Geriatrics, Volume 3, Issue 4 (December 2018) – 33 articles

Proprioceptive input may greatly affect postural stability. However, the proprioceptive postural strategy in elderly, middle-aged, and young people has not been investigated sufficiently. Hence, in this study, we aimed to investigate differences in proprioceptive postural strategies of elderly, middle-aged, and young people. The center of pressure displacement was determined in 23 elderly, 23 middle-aged, and 23 young people during upright stance on a balance board with their eyes closed. Vibratory stimulations at 30, 60, and 240 Hz were applied to the lumbar multifidus (LM) and gastrocnemius (GS) muscles to evaluate the contributions of different proprioceptive signals used in balance control. Compared with middle-aged and young people, elderly people showed a high dependence on postural control of the GS at 30 Hz (p-values: Young and elderly: 0.033; middle-aged and elderly: 0.001). Moreover, compared with young people, elderly people were more dependent on postural control of the LM at 240 Hz (p = 0.016). There were no significant differences with respect to the GS at 60 and 240 Hz, and with respect to the LM at 30 and 60 Hz between the elderly, young, and middle-aged people. Thus, the postural control strategy of elderly people depends on the GS at 30 Hz. Full article

Background: Muscle health is recognized for its critical role in the functionality and well-being of older adults. Readily accessible, reliable, and inexpensive methods of measuring muscle health are needed to advance research and clinical care. Methods: In this prospective, blinded study, 27 patients underwent quantitative muscle ultrasound (QMUS), standard electrical impedance myography (sEIM), and handheld electrical impedance myography (hEIM) of the anterior thigh musculature by two independent examiners. Subjects also had dual-energy X-ray absorptiometry (DEXA) scans and standardized tests of physical function and strength. Data were analyzed for intra- and inter-rater reliability, along with correlations with DEXA and physical measures. Results: Measures of intra- and inter-rater reliability were excellent (>0.90) for all QMUS, sEIM, and hEIM parameters except intra-rater reliability of rectus femoris echointensity (0.87–0.89). There were moderate, inverse correlations between QMUS, sEIM, and hEIM parameters and measures of knee extensor strength. Moderate to strong correlations (0.57–0.81) were noted between investigational measures and DEXA-measured fat mass. Conclusions: QMUS, sEIM and hEIM were highly reliable in a controlled, same-day testing protocol. Multiple correlations with measures of strength and body composition were noted for each method. Point-of-care technologies may provide an alternative means of measuring health. Full article

Incontinence is a common yet under-recognized issue that impacts quality of life, especially for older adults in whom there is often a multifactorial etiology. A retrospective chart review was performed on a representative sample of patients seen at our multidisciplinary continence clinic in Vancouver, Canada from January to December 2017 inclusive. Initial assessment was performed by the nurse continence advisor (NCA) or geriatrician depending on the source of referral. The pelvic floor physiotherapist (PFP) could then be consulted based on perceived need. The average age at assessment was 76 years old (range 29–102), with 82% of patients ≥65 years and 27% ≥85 years old. The majority of patients were referred for bladder incontinence (72%), with the remaining patients referred for bowel incontinence (28%) or pessary care (7%). Referrals came from a variety of sources including physicians (62%), nurses (22%), allied health care providers (12%) and self-referral (5%). Multimorbidity was common, with 40% of patients having a Charlson Comorbidity Index ≥6. The same proportion of patients (40%) were on ≥5 prescription medications. Many patients were functionally dependent for either instrumental activities of daily living (52%) or activities of daily living (25%). Non-pharmacologic treatments were commonly recommended, with the majority of patients counselled on lifestyle changes (88%) and taught Kegel exercises (70%). For patients seen by the geriatrician, modifications were made to non-continence medications in 50% of cases and medical comorbidities were optimized in 39% of cases. In terms of pharmacologic therapy, over-the-counter (OTC) medications were initiated in 45% of patients whereas continence-specific prescription medications were started in 17% of patients. A multidisciplinary continence clinic can play an important role in promoting successful aging by assessing and treating medical causes of incontinence in medically complex older adults. Full article

