Geriatrics, Volume 9, Issue 5 (October 2024) – 32 articles

Background/Objectives: In the context of an aging society, physical disability and its relationship with frailty is of growing concern. The aim of this study was to examine the associations between oral function, social participation, and loneliness among community-dwelling middle-aged and older adult physically disabled individuals. Methods: In this cross-sectional study, the participants were 140 individuals with certified physical disabilities living in the studied area. Demographic characteristics, outing activities, loneliness (Three-Item Loneliness (TIL) Scale), and frailty/ability to live independently (Kihon Checklist (KCL)) were assessed using a questionnaire survey. The participants were divided into two groups based on the presence or absence of oral dysfunction (OD), and statistical analyses were performed to compare the groups. Results: The group with OD had significantly higher TIL and KCL total scores and significantly lower mobility, confinement, cognitive function, greater levels of depression, and fewer outing activities (volunteering, movies, festivals, sports) compared to the group without OD. In a multivariate, age- and sex-adjusted binomial logistic regression analysis, outing activities (OR = 0.011, 95% CI: 0.000–0.529, p = 0.023) and loneliness (OR = 6.174, 95%CI: 1.292-29.502, p = 0.023) were identified as significant factors. Conclusions: An association was found between OD, loneliness, and social activities among middle-aged and older individuals with physical disabilities. The results suggest that future interventions should consider the relationship between oral function and factors such as depression, loneliness, social isolation, and social engagement as a means to mitigate frailty and other health and well-being concerns for physically disabled individuals. Full article

Background/Objectives: Life expectancies have increased in most countries, leading to a higher accident rate among older drivers than their younger counterparts. While numerous studies have analyzed the decline in cognitive abilities and physical limitations as contributing factors, there are other considerations. For instance, younger male drivers tend to take more risks than younger female drivers. However, there is a lack of research and evidence regarding the role of gender in risk-taking among individuals over 65. Given this gap, our current study aims to investigate the relationship between gender and risk propensity in this particular age group. The primary goal was to determine if driving experience affects the gender gap in risk attitude; Methods: We studied risk behavior in both car drivers and pedestrians. Our sample included 200 individuals (101 women), all over 65, with the same weekly driving times. After a brief demographic and anamnestic interview, they completed the Driver Road Risk Perception Scale (DRPS) and the Pedestrian Behavior Appropriateness Perception Scale (PBAS) questionnaires. They also provided information about traffic violations and road crashes; Results: Our research revealed that older male drivers continue to tend to risky behavior, highlighting the need for targeted interventions to improve risk awareness, especially among older men; Conclusions: Our findings suggest that road safety messages should specifically target male drivers as they are less likely to view responsible driving actions, such as observing speed limits, as desirable. Full article

Background/Objectives: Many older adults who require long-term care need oral health management. However, access to dental care is limited, and connecting older patients with dental professionals is a future challenge. Therefore, the development of a remote oral health assessment system is required. This study aimed to investigate the usefulness of video-based oral health assessments in older adults residing in facilities. Methods: This study comprised 60 older adults residing in facilities who consented to dental home visit treatment by the Department of Oral Function Management at Showa University Dental Hospital between July 2021 and December 2022. The Oral Health Assessment Tool (OHAT) was used to evaluate the oral health status at the facilities by one dentist. The concordance of the oral health assessments conducted by this dentist at the facilities (OHAT-B) was compared with those conducted by the same dentist (OHAT-V1) and two other dentists (OHAT-V2 and V3) using approximately 1 min video recordings of the oral cavity taken with a mobile electronic device. Results: On the OHAT total score, the intraclass correlation coefficient (ICC [1.1]) for OHAT-B and V1 was 0.931; the ICC (2.1) was 0.889 when compared with V2 and 0.788 when compared with V3. Moreover, the comparison between V2 and V3 showed high agreement, with an ICC (2.1) of 0.750. Conclusions: This study revealed that the oral health assessment of older adults residing in facilities using video recordings of the oral cavity taken with a mobile electronic device may be possible, suggesting the possibility of remote oral health assessment. Full article

