IMAT, muscle strength, functionality and mortality. In addition, the relation with nutritional status is screened. For six months, all patients [...] Read more.
Intramuscular adipose tissue (IMAT) could be an important missing value in the assessment of sarcopenia. This study tries to determine the relation between IMAT, muscle strength, functionality and mortality. In addition, the relation with nutritional status is screened. For six months, all patients admitted to the University Geriatric Center of Antwerp were evaluated for strength (hand grip), functionality (short physical performance battery—SPPB) and nutritional status. After one year, patients/relatives were contacted to obtain a current health status (mortality). A total of 303 patients were included at a mean age of 83.0 ± 6.4 years. The mean percentage of IMAT was 29.2% ± 13.0% (range 3.2%–86.2%). There was a negative correlation between IMAT and both grip strength and SPPB. SPPB was positively correlated with both grip strength and muscle mass. There was a positive correlation between IMAT and mortality. There was a negative correlation between grip strength, SPPB and mortality. IMAT did not have a clear relation with nutritional status. IMAT should be addressed in the work-up of sarcopenia, as it is correlated with muscle strength, functionality and mortality. In this cohort of hospitalized geriatric patients, there is a mean of about one-third of measured muscle volume that appears to be adipose tissue. Full article
(This article belongs to the Special Issue Frailty and Sarcopenia in Old Age)
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Article
Anterior Thigh Tissue Thickness Measured Using Ultrasound Imaging in Older Recreational Female Golfers and Sedentary Controls
by Isabel Herrick, Simon Brown, Sandra Agyapong-Badu, Martin Warner, Sean Ewings, Dinesh Samuel and Maria Stokes
Geriatrics 2017, 2(1), 10; https://doi.org/10.3390/geriatrics2010010 - 07 Feb 2017
Cited by 11 | Viewed by 8900
Abstract
Physical activity is vital for the prevention of sarcopenia and frailty. The training effects of recreational golf on muscle function in older people are unknown. The present study examined quadriceps muscle and subcutaneous fat thickness in 66 older females. Thirty-one golfers (mean age [...] Read more.
Physical activity is vital for the prevention of sarcopenia and frailty. The training effects of recreational golf on muscle function in older people are unknown. The present study examined quadriceps muscle and subcutaneous fat thickness in 66 older females. Thirty-one golfers (mean age 69.1 years, standard deviation ±3.4) were compared with 35 less active non-golfers (73.4 ± 4.2 years). Images of the dominant anterior thigh were obtained using real-time B-mode ultrasound imaging. Thickness of muscle (rectus femoris, vastus intermedius, and intermuscular fascia) and subcutaneous tissue (fat and perimuscular fascia) was measured, and percentage contributions calculated. Muscle thickness was significantly greater (p < 0.001) in golfers (mean 2.78 cm ± 0.73 cm) than non-golfers (2.18 cm ± 0.55 cm). Mean percentage contribution of muscle and non-contractile tissue was 64% ± 9% and 36% ± 9%, respectively, in golfers, compared to 58% ± 8% and 42% ± 8% in non-golfers (p = 0.013). Multiple linear regression analysis, controlling for age and BMI, showed that golfers still had higher total anterior thigh thickness (regression parameter for non-golfers B = −0.984, p = 0.004) and higher muscle thickness (B = −0.619, p = 0.002). This study indicates an association between recreational golf and greater relative thigh muscle thickness and lower subcutaneous fat than in less active controls. Training effects need to be examined in prospective controlled trials in males and females in different age groups. Full article
(This article belongs to the Special Issue Frailty and Sarcopenia in Old Age)
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Review
Response to Pulmonary Rehabilitation in Older People with Physical Frailty, Sarcopenia and Chronic Lung Disease
by Luke Attwell and Michael Vassallo
Geriatrics 2017, 2(1), 9; https://doi.org/10.3390/geriatrics2010009 - 22 Jan 2017
Cited by 11 | Viewed by 7486
Abstract
Frailty and sarcopenia are two important clinical syndromes associated with the ageing process, with a high risk of morbidity and mortality. Patients with chronic disease have been shown to have an accelerated decline into a frail state, with patients with both chronic lung [...] Read more.