Evidence suggests that community dwelling older adults (CDOA) are at risk for dysphagia (swallowing difficulties). Dysphagia is often unidentified until related morbidities like under nutrition or pneumonia occur. These cases of unidentified dysphagia, prior to any clinical intervention, may be termed ‘pre-clinical dysphagia’. Identifying pre-clinical dysphagia is challenged by the lack of validated tools appropriate for CDOA. This study addresses preliminary development of a novel patient reported outcome (PRO) screening tool for pre-clinical dysphagia. Initially, 34 questions were developed from literature review and expert opinion. Following pilot testing (n = 53), the questionnaire was revised and tested on 335 additional CDOA. Face validity, content validity, item analysis, reliability (internal consistency), and construct validity (exploratory factor analysis) measures were completed. Psychometric validation resulted in a 17-question PRO tool. Construct analysis identified a three-factor model that explained 67.345% of the variance. Emergent factors represented swallowing effort, physical function, and cognitive function. The results revealed strong construct validity and internal consistency (Cronbach’s α = 0.90). A novel, simple PRO incorporating multiple function domains associated with aging demonstrated strong preliminary psychometric properties. This tool is more comprehensive and aging-focused than existing dysphagia screening tools. Inclusion of multiple domains may be key in early identification of pre-clinical dysphagia. Full article

By 2040, more than a quarter of the U.S. population will have diagnosed arthritic conditions. Adults with arthritis and other rheumatic conditions earn less than average yet have medical care expenditures that are over 12% of average household income. Adaptive aids can help arthritis patients continue to maintain independence and quality of life; however, their high costs limit accessibility for older people and the poor. One method used for consumer price reduction is distributed manufacturing with 3-D printers. In order to assess if such a method would be financially beneficial, this study evaluates the techno-economic viability of distributed manufacturing of adaptive aids for arthritis patients. Twenty freely accessible designs for 3-D printable adaptive aids were successfully fabricated on low-cost desktop 3-D printers and performed their functions adequately. The financial savings averaged >94% compared to commercially-available products. Overall, twenty adaptive aids were printed for US$20 of plastic; while on average, each adaptive aid would save over US$20. As printing a tiny subset of the adaptive aids needed by a single patient would recover the full capital and operational costs of a low-cost 3-D printer, it can be concluded that there is considerable potential for distributed manufacturing to assist arthritis patients. Full article

This paper reports the findings from a study to investigate health care professionals’ views regarding the use and acceptability of two similar paper-based advance care planning (ACP) documents designed for older adults in their last year of life to inform end-of-life care provision. Participants’ views of using PEACE (Proactive Elderly Persons Advisory Care), a nurse led model with community geriatrician oversight, and PACe (proactive anticipatory care plan), a general practitioner (GP) led model implemented by two clinical commissioning groups (CCGs) as part of a wider pilot to determine their ability to improve end-of-life care provision, were explored. Hospital admission avoidance matrons took part in face to face interviews and care staff employed in private residential care homes took part in individual telephone interviews to explore their views of using the PEACE tool. Telephone interviews were conducted with GPs to explore their views of PACe. GPs and admission avoidance matrons were employed by CCGs and all study participants were recruited from the South East of England, where data collection took place in 2015. The data were analysed thematically. Findings from the study demonstrate how both tools provide a focus to ACP discussions to inform individual end-of-life care preferences. The importance of relationships was a pivotal theme established, trusting inter-professional relationships to enable multidisciplinary teamwork and a prior relationship with the older person (or their proxy in the case of cognitive impairment) to enable such conversations in the first place. Both tools enabled participants to think critically and reflect on their own practice. Notwithstanding participants’ views to improve their layout, using a paper-based approach to deliver streamlined ACP and end-of-life care was a theme to emerge as a potential barrier, and highlighted problems with accessing paper-based documentation, accuracy and care co-ordination in the context of multidisciplinary team working. The value of technology in overcoming this barrier and underpinning ACP as a means to help simplify service provision, promote integrated professional practice and provide seamless care, was put forward as a way forward. Full article