Background/Objective: The present study aimed to contribute to analyzing the psychometric properties of the WHO Quality of Life Scale for Older Adults (WHO-QoL-Old) in a sample of older adults in Michoacán, Mexico. Methods: 111 older adults from Michoacán, Mexico, participated in the study. Confirmatory factor analysis (CFA) was conducted to test the fit of various models. Data analysis was performed using R Studio, considering the ordinal nature of the items in the model estimation method. Internal consistency was evaluated using the alpha coefficient (α) and McDonald’s omega coefficient (ω). Results: The CFA indicated that the six-correlated-factor model proposed theoretically showed a very good fit (χ²: 397.11, p < 0.001; CFI: 0.958; SRMR: 0.079; RMSEA: 0.079). The factors within the model demonstrated acceptable internal consistency, with an alpha coefficient ranging from 0.739 to 0.874 and an omega coefficient ranging from 0.748 to 0.882. Conclusions: It is concluded that the WHO-QoL-Old scale presents good psychometric properties for the Mexican older adult population. Full article

Objective: The aim of this study was to clarify the link between experiencing cerebrovascular diseases (strokes as an explicit example) and fear of falling (FOF) among middle-aged and older adults in Europe. Methods: Longitudinal data were used from wave 5 to wave 7 of the representative Survey of Health, Ageing and Retirement in Europe (SHARE). Self-reported tools were used to quantify the key variables. Fear of falling was similarly assessed using a dichotomous yes or no question, “For the past six months at least, have you been bothered by any of the health conditions on this card”, with fear of falling being one of the options. It was adjusted for various sociodemographic and health-related factors. In particular, to account for unobserved heterogeneity, conditional fixed effect regressions (FE) were used. Accordingly, change in an individual’s FOF status over the included waves was analysed and correlated with the reported change of all the included time-varying independent variables within the same individual, including experiencing stroke or other cerebrovascular diseases. The final analytical sample equalled n = 22.071 observations. Results: Conditional logistic FE regressions showed that the onset of a stroke or other forms of cerebrovascular disease was not associated with an increased likelihood of experiencing fear of falling (OR = 1.25, p = 0.095). However, stratified by sex, such an association was present in men (OR = 1.79, p = 0.006), though not in women (OR = 0.94, p = 0.732). Conclusions: The onset of a stroke or other cerebrovascular diseases was associated with an increased likelihood of experiencing FOF in men but not women. Efforts are required to assist older men in avoiding FOF after the onset of stroke or other cerebrovascular pathologies. Full article

Objective: This study aims to clarify the gazing characteristics of older drivers while driving cars using a gaze analysis device. Methods: The participants included 16 older and 12 middle-aged drivers who drove cars daily. After conducting cognitive and attentional function tests, eye gaze while watching driving videos was measured using an eye tracker. Ten driving videos were prepared. In addition, a total of 34 hazard areas were analyzed. Results: The results of the gaze measurement parameters were statistically compared between the two groups. In the older group, the gaze analysis results indicated that while viewing driving videos, the search for areas close to the car was expanded. In addition, in several hazard areas, we observed a decrease in the number of drivers gazing at the driver, shortened total gazing time, delay in the timing of gazing, and decrease in the number of visits. Conclusions: Older drivers’ eye movement is increased; however, it is characterized by gazing at unimportant areas, indicating an inefficient scanning pattern. Although these results do not indicate an obvious decline in driving ability among older drivers, the decline in hazard perception may become apparent in some situations. The data contain underpowered results and require revalidation in larger studies. Full article

Background/Objectives: An association between oral function and physical fitness, including walking capacity, has been reported. However, the association between masticatory behaviors and walking ability—both of which represent patterns of movement in daily life—has not been clarified. This study aimed to investigate the association between masticatory behaviors, oral function, and walking capacity in older people. Methods: One hundred community-dwelling older people (31 men, 69 women, mean age 75.7 ± 6.3 years) were selected to participate in this study. Age, sex, masticatory behaviors, oral functions (tongue pressure, tongue–lips motor function, occlusal force, and masticatory performance), and walking capacity were assessed. Masticatory behaviors were assessed during the consumption of one rice ball (100 g) using a wearable chewing counter, and the number of chews, chewing rate, the number of chews per bite, and meal time were recorded. Walking capacity was assessed using the timed up and go test (TUG). Spearman’s rank correlation coefficients were calculated to assess the strength and direction of the association. Results: Moderate negative correlations were observed between TUG time and tongue pressure and between TUG time and tongue–lips motor function (/ta/ and /ka/) (rs = −0.33, −0.21, −0.28, respectively). In addition, moderate negative correlations between TUG time and chewing rate (rs = −0.22) and between TUG time and meal time (rs = 0.33) were observed, suggesting that lower walking capacity was associated with slower chewing rate and longer meal times. Conclusions: In community-dwelling older people, declines in mastication speed and dexterity and tongue strength are associated with lower walking capacity. Full article