Frailty and sarcopenia are two important clinical syndromes associated with the ageing process, with a high risk of morbidity and mortality. Patients with chronic disease have been shown to have an accelerated decline into a frail state, with patients with both chronic lung disease and frailty having a higher mortality than those with frailty alone. Pulmonary rehabilitation has been found to be an effective intervention in patients with chronic obstructive pulmonary disease (COPD), yet the effect of frailty on this as intervention remains unclear. A narrative literature search of PubMed, Medline complete and the Cochrane library was performed by the reviewers using predefined criteria. Only 3 studies met the selection criteria and were reviewed. These studies highlighted that, although completion rates are lower in patients with both COPD and frailty, pulmonary rehabilitation remains effective as an intervention in this subgroup of patients, with up to 61% of frail patients no longer meeting frailty criteria after completion of a pulmonary rehabilitation programme. Full article
(This article belongs to the Special Issue Frailty and Sarcopenia in Old Age)
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Review
Managing Ethical Dilemmas in End-Stage Neurodegenerative Diseases
by James Alvin Low and Esther Ho
Geriatrics 2017, 2(1), 8; https://doi.org/10.3390/geriatrics2010008 - 20 Jan 2017
Cited by 8 | Viewed by 12367
Abstract
Neurodegenerative diseases are chronic, progressive and incurable illnesses that ultimately lead to death. The patient deteriorates inexorably towards the terminal phase of the disease when he becomes mentally and physically incapacitated. This article discusses the many ethical and moral dilemmas faced by the [...] Read more.
Neurodegenerative diseases are chronic, progressive and incurable illnesses that ultimately lead to death. The patient deteriorates inexorably towards the terminal phase of the disease when he becomes mentally and physically incapacitated. This article discusses the many ethical and moral dilemmas faced by the clinician and family members as they care for patients with neurodegenerative illnesses approaching the end of life. Topics discussed will include steps on how to assess mental capacity and decision-making capability, advance care planning, withholding and/or withdrawing treatment, food refusal, the do-not-resuscitate order and euthanasia. An approach to ethical decision-making incorporating Jonsen’s 4-topic approach will also be discussed briefly. Full article
(This article belongs to the Special Issue The Challenges of Caring of Neurodegenerative Diseases)
173 KiB  
Review
Challenges of Dementia Care in China
by Zheng Chen, Xuan Yang, Yuetao Song, Binbin Song, Yi Zhang, Jiawen Liu, Qing Wang and Jia Yu
Geriatrics 2017, 2(1), 7; https://doi.org/10.3390/geriatrics2010007 - 18 Jan 2017
Cited by 47 | Viewed by 10111
Abstract
Dementia results in brain dysfunction, disability and dependency among affected people, causing an overwhelming burden for caregivers. China has the largest number of people with dementia worldwide and is facing severe challenges with respect to dementia care, including poor awareness of dementia in [...] Read more.
Dementia results in brain dysfunction, disability and dependency among affected people, causing an overwhelming burden for caregivers. China has the largest number of people with dementia worldwide and is facing severe challenges with respect to dementia care, including poor awareness of dementia in the public, inadequate knowledge of dementia for medical professionals and caregivers, an underdeveloped dementia service system, and high costs of dementia care. To address these challenges, China is taking action to increase dementia awareness and education among the public and care providers, and develop policies, services and resources for dementia care. Full article
(This article belongs to the Special Issue The Challenges of Caring of Neurodegenerative Diseases)
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Review
Systemic Inflammation in the Genesis of Frailty and Sarcopenia: An Overview of the Preventative and Therapeutic Role of Exercise and the Potential for Drug Treatments
by Stephen C. Allen
Geriatrics 2017, 2(1), 6; https://doi.org/10.3390/geriatrics2010006 - 17 Jan 2017
Cited by 15 | Viewed by 8081
Abstract
The clinical, pathological and biological characteristics of frailty and sarcopenia are becoming better understood and defined, including the role of systemic inflammation. It is increasingly apparent that in older adults there is a tendency for the innate immune network to shift toward a [...] Read more.