Background: Body mass index (BMI) is related to health in the elderly. The purpose of this study was to investigate the physical characteristics in underweight, overweight, and obese Japanese community-dwelling elderly women compared to normal-weight elderly women. Methods: The study participants included 212 community-dwelling elderly women. They were categorized as underweight (BMI < 18.5), normal weight (18.5 ≤ BMI ≤ 22.9), overweight (23 ≤ BMI ≤ 24.9), and obese (BMI ≥ 25). Data on skeletal muscle mass index (SMI), number of trunk curl-ups performed within 30 seconds, knee extension strength, one-leg standing time, and walking speed were recorded. Results: In the underweight group, the number of trunk curl-ups was significantly lower than that of the normal-weight group (p = 0.011) and the correlation between knee extension strength and walking speed was relatively higher than in the normal-weight group (r = 0.612 vs. r = 0.471). In the overweight group, the SMI was significantly increased (p < 0.001), but knee extension strength was not increased (p = 0.235) compared to that of the normal-weight group. In the obese group, one-leg standing time was significantly shorter than in the normal-weight group (p = 0.016). Conclusions: Physical characteristics vary according to BMI and these findings are useful in assessing and planning interventional programs to improve and maintain physical function in elderly women. Full article

Pancreatic cancer is the eleventh most common cancer, yet it is the third leading cause of mortality. It is also largely a disease of older adults, with the median age of 71 at diagnosis in the US, with <1% of diagnoses occurring prior to age 50. Current NCCN guidelines recommend surgery for localized disease, followed by adjuvant therapy and/or consideration of enrollment in a clinical trial. For metastatic disease, current guidelines recommend clinical trial enrollment or systemic chemotherapy based on results from the landmark ACCORD-11 and MPACT trials. However, these trials focused heavily on younger, more fit patients, with the ACCORD-11 trial excluding patients over age 75 and the MPACT trial having 92% of its patients with a Karnofsky performance score >80. This article summarizes the available evidence in current literature in regards to the best treatment options for older adults, who represent the majority of pancreatic cancer diagnoses. Full article

Comprehensive geriatric assessment, defined as an interdisciplinary assessment and development of an overall plan of treatment and follow-up, has become a fundamental part of clinical geriatric care. Since the 1970s, the US Department of Veterans Affairs (VA) has encouraged the development of geriatric evaluation and management programs. Evolution of geriatric evaluation and management has occurred over time and many VA medical centers have transferred inpatient geriatric evaluation programs to long-term care Community Living Centers, home, and outpatient settings. Availability of geriatric resources and trained personnel across the continuum of care as well as administrative collaboration between care components are critical to the successful implementation of geriatric services. Facilities may need to prioritize their resources and utilize the most effective and relevant elements of geriatric evaluation and management according to patient population needs, available space, resources, and institutional priorities. New risk assessment tools derived from the VA’s experience in geriatric evaluation may be useful for targeting services for other high-risk populations. Full article

Changes in both swallowing and taste commonly occur in advanced age, though the relationship between the two is unknown. This study examined the association between a water swallow screen test and taste identification and intensity rating. Participants included 47 community-dwelling women aged 85–94 years. Participants completed three trials of a water swallow screen and were observed for signs of aspiration, which, if present, indicated failure. Four pure taste stimuli at low and high concentrations and water were presented, and participants selected one of five taste labels and rated their intensity on the generalized Labeled Magnitude Scale. Ratios of intensity ratings were computed for each taste stimulus to compare the perception of low and high concentrations. The association between water swallow screen failure, correct taste identification, and taste intensity ratio was evaluated with logistic regression modeling, with mediating factors of frailty and number of comorbidities. Failure of three water swallow screen trials was associated with a higher taste intensity ratio for caffeine (bitter) and a lower taste intensity ratio for sucrose (sweet). Correct identification of taste, frailty, and number of comorbidities were not associated with failure of any number of water swallow screen trials. Intensity ratings of certain tastes may be associated with swallowing in old-old women. Heightened vigilance in this population may be necessary to prevent complications related to dietary intake. Full article