Background: This study provides a detailed examination of older Veterans with traumatic brain injury (TBI) and dementia and their caregivers, focusing on Veterans’ demographic, clinical, functional, safety risk, and behavioral characteristics and caregivers’ demographic, clinical, and care-related characteristics and well-being. Methods: Veterans’ caregivers (N = 110) completed a telephone-based survey. Results: Veterans averaged eight comorbid health conditions, with over 60% having chronic pain, hypertension, post-traumatic stress disorder, or depression. Caregivers reported helping with an average of three activities of daily living, with the highest percentages of Veterans needing assistance with grooming, dressing, and bathing. Almost all Veterans needed assistance with shopping, cooking, medication management, housework, laundry, driving, and finances. Veterans averaged two safety risks, the most common being access to dangerous objects, access to a gun, and not being able to respond to emergency situations. Although Veterans averaged 14 behavioral concerns, caregivers reported that their family needs relating to TBI were generally met or partly met, and they voiced confidence in their ability to respond to behaviors and control their upsetting thoughts. Caregivers’ mean burden score was severe, while mean depression and anxiety scores were mild. Caregivers reported an average of 10.5 h per day providing care and 20.1 h per day on duty. Conclusions: The findings demonstrate the increased presence of impairments, safety risks, and behavioral issues in Veterans with comorbid TBI and dementia, as well as increased impacts on families’ burdens and care provision requirements. Clinicians should be alert for and educate TBI patients and caregivers on the warning signs of post-TBI dementia and its associated functional, behavioral, and safety risk profile, as well as challenges related to caregiver well-being. Healthcare policymakers must consider the increased caregiver demands associated with comorbid TBI and dementia, as well as the need for expanded long-term support and services. Full article

Background: GaitSmart (GS) is a sensor-based digital medical device that can be used with the integrated app vGym to provide a personalised rehabilitation programme for older people undergoing total hip arthroplasty (THA) or total knee arthroplasty (TKA). This study aimed to determine whether the GS intervention used in the rehabilitation of older people undergoing THA or TKA is potentially cost-effective compared to the current standard of care (SoC). Methods: Decision-analytic modelling was conducted to estimate the cost-effectiveness over a seventeen-week time horizon from an NHS perspective. UK clinical and cost data from the GaitSmart randomised clinical trial was used to obtain the input parameters, and a sensitivity analysis was performed to address uncertainties. Results: Over a seventeen-week time horizon, GS incurred cost savings of GBP 450.56 and a 0.02 gain in quality-adjusted life years (QALYs) compared to the SoC. These results indicate that GS is the dominant intervention because the device demonstrated greater effectiveness and lower costs. Probabilistic sensitivity analyses confirm the robustness of our results. Conclusions: GS appears to offer short-term efficiency benefits and demonstrates cost-effectiveness for the improvement in gait in people undergoing THA or TKA, compared to the SoC. Full article

In this study, we investigated the effect of regular walking and its combination with manual techniques/resistance exercise. The position of the shoulder girdle was assessed using the acromion-wall distance (AD). The intervention took place twice a week for 4 weeks. A total of 88 seniors over the age of 60 successfully completed the study. The results showed a statistically significant improvement of AD in the left shoulder within the group that underwent walking combined with resistance exercise. The remaining groups did not show any statistically significant change in AD. Background: The world population is rapidly aging; therefore, it is necessary to respond to this challenge in time. One of the typical involutional signs of old age is a hunched posture combined with a forward position of the shoulder girdle. This posture negatively impacts various bodily functions, postural stability, and strain on the musculoskeletal system. Objectives: We aimed to evaluate the effect of walking and walking combined with manual therapy/resistance exercise on scapular positioning in healthy elderly individuals. Methods: Participants of experimental groups underwent a 4-week training session that involved walking and manual techniques/resistance training applied 2x/week. Participants of the control group maintained their usual daily habits. Results: Our results showed statistically significant improvement in scapular positioning of the left shoulder in participants who underwent regular walking combined with resistance exercise training. Conclusions: These results suggest that regular walking combined with resistance training, when properly dosed, may beneficially influence scapular positioning in healthy elderly individuals. Full article