The clinical, pathological and biological characteristics of frailty and sarcopenia are becoming better understood and defined, including the role of systemic inflammation. It is increasingly apparent that in older adults there is a tendency for the innate immune network to shift toward a pro-inflammatory setting, often due to the presence of chronic inflammatory diseases but also associated with age alone in some individuals. Furthermore, acute inflammation tends to resolve more slowly and less completely in many elderly people. Inflammation contributes to the pathogenesis of sarcopenia and other components of the frailty syndrome. Blood levels of inflammatory cytokines and acute phase proteins, are reduced by exercise, and there is a growing body of epidemiological, observational and intervention research that indicates that regular moderate exercise improves strength, function, morbidity and mortality in middle-aged and elderly adults. There is also an increasing awareness of the potential role of drugs to ameliorate inflammation in the context of frail old age, which might be particularly useful for people who are unable to take part in exercise programs, or as adjunctive treatment for those who can. Drugs that shift the innate immune biochemical network toward an anti-inflammatory setting, such as methyl-xanthines and 4-amino quinolones, could be of value. For example, theophylline has been shown to induce a 20 percent fall in pro-inflammatory tumor necrosis factor (TNF) and 180 percent rise in anti-inflammatory interleukin-10 production by peripheral blood monocytes, and a fall of 45 percent in interferon-gamma (IF-gamma) release. Such properties could be of therapeutic benefit, particularly to re-establish a less inflamed baseline after acute episodes such as sepsis and trauma. Full article
(This article belongs to the Special Issue Frailty and Sarcopenia in Old Age)
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Article
Problem Adaptation Therapy for Pain (PATH-Pain): A Psychosocial Intervention for Older Adults with Chronic Pain and Negative Emotions in Primary Care
by Dimitris N. Kiosses, Lisa D. Ravdin, Amy Stern, Ruth Bolier, Cara Kenien and M. Carrington Reid
Geriatrics 2017, 2(1), 5; https://doi.org/10.3390/geriatrics2010005 - 16 Jan 2017
Cited by 3 | Viewed by 7879
Abstract
Chronic pain is highly prevalent in older adults, contributes to activity restriction and social isolation, disrupts family and interpersonal relationships, and poses a significant economic burden to society. Negative emotions such as sadness, anxiety, helplessness, and hopelessness are associated with chronic pain and [...] Read more.
Chronic pain is highly prevalent in older adults, contributes to activity restriction and social isolation, disrupts family and interpersonal relationships, and poses a significant economic burden to society. Negative emotions such as sadness, anxiety, helplessness, and hopelessness are associated with chronic pain and contribute to poor quality of life, impaired interpersonal and social functioning, and increased disability. Psychosocial interventions for older adults with chronic pain have been historically developed for, and are almost exclusively delivered to, cognitively intact patients. Therefore, many older adults with chronic pain and comorbid cognitive deficits have limited treatment options. Our multidisciplinary team developed Problem Adaptation Therapy for Pain in Primary Care (PATH-Pain), a psychosocial intervention for older adults with chronic pain, negative emotions, and a wide range of cognitive functioning, including mild-to-moderate cognitive impairment. In the current article, we describe the principles underlying PATH-Pain, review the steps taken to adapt the original PATH protocol, outline the treatment process, and present a case illustrating its potential value. Full article
(This article belongs to the Special Issue Depressive Disorder in the Elderly)
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Article
Impact of Hospital Design on Acutely Unwell Patients with Dementia
by Caitlin Young, Chris Edwards and Inderpal Singh
Geriatrics 2017, 2(1), 4; https://doi.org/10.3390/geriatrics2010004 - 12 Jan 2017
Cited by 5 | Viewed by 7437
Abstract
Increasing emphasis on patient privacy and satisfaction has seen more 100% single-room hospitals opened across the UK. Few studies have addressed the impact of these new hospital designs (single rooms) on clinical outcomes specifically for acutely unwell frail patients with dementia. The objective [...] Read more.