Singapore has experienced rapid development in the past 50 years. This has presented unique challenges with regard to land space and a rapidly ageing population. The role of extrinsic factors in successful ageing is well documented, and places a degree of responsibility on the state and healthcare systems. Singapore has taken many proactive measures to meet this responsibility by implementing policy changes across multiple domains including housing, transport, education and research. One hospital in the north east of Singapore has undertaken a frailty screening program that aims to identify, prevent and reverse frailty at an early stage. This paper provides a review of these national and regional measures. Full article

Malaysia became the centre of international attention when it democratically removed a semi-authoritarian government of 62 years during its 14th general election this year. This electoral success has provided geriatric medicine in Malaysia with a high-impact ageing icon by installing the oldest prime minister in the world. A wave of optimism for the expansion of geriatric services in Malaysia, which met with numerous challenges in the last two decades, has emerged as a result of this political change. The number of geriatrics specialists and services had begun to see slow expansions under the previous government. However, existing geriatricians will need to reassess the landscape of delivery and access to care in our rapidly growing ageing population and develop new strategies to truly expand their services. In addition to unrelenting efforts in the recruitment and training of future geriatricians, the steady expansion of the geriatric workforce should take into account the inclusion of geriatric medicine in the undergraduate training curricula of all healthcare professionals. Expansion of geriatric services will also be a cost-effective strategy to reduce the growing national healthcare budget incurred by the growing needs of an ageing population. Full article

The terms successful aging (SA) and frailty appear to have much in common, both in terms of overlapping constructs and common challenges with consensus and operationalization. The aim of this review is to summarize existing literature that defines that relationship. Primary and secondary source articles that used either term in the title or abstract were systematically reviewed for relevance to the study objective. Of 61 articles that met these criteria, 30 were secondary source, and of these four were highly relevant. Four of the remaining 31 original research articles were selected, and the prevalence of frailty and SA in populations with different characteristics were described and compared. The same model of frailty was used in all primary studies, but definitions for successful aging were heterogeneous. The prevalence of frailty ranged from 11.8% to 44.0% and that of SA ranged from 10.4% to 47.2%. The definitions used for each, especially the extent of multidimensionality, appeared to reflect the degree of overlap between SA and frailty. Whether frailty and SA are part of the same or different constructs, there is a pressing need for an ordered taxonomy to advance research that translates into clinical practice. Full article

Research in care homes has demonstrated that medication management practices in patients with dysphagia and those receiving medicines covertly may be inappropriate, illegal, and potentially cause harm. This paper presents the results of a feasibility study piloting a resident and healthcare professional best practice charter to improve such practices in care home residents with dysphagia. A charter was developed through a multi-professional expert panel, implemented in one care home, and then piloted in 22 homes in England, Wales, and Northern Ireland. A website was setup and developed iteratively to support the process. Care home staff and residents provided initial feedback on the implementation process and on perceived outcomes six months post implementation. A total of 16 (88.9%) out of 18 respondents from nine homes for six months reported a positive response to the charter. More than 80% of responses regarding the implementation process, impact on staff confidence, and perceived usefulness of the charter were positive. Perceived effectiveness and usefulness could, however, be further improved especially the perceived effect on frequency of medication review, which is reliant on external stakeholder involvement. The charter and supporting website were well received with respondents believing that it was useful, staff showing more confidence, and residents having enhanced care. Approaches to enhancing the charter’s effectiveness were identified. Full article