Background/Objectives: Sarcopenia is a muscular disease characterized by loss of muscular strength and function, affecting mainly women, and associated with increased mortality risk. The aim of this study was to compare active women with inactive women of different age groups regarding muscle mass, strength, and muscle quality. Methods: This study included 147 women (85 runners and 62 inactive), divided into <50 and ≥50 years old. Participants were evaluated for knee flexor and extensor peak torque (PT), body composition, and training habits. Results: For knee extensor muscles, there was an age group effect (F(2.146) = 40.5; p < 0.001) on absolute PT (Nm); an age group effect (F(2.146) = 44.1; p < 0.001) and a physical activity group effect (F(2.146) = 113.0; p < 0.001) on PT adjusted by body mass (Nm/kg); and an age group effect (F(2.146) = 36.9; p < 0.001) and a physical activity group effect (F(2.146) = 6.1; p = 0.014) on PT adjusted by lean mass (Nm/kgLM). There was no interaction effect. Conclusion: In both age groups, active women had greater strength and higher muscle quality than inactive women, but the difference in strength, muscle mass, and muscle quality between younger and older women were the same among runners and inactive women. Full article

Background/Objectives: This retrospective study focused on the role of Dopamine Transporter (DAT) scans in diagnosing Parkinson’s Disease (PD) in older adults with cognitive impairment (CI). Methods: We retrospectively analyzed brain imaging of 6483 individuals aged 60 and above with CI. Among these, 297 underwent a DAT scan, with 189 testing positive and 89 starting dopamine therapy. In contrast, 173 patients exhibited PD-associated structural changes on CT or MRI without receiving DAT scans or treatment. Results: Of these patients, 50 (29%) experienced falls. This points towards a potential missed diagnosis of PD, which can respond to therapy in the early stages. Conclusions: Our results suggest that providers may overlook subtle signs of parkinsonism in patients with CI, resulting in symptoms worsening and treatment delay. Since CI is often first brought to the attention of PCPs, our findings call for an increased effort to inform PCPs of the role of DAT scans in aiding the diagnosis of dopamine deficiency states. By understanding PD-related structural changes seen on brain imaging and using a DAT scan to confirm dopamine deficiency, treatment for PD or related states might be started earlier or a timely referral made to a specialist, reducing patient disability and improving their quality of life. Full article

Introduction: Obesity is a chronic, relapsing, and progressive disease. The issue of obesity affects 50 to 80% of patients who have been diagnosed with breast cancer. The aim of this study is to assess the scale of the problem of obesity among breast cancer survivors (BCS) older than 60 years, evaluate their physical fitness, and study the relationship between the occurrence of obesity and levels of fitness among breast cancer survivors. The relationship between fitness and sociodemographic factors has also been analyzed. Materials and Methods: This original epidemiological clinical study included a cohort of 88 female breast cancer survivors treated in 2022 in Holycross Cancer Center, Kielce, Poland. A questionnaire involving demographic information and medical data was utilized. The Senior Fitness Test (SFT) battery has been used to assess the physical fitness of the patients. Body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), and waist-to-height ratio (WHtR) were also analyzed. Results: More than 70% of the studied breast cancer survivors were classified as overweight or obese, according to BMI and WC indices. Depending on the SFT trial, the regression coefficients indicated worse results in participants who were older, lived in urban areas, were professionally active, less educated, and had higher obesity indices. The analysis of the relationship between obesity indices and fitness components revealed that all obesity indices were significantly associated with lower body flexibility (BMI p = 0.0118, WC p = 0.0092, WHR p = 0.0364, WHtR p = 0.0095). Upper body flexibility was significantly correlated with BMI indices (p = 0.0091, p = 0.0193) and WHtR (p = 0.0095). Agility and balance were significantly associated with WC (p = 0.0193), WHR (p = 0.098), and WHtR (p = 0.0095). Lower body strength was significantly correlated with the WHR index (p = 0.0487). Significant differences were found in upper body strength depending on the WHtR category. Conclusions: In the studied group of breast cancer survivors, there is a high prevalence of overweight and obesity. With increasing obesity rates, older age, and lower education levels, physical activity measured by the SFT decreases. Living in urban areas and being professionally active also predispose to lower physical activity levels. As obesity indices increase, physical fitness decreases in trials assessing upper and lower body strength, upper and lower body flexibility, as well as agility and dynamic balance. Full article