Increasing emphasis on patient privacy and satisfaction has seen more 100% single-room hospitals opened across the UK. Few studies have addressed the impact of these new hospital designs (single rooms) on clinical outcomes specifically for acutely unwell frail patients with dementia. The objective of this study was to profile and compare the clinical outcomes of acutely unwell patients with dementia admitted to two different hospital environments. This prospective observation study was conducted for 100 dementia patients admitted at Ysbyty Ystrad Fawr (hospital with 100% single rooms) and Royal Gwent Hospital (traditional multi-bed wards) under the same University Health Board. The length of stay (LoS) was significantly longer for patients admitted to single rooms. The clinical profile of the patients was similar in both hospitals and has no association with LoS. There was no significant difference in terms of incidence of inpatient falls, fall-related injury, discharge to a new care home, 30-day readmission, or mortality. The single room environment appears to influence LoS, as previously reported; however, following the introduction of quality improvement initiatives to prevent inpatient falls, single rooms do not appear to be associated with higher inpatient fall incidence. We propose more research to understand the relationship between single rooms and LoS. Full article
(This article belongs to the Special Issue The Challenges of Caring of Neurodegenerative Diseases)
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Editorial
Acknowledgement to Reviewers of Geriatrics in 2016
by Geriatrics Editorial Office
Geriatrics 2017, 2(1), 3; https://doi.org/10.3390/geriatrics2010003 - 11 Jan 2017
Cited by 21 | Viewed by 4575
Abstract
The editors of Geriatrics would like to express their sincere gratitude to the following reviewers for assessing manuscripts in 2016. Full article
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Review
iPad Use in Stroke Neuro-Rehabilitation
by Khalid Ameer and Khalid Ali
Geriatrics 2017, 2(1), 2; https://doi.org/10.3390/geriatrics2010002 - 06 Jan 2017
Cited by 18 | Viewed by 11592
Abstract
Neuro-rehabilitation services are essential in reducing post-stroke impairments, enhancing independence, and improving recovery in hospital and post-discharge. However these services are therapist-dependent and resource intensive. Patients’ disengagement and boredom in stroke units are common which adversely affect functional and psychological outcomes. Novel techniques [...] Read more.
Neuro-rehabilitation services are essential in reducing post-stroke impairments, enhancing independence, and improving recovery in hospital and post-discharge. However these services are therapist-dependent and resource intensive. Patients’ disengagement and boredom in stroke units are common which adversely affect functional and psychological outcomes. Novel techniques such as use of iPads™ are increasingly researched to overcome such challenges. The aim of this review is to determine the feasibility, effectiveness, acceptability, and barriers to the use of iPads™ in stroke neuro-rehabilitation. Four databases and manual literature search were used to identify published studies using the terms “iPad”, “Stroke”, and “neuro-rehabilitation”. Studies were included in accordance with the review selection criteria. A total of 16 articles were included in the review. The majority of the studies focused on iPads use in speech and language therapy. Although of small scale, the studies highlighted that iPads are feasible, have the potential to improve rehabilitation outcomes, and can improve patient’s social isolation. Patients’ stroke severity and financial limitations are some of the barriers highlighted in this review. This review presents preliminary data supportive for the use of iPad technology in stroke neuro-rehabilitation. However, further research is needed to determine impact on rehabilitation goals acquisition, clinical efficacy, and cost-efficiency. Full article
(This article belongs to the Special Issue Stroke in Ageing)
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Article
Integrated Care for People with Dementia—Results of a Social-Scientific Evaluation of an Established Dementia Care Model
by Stefanie Richter
Geriatrics 2017, 2(1), 1; https://doi.org/10.3390/geriatrics2010001 - 27 Dec 2016
Cited by 2 | Viewed by 8088
Abstract
Currently, approximately 46.8 million people worldwide and 1.47 million German people are affected by dementia. The rising numbers of cases of people with dementia, the need for complex care and the insufficient care available call for innovative and sustainable solutions both in Germany [...] Read more.
Currently, approximately 46.8 million people worldwide and 1.47 million German people are affected by dementia. The rising numbers of cases of people with dementia, the need for complex care and the insufficient care available call for innovative and sustainable solutions both in Germany and many other countries. This article presents results of the social-scientific evaluation of an established care model for people with dementia developed by the professionals as a result of acute problems in care in north-east Germany. In addition to the central elements of the model, the conditions of intersectoral and interprofessional cooperation as well as the qualification profile requirements of the professional groups involved are presented in detail. The results can give suggestions for the organization of integrated care for people with dementia in other countries. Further, the author would hereby like to highlight the gain from the scientific examination of solutions to problems in the field. Full article
(This article belongs to the Special Issue The Challenges of Caring of Neurodegenerative Diseases)
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