Preventing malnutrition and dehydration in older care home residents is a complex task, with both conditions remaining prevalent, despite numerous guidelines spanning several decades. This policy-mapping scoping review used snowballing search methods to locate publicly-available policies, reports and best practice guidelines relating to hydration and nutrition in UK residential care homes, to describe the existing knowledge base and pinpoint gaps in practice, interpretation and further investigation. The findings were synthesised narratively to identify solutions. Strategies for improvements to nutritional and hydration care include the development of age and population-specific nutrient and fluid intake guidelines, statutory regulation, contractual obligations for commissioners, appropriate menu-planning, the implementation and auditing of care, acknowledgment of residents’ eating and drinking experiences, effective screening, monitoring and treatment and staff training. The considerable body of existing knowledge is failing to influence practice, relating to translational issues of implementing knowledge into care at the point of delivery, and this is where future research and actions should focus. Full article

The general objective of this study was to analyze cognitive plasticity as a variable related to successful aging in a group of young-old adults and old-old adults using the Auditory Verbal Learning Test—Learning Potential (AVLT-LP). Method: A total of 569 persons, with mean age 76.67 years (379 between the ages of 65 and 80 years, and 190 older than age 80). They were assessed with a socio-health questionnaire, with the AVLT-LP, and with the Spanish version of the Mini Mental State Examination. Results: The results showed significant differences on the test, in favor of the younger group, while the over 80 group gave poorer performance and showed less cognitive plasticity. With relation to gender, slight differences appeared in favor of the women, on the first four test trials, but not on the last two, nor in delayed recall or cognitive plasticity. As for cognitive status, the results showed significantly better task performance levels in healthy elders, as well as greater plasticity. Nonetheless, certain persons with high plasticity were also found among those with cognitive impairment. Conclusions: The data obtained here offers evidence for the importance of cognitive plasticity in elders and its relation to longevity and successful aging. It also provides information about the influence of variables like age, gender and cognitive status on a verbal memory and plasticity assessment task that is in wide use today. Full article

Despite obstacles, many rural-dwelling older adults report that positive aspects of rural residence, such as attachment to community, social participation, and familiarity, create a sense of belonging that far outweighs the negative. By being part of a community where they are known and they know people, rural elders continue to find meaning, the key to achieving successful aging in this last stage of life. This scoping review explored factors influencing social participation and, through it, successful aging among rural-dwelling older adults. We sought to answer the question: what factors enhance or detract from the ability of rural-dwelling older adults to engage in social participation in rural communities? The scoping review resulted in 19 articles that highlight the importance of supports to enable older people to spend time with others, including their pets, engage in volunteer and community activities, and help maintain their home and care for their pets. Overall, the lack of services, including local health care facilities, was less important than the attachment to place and social capital associated with aging in place. Full article

This study investigated factors associated with older African American men’s unmet health communication needs in the context of patient–provider interactions. Responses to a health survey were analyzed for 430 African American men attending a Midwest community health fair. The outcome measure was the extent to which men could get their health-related questions answered during recent medical visits. Men’s mean age was 54; 39% had one chronic condition and 22% had two or more comorbidities. The 53% who usually or always had their questions answered were older, had less comorbidity, higher educational attainment, higher annual incomes, were more likely to be married and have any type of insurance, and have a personal physician. Access to care was the primary factor in shaping men’s opportunities to ask health-related questions, and older multimorbid and low-income African American men may face increased barriers to healthcare access, and thus barriers to patient-centered care and communication. Full article