Physical function trajectory (PFT) is associated with mortality and hospitalization risks. We aimed to identify and compare the PFTs of newly admitted high-functioning older adults during their first six months at long-term care (LTC) facilities. In this multicenter retrospective cohort study, we included newly admitted high-functioning older adults (Barthel index > 60) from 47 Japanese LTC facilities. The primary outcome was physical function changes after admission. Data were collected from the Long-Term Care Information System for Evidence (LIFE), which monitored LTC facility residents’ function between 1 January 2021 and 31 January 2022. A group-based trajectory model and binomial logistic regression analyses were applied to identify and compare residents’ PFTs. Among the 718 residents included, the average age was 85.69 years and 64.5% were female. PFTs were classified as maintenance (66.0%), improvement (9.5%), slight decline (16.6%), and large decline (7.9%). The improvement group had significantly fewer residents who expressed a lack of interest in daily activities (odds ratio (OR) 0.45; 95% confidence interval (CI) 0.21–0.97) compared to the maintenance group. The large decline group had significantly more residents with a low BMI at admission (OR 2.42; 95% CI 1.29–4.55) and residents who did not use dentures (OR 0.49; 95% CI 0.26–0.95), compared to the maintenance group. Considering future PFTs may aid the development of care plans and the provision of appropriate interventions. Moreover, utilizing existing data has the potential to maintain residents’ physical independence and enhance the quality of care without burdening residents themselves or staff. Full article

(1) Background: Mental health issues in older adults, particularly cognitive impairment and depression, can affect nutritional status. This study investigates the prevalence of malnutrition among community-dwelling older adults at risk of social exclusion and dependency in Lebanon and its association with cognitive impairment and depression. (2) Methods: This cross-sectional study used secondary data from the TEC-MED project, involving 1410 older adults aged 60 and above in Beirut. Nutritional status was assessed with the Mini Nutritional Assessment _Short Form (MNA_SF), cognitive impairment with the AD8 Dementia Screening Interview, and depression with the Geriatric Depression Scale (GDS-15). (3) Results: 87.2% of participants were at risk of malnutrition, and 2.5% were malnourished. Cognitive impairment was present in 82.2% of the sample and 45% experienced moderate to severe depression. Malnourished individuals had significantly higher rates of cognitive impairment (96.7% vs. 57.8%) and depression (85.7% vs. 23.2%). Significant associations were found between the risk of malnutrition, decreased food intake, cognitive impairment, and depression; however, no significant association was found with BMI. Logistic regression analysis indicated that older age, cognitive impairment, and depression were significant predictors of malnutrition, while having a caregiver was protective. (4) Conclusions: The high prevalence of risk of malnutrition among vulnerable older adults with cognitive impairment and depression underscores the need for policies integrating nutritional screening into routine health check-ups for older adults. Full article

The Royal Hospital Chelsea has been home to veterans of the British Army since 1692. Opportunities to remain physically active throughout the life course of its residents include participation in numerous hobbies within the quasi-military environment, and in the civic engagement representational role of the Chelsea Pensioner. This study examines the influence the Royal Hospital Chelsea culture has on resident opportunities to remain active. A non-traditional mixed-methods convergent design was used across three participant groups. Staff and established residents engaged in semi-structured qualitative interviews, with established residents and a cohort of new residents completing Quality of Life questionnaires. The findings indicate established Chelsea Pensioners experienced a sense of pride and purpose, elevated social status, and increased life satisfaction as a result of engaging in multiple activities. New Chelsea Pensioners demonstrated a trend towards increased quality of life after six months’ residence at the Royal Hospital Chelsea. Further research is required to explore the transferability of similar interventions into other residential establishments. Full article