Hypothesis: Anti-diabetic drugs modulate p-21 activated kinase (PAK) signaling. Introduction: Type 2 diabetes mellitus (T2DM) is a chronic inflammatory disease associated with increased cancer risk. PAK signaling is implicated in cellular homeostasis when regulated, and cancer when unrestrained. Recent reports provided a role for PAK signaling in glucose homeostasis, but the role of PAKs in the pathogenesis of T2DM is unknown. Here, we performed a mini-meta-analysis to explore if anti-diabetic drugs modify PAK signaling pathways, and provide insight regarding modulation of these pathways, to potentially reduce diabetes-associated cancer risk. Methods: PAK interacting partners in T2DM were identified using the online STRING database. Correlation studies were performed via systematic literature review to understand the effect of anti-diabetic drugs on PAK signaling. A mini-meta-analysis correlated multiple clinical studies and revealed the overall clinical response rate and percentage of adverse events in piogliazone (n = 53) and metformin (n = 91) treated patients with PAK-associated diseases. Results: A total of 30 PAK interacting partners were identified (10: reduced beta-cell mass; 10: beta-cell dysfunction; 10: obesity-insulin resistance), which were highly associated with Wnt, and G-protein signaling. The anti-diabetic drug metformin activated signaling pathways upstream; whereas pioglitazone inhibited pathways downstream of PAK. Overall, clinical response upon pioglitazone treatment was 53%. Seventy-nine percent of pioglitazone and 75% of metformin treated patients had adverse events. Pioglitazone reduced molecular-PAK biomarkers of proliferation (Ki67 and CyclinD1), and metformin had the opposite effect. Conclusions: PAK signaling in T2DM likely involves Wnt and G-protein signaling, which may be altered by the anti-diabetic drugs metformin and pioglitazone. Apart from the therapeutic limitations of adverse events, pioglitazone may be promising in chemoprevention. However long-term multi-centered studies, which initiate pioglitazone treatment early will be required to fully assess the full potential of these drugs. Full article

The participation rate of older people in the labour market is forecast to increase due to demographic changes afoot. For example, low fertility rates, higher life expectancy, and increases in the retirement age will affect labour availability. The working-age population trends indicate that the age group 55–64 years will expand. This trend is bolstered by policy debate about the sustainability of economic and social support systems for the wider population and necessary strategies to keep older workers in labour markets. Within the UK, as the statutory pension age is placed now at 67, changes affecting the national default retirement age (previously age 60 for women and 65 for men) already mean that many older workers will feature in workplaces past historical expectations. A lack of sensitivity about the adjustments older workers needed, due to age-related changes in health and functional capacities, attests the demoted valuing of ageing workers. Despite a rise in the importance of wisdom across cultures, the significance of experience that comes with ageing, however, has become less revered within the UK resulting in less than the institutional promotion of Positive Ageing might depict. This paper draws from a structured review of literature (SLR) which seeks to address the question of what is currently identified as ‘Positive Ageing’ to consider what contributions can be found in current literature that may represent these changes in the UK. The paper concludes that demographic change has stimulated significant re-thinking of workplace strategies for the maintenance of health and well-being of ageing workers at national or governmental policy levels. To ensure sustainability, workability, and productivity in work, however, the concept of Positive Ageing towards later life might be furthered despite that, at the organizational level, its enactment remains incomplete currently post retirement age. Full article

Falls and fall-related injuries are a serious health concern in geriatric populations, especially with age-related deficits in postural control and during postural control challenging dual-task situations. Balance training has been reported to be beneficial in reducing falls. However, some of these exercises have their inherent physical challenges that prevent the elderly population from performing them effectively. Other concomitant age-related illness in the elderly pose further challenges in performing these exercises. Hence, the topic of finding alternative types of balance training that are effective and are performed in a safer environment is constantly researched. One such alternative is hydrotherapy that focuses on balance and postural perturbation-based exercises in water-based environments such as aquatic swimming pools or in dedicated hydrotherapy pools. Hydrotherapy for geriatric populations has been reported to be beneficial in improving balance, motor and cognitive tasks with improved motivation and positive attitude towards exercises. Additionally, hydrotherapy also has properties of buoyancy, resistance and temperature, which benefit biomechanical and physiological wellness and offers a safe environment to perform balance training. Hydrotherapy balance training need to be scaled and prescribed according to individual needs and can serve as an effective training and rehabilitation protocol in reducing falls in geriatric population. Full article