(1) Background: In a society with an advancing aging rate, medical systems are coming under pressure due to an increasing flow of older patients with multiple somatic diseases, exacerbated by their psychological and sociological backgrounds. We aimed to investigate the relationship between frailty and loneliness in older adults and to provide a holistic perspective on these concepts. Our research question was “Is there a link between the loneliness and frailty in older people?” (2) Methods: To assess the link between loneliness and frailty, we conducted a search accessing Index Medicus and PubMed; the timeframe of our research was from 2013 until 2023. Data regarding the study population, as well as loneliness and frailty assessments and approaches, were extracted. (3) Results: A positive relationship between loneliness and the appearance and progression of frailty in older adults is argued for. (4) Conclusions: Frailty and loneliness in older adults are often interconnected and can have a significant impact on their overall well-being. Early identification of frailty by assessing risk factors (including loneliness and/or social isolation) should become a standard of care for older patients. Appropriate combined interventions that effectively address both frailty and loneliness (physical exercises, psychological support, and social engagement) can promote healthier aging, prevent health deterioration, maintain independence, and reduce healthcare costs. Full article

Background. While prognostic guidelines for pneumonia have widely allowed clinicians to treat patients, poor prognostic factors for 1- or 2-year survival times have never been mentioned to our knowledge. Patients and methods. We conducted this retrospective study to evaluate whether malnutrition according to the GLIM criteria is a poor prognostic factor for 1- or 2-year survival among patients with aspiration pneumonia. All patients with community-onset aspiration pneumonia who were admitted to Aichi Medical University and had intervention from our nutrition support team (NST) in 2019 and 2020 were enrolled in this study. Results. A total of 56 patients were enrolled in the study. The mean age was 86 ± 6.5 and 25 (45%) were male. Thirty-one patients died during this observational period. Comparing the survival and death group, higher respiratory rate (RR) and malnutrition were seen more frequently in the death group than in the survival group. Then, the patients were divided into the following three groups: those with an RR ≥ 22 and malnutrition, those with malnutrition, and a control group [patients who were not malnourished and had a low RR (<22)]. Comparing the three groups, patients with an RR ≥ 22 and malnutrition had significantly shorter overall survival times (OSs) than those in the other groups (p = 0.009 by Log-Rank test) for 1-year prognosis. The result of 2-year prognosis displayed a statistical significance that was the same as that for 1-year prognosis (p = 0.004 by Log-Rank test). The Cox hazard regression model showed that a higher RR was an independent poor prognostic factor for 1- and 2-year survival among aspiration pneumonia patients. Conclusions. This pilot study showed that combined scores of higher RR and malnutrition according to the GLIM criteria (modified R-GLIM score) was an independent poor prognostic factor for 1 or 2-year survival among super-elderly patients (aged over 80 years) with aspiration pneumonia. Full article

Social isolation and loneliness are major public health concerns and are associated with morbidity and mortality. As this is an increasing issue in older adults, guidance for healthcare providers is a priority. The Canadian Coalition for Senior’s Mental Health (CCSMH) has developed the first Canadian social isolation and loneliness guidelines to help providers recognize, assess, and manage social isolation and loneliness among older adults. We review and summarize these guidelines to support healthcare and social service providers to apply best practices and evidence-based care for older adults experiencing social isolation and loneliness. Full article

Maximising the potential benefit of resistance exercise (RE) programs by ensuring optimal recovery is an important aim of exercise prescription. Despite this, research surrounding recovery from RE in older adults is limited and inconsistent. The following randomised controlled trial was designed to investigate the efficacy of milk consumption for improving recovery from RE in older adults. However, the study encountered various challenges that may be applicable to similar studies. These include recruitment issues, a lack of measurable perturbations in muscle function following RE, and potential learning effects amongst participants. Various considerations for exercise research have arisen from the data which could inform the design of future studies in this area. These include (i) recruitment—consider ways in which the study design could be altered to aid recruitment or allow a longer recruitment period; (ii) learning effects and familiarisation—consider potential learning effects of outcome measures and adjust familiarisation accordingly; (iii) identify, validate and optimise protocols for outcome measures that are applicable for the specific population; (iv) adjust the exercise protocol according to the specific aims of the study (e.g., are you replicating a usual exercise bout or is the intent to cause large amounts of muscle damage?). Full article