Elders experience chronic disease disparities and barriers to access technology designed to support recommended self-management behaviors. Elders from racial minority groups are among those who experience particular disparities in chronic disease incidence, outcomes, and barriers to technology use. In order to investigate strategies to address barriers, the study team recruited elder African Americans with diabetes and young adults connected to the elders through naturally occurring familial or social networks. Participants attended a community-based health education session focused on enhancing self-efficacy for recommended self-management and using consumer-oriented technology accessible on their smartphones for self-management support. To assess enduring impact, the study team conducted a pilot study to investigate perceptions and use one month following the health education session. Both elders and young adults offered perspectives on what was effective in teaching elders how to use technology. Both age groups stressed that having patience was crucial, as is providing encouragement for the elders to try tasks on their own. Both elders and young adults also showed a statistically significant increase in aspirations to work together for additional intergenerational health and technology knowledge exchange. Several elder participants continued using technology that they first used during the session. This novel, pilot study describes how to promote self-management and technology use for individuals plagued by persistent chronic disease and technology use disparities. Full article

Reductions in muscle mass and strength are well known complications of advancing age. All muscles of the body are affected, including those critical to chewing and swallowing. A diagnosis of frailty and its features of weakness and unintentional weight loss are particularly relevant to the aging swallowing system. Age related changes to eating and swallowing function means that there is a natural tendency for elders to self-select ‘soft’ foods due to loss of dentition and fatigue on chewing. However, it is not well known that tooth loss and poor dental status is associated with increased choking risk, especially as people age. In fact, people over 65 years of age have seven times higher risk for choking on food than children aged 1–4 years of age. Texture modified foods are provided clinically to reduce choking risk and manage dysphagia. Although certain food textures offer greater swallowing safety, they significantly restrict food choice. This commentary paper will highlight age-related changes to the eating and swallowing system, noting especially those that are relevant for frail elders. Swallowing impairments also affect the ability to manage liquids, and aspiration risk in healthy and frail elders is also discussed. Modified food textures that are most often recommended by clinicians to maintain sufficient oral intake and reduce choking risk will be described, while also highlighting the nutritional challenges associated with these foods and offering some solutions. The ethical challenges associated with balancing the autonomy of choice of food textures with swallowing safety will be addressed. Full article

Patients with suspected hip fractures who require further imaging to confirm or disprove the diagnosis may be admitted to orthopaedic or medical departments. We aim to provide evidence regarding the appropriate admission pathway for such patients. This is a retrospective study of all suspected hip fracture patients receiving second-line imaging between 1 January 2015 to 30 June 2016 in one hospital trust. Information was gained from hospital records to determine indication and result of imaging, eventual diagnoses, length of stay, and inpatient mortality. During the study period, 126 patients underwent cross-sectional imaging for clinically suspected but unproven hip fractures. Of these, 27% were positive for hip fractures (n = 34, 3.2% of hip fracture admissions) whilst the remainder were negative. Of the patients without hip fractures, 50 (54%) had a concomitant medical discharge diagnosis. Thirty-one different diagnoses were found in this cohort. This research provides evidence for geriatrician-led admission of patients with suspected but unproven hip fracture, due to the frailty and medical requirements of this patient group. Full article

We undertook a systematic review of swallowing biomechanics, as assessed using pharyngeal and esophageal manometry in healthy or dysphagic older individuals aged over 60 years of age, comparing findings to studies of younger participants. PRISMA-P methodology was used to identify, select, and evaluate eligible studies. Across studies, older participants had lower upper esophageal sphincter (UES) resting pressures and evidence of decreased UES relaxation when compared to younger groups. Intrabolus pressures (IBP) above the UES were increased, demonstrating flow resistance at the UES. Pharyngeal contractility was increased and prolonged in some studies, which may be considered as an attempt to compensate for UES flow resistance. Esophageal studies show evidence of reduced contractile amplitudes in the distal esophagus, and an increased frequency of failed peristaltic events, in concert with reduced lower esophageal sphincter relaxation, in the oldest subjects. Major motility disorders occurred in similar proportions in older and young patients in most clinical studies, but some studies show increases in achalasia or spastic motility in older dysphagia and noncardiac chest pain patients. Overall, study qualities were moderate with a low likelihood of bias. There were few clinical studies specifically focused on swallowing outcomes in older patient groups and more such studies are needed. Full article

New-onset swallowing difficulties in older patients during unrelated hospital admissions are well recognized and may result in prolonged hospital stay and increased morbidity. Presbyphagia denotes age-related swallowing changes which do not necessarily result in pathological effects. The trajectory from presbyphagia to dysphagia is not well understood. This retrospective observational study compared quantitative videofluoroscopic measures in hospitalized older adults aged 70–100 years, reporting new dysphagia symptoms during admission (n = 52), to healthy asymptomatic older (n = 56) and younger adults (n = 43). Significant physiological differences seen in hospitalized older adults but not healthy adults, were elevated pharyngeal area (p < 0.001) and pharyngeal constriction ratio (p < 0.001). Significantly increased penetration (p < 0.001), aspiration (p < 0.001) and pharyngeal residue (p < 0.001) were also observed in the hospitalized older cohort. Reasons for onset of new swallow problems during hospitalization are likely multifactorial and complex. Alongside multimorbidity and polypharmacy, a combination of factors during hospitalization, such as fatigue, low levels of alertness, delirium, reduced respiratory support and disuse atrophy, may tip the balance of age-related swallowing adaptations and compensation toward dysfunctional swallowing. To optimize swallowing assessment and management for our aging population, care must be taken not to oversimplify dysphagia complaints as a characteristic of aging. Full article

People with dementia frequently develop dysphagia (swallowing impairment), which causes them to be at high risk of aspiration pneumonia, resulting in hospital admissions. These individuals are advised against alternative nutrition and hydration as this does not eliminate the risk of developing chest infections. The purpose of this study was to establish the impact on length of stay by having a protocol to guide eating and drinking despite aspiration risks (risk feeding). A risk-feeding protocol was developed and implemented in a hospital setting. The quality improvement methodology of Plan-Do-Study-Act (PDSA) was employed to evaluate the impact of a protocol on the length of stay in patients with dementia and aspiration pneumonia. Annual audits (2016–2018) on the time taken from admission to when a route of nutrition was established were conducted, with adaptations made to the protocol. There was a reduction in nutrition planning times with each year. On closer evaluation of the data, improved nutrition planning times for this cohort impacted on a shorter length of stay. Having a model of care in place to guide feeding decisions in dementia coordinates care, as demonstrated in timely decision-making. For patients who are admitted with aspiration pneumonia and dementia, a decreased length of stay is evident. Full article

Background and objective: Worldwide, 26 million older adults die from chronic disease, and chronic pain is typically a part of the experience of chronic disease. This study explores the perception of chronic pain for home-dwelling Chinese older adults and its influence on (1) self-management ability and (2) management and reduction of chronic pain. Methods: Adopting a qualitative study design, we conducted in-depth interviews with 10 Chinese community-dwelling older adults who experience chronic pain. Half of our informants perceive chronic pain, whereas the other half, diagnosed with Alzheimer’s disease, do not report that they perceive chronic pain. Data were analyzed with inductive thematic analysis. Results: Chronic pain perception plays important roles in (1) defining the challenge of self-management, (2) connecting previous caretaking experience, (3) adjusting the identity of self-management, (4) acquiring support from important others and (5) re-planning self-management arrangements. Conclusion: Pain perception helps to motivate Chinese older adults to face health challenges and regain self-management capacity through adjustments in self-identity and care experience with the support of important others. Pain perception can consolidate the situation of independent living of older adults. It helps to motivate Chinese older adults to face health challenges and regain self-management capacity. Full article