The burden of caregivers of people with dementia with Lewy bodies (DLB) is high; however, factors related to their caregiving burden are not fully clarified. We herein investigated factors associated with increasing caregiver burden for caregivers of people with DLB. To explore factors associated with caregiver burden, a linear regression analysis was conducted using the J-ZBI_8 total score as the dependent variable and a total of 36 factors as independent variables. This analysis included 252 pairs of people with DLB and their caregivers. Caregivers’ mean J-ZBI_8 was 8.4, indicating that caregiver burden was generally high. First, we identified 20 factors associated with caregiver burden in univariable analysis. Finally, multivariable analysis found three significant factors: irritability (β = 0.208, p < 0.001), use of “short stay” or “small-scale, multifunctional home care” (β = 0.208, p < 0.001), and nighttime behavior (β = 0.138, p = 0.020) were significantly associated with J-ZBI_8 total scores. Irritability and nighttime behavior were found to be contributing factors to caregiver burden. High caregiver burden among caregivers of people with DLB may result in the use of social services providing overnight stays, but to what extent such services reduce caregiver burden is unknown. Full article

Non-melanoma skin cancers (NMSCs) are a significant cause of morbidity and mortality; their incidence is increasing most in older patients. NMSCs have traditionally been treated with surgical excision, curettage, Mohs micrographic surgery (MMS), and superficial radiotherapy (SRT). Image-guided SRT (IGSRT) is a treatment option for poor surgical candidates or patients with low- or high-risk, early-stage NMSC who prefer to avoid surgery. This large retrospective cohort study compared 2-, 4-, and 6-year freedom from recurrence in biopsy-proven NMSC lesions treated with IGSRT (n = 20,069 lesions) between patients aged < 65 years (n = 3158 lesions) and ≥65 years (n = 16,911 lesions). Overall freedom from recurrence rates were 99.68% at 2 years, 99.57% at 4 years, and 99.57% at 6 years. Rates did not differ significantly by age (p = 0.8) nor by sex among the two age groups (p > 0.9). There was a significant difference in recurrence among older patients when analyzed by stage (p = 0.032), but no difference by stage in younger patients (p = 0.7). For early-stage NMSCs, IGSRT is a clinically equivalent alternative to MMS and statistically significant in superiority to non-image-guided SRT. This study demonstrates that there is no significant effect of age on 2-, 4-, or 6-year freedom from recurrence in patients with IGSRT-treated NMSC. Full article

Although many physical activity (PA) interventions for older adults have proven effective in controlled research settings, optimal implementation in real life remains challenging. This study identifies determinants perceived by stakeholders when implementing community-based PA interventions for older adults. We interviewed 31 stakeholders guided by the Consolidated Framework for Implementation Research (CFIR). Results showed that stakeholders are very specific about the role they can play in implementation, making collaboration between stakeholders crucial. Barriers and motivators were identified in the CFIR intervention characteristics domain (relative advantage, complexity and costs, evidence quality and strength, and adaptability and trialability), in the outer setting domain (cosmopolitism, patient needs, and external policy and incentives), in the inner setting domain (implementation climate, relative priority, compatibility and organizational incentives and rewards) and in the individual characteristics domain (knowledge and beliefs, and other personal attributes). An overarching theme was the stakeholders’ emphasis on aiming for broad health goals in interventions, as they perceive PA as a means to reach these goals rather than an end in itself. Another overarching theme requiring attention in future implementation efforts is the need to tailor implementation efforts to the specific needs of older adults as the end users of the intervention. Full article

The promotion of oral health in nursing care is essential for preventing oral diseases and maintaining health in elderly vulnerable populations. There is a need for standardized guidelines and education. The aim of this study was to collect data on the attitudes and hopes of caregivers regarding the implementation of the German Expert Nursing Standard “Promotion of Oral Health in Nursing” (GENS-POHN) and to evaluate their oral healthcare knowledge before implementation. A cross-sectional study was conducted in five different care settings in Germany. A self-administered questionnaire was used to collect data on the attitudes and hopes of nursing assistants regarding the GENS-POHN. Oral healthcare knowledge was evaluated before implementation. Most participants had a positive attitude towards the GENS-POHN and hoped that its implementation would lead to greater safety and competence in daily oral healthcare tasks. Few participants currently use screening or assessment instruments for oral care. There is a need for further education and training, as well as the development and implementation of standardized guidelines and tools for screening and assessment, in oral care. The GENS-POHN as an expert standard could be made accessible to an international audience by translating it into other respective national languages, thereby enhancing its usability for a wider range of users. Full article

The objective of the present study was to analyze the psychometric properties of a life satisfaction scale in older Peruvian adults using an exploratory graph analysis (EGA) approach. A total of 407 older adults aged between 60 and 95 years (M = 69.5; SD = 6.7) from three comprehensive elderly care centers (CIAMs) in Lima, Peru, were recruited. A non-probabilistic convenience sampling was used. The Satisfaction with Life Scale (SWLS) was analyzed using EGA with the Gaussian GLASSO model to assess its dimensionality and structural consistency. The relationship with other variables was analyzed using scales such as the GAD-7 and PHQ-9. The network structure of the SWLS indicates a single dimension. Additionally, network loadings (nodes) were examined, showing high values (>0.35) for most items except item 1, which had a moderate loading (>0.25). Structural reliability showed that a single dimension was identified 100% of the time. The post hoc CFA considering the unidimensional network structure obtained through EGA showed satisfactory fit (χ2/df = 3.48, CFI = 0.96, TLI = 0.92, SRMR = 0.02, RMSEA = 0.07 [90% CI 0.05, 0.08]). Finally, internal consistency reliability was acceptable (ω = 0.92). The SWLS measure is robust and consistent. These findings are a valuable reference for advancing research on aging in Peru, as they provide a practical, valid, and reliable measure. Full article

Aging is a natural, complex, and individual process that focuses on the progressive decay of the body and a decrease in cell function that begins in approximately the sixth decade of life and ends with death. Current scientific evidence shows that the aging process is mostly related to genetic load and varies because of the environment. Therefore, aging can be adjusted through the intervention of factors that control homeostasis in genetic, biochemical, and immunological processes, including those involving the gut microbiota. Indeed, the diversity of the gut microbiota decreases during aging, based on the presence of modifications in the hormonal, immunological, and operational processes of the gastrointestinal tract. These modifications lead to a state of dysbiosis. However, altering bacterial communities remains complicated due to the great diversity of factors that influence their modification. Alterations caused by the aging process are known to foster dysbiosis and correspond to conditions that determine the degree of frailty in senior citizens. Consequently, the microbial structure can be used as a biomarker for geriatric care in the promotion of healthy aging. Full article

The global increase in dementia cases highlights the urgent need for effective treatment and care strategies. The aim of this study was to evaluate the effects of group reminiscence therapy on cognitive function, subjective well-being, and behavioral and psychological symptoms of dementia (BPSD) in older adults with moderate to severe dementia. A pre–post comparative design was used, with 49 participants receiving eight group reminiscence therapy sessions over 4 weeks. Baseline, one-week, and one-month postintervention assessments were conducted using the Hasegawa Dementia Scale-Revised (HDS-R), the Neuropsychiatric Inventory-Nursing Home Version (NPI-NH), and the Philadelphia Geriatric Center Morale Scale (PGC Morale Scale). The results showed no significant improvement in HDS-R scores, but significant improvements in PGC Morale Scale (p = 0.0417) and NPI-NH scores (p = 0.00226), indicating improved well-being and reduced BPSD. These findings suggest that group reminiscence therapy is effective in improving BPSD. Future research should focus on extending the duration of the intervention, including different populations, and combining group reminiscence therapy with other therapeutic approaches to fully determine its long-term benefits and mechanisms. Research on its cost-effectiveness and cultural applicability could further validate and improve the use of group reminiscence therapy in diverse care settings. Full article

Age-related declines in the musculoskeletal system may place additional demands on the lumbar spine during everyday activities such as walking. This study aimed to investigate age-related differences in the functional demand (FD) of walking on the lumbar spine in older and younger adults. A motion analysis system with integrated force plates was used to acquire kinematic and kinetic data on 12 older (67.3 ± 6.0 years) and 12 younger (24.7 ± 3.1 years) healthy men during walking at a self-selected speed along a 10 m walkway. Isokinetic dynamometry was used to acquire the maximal joint moment capacity of the lumbar spine. The FD of the lumbar spine was calculated as the muscle moment during key phases of the gait cycle (GC) relative to the maximum moment capacity of the lumbar spine. The difference in FD between age groups was not significant (p = 0.07) and there were no significant differences between the young group (YG) and older group (OG) for any individual phase in the GC. Despite the lack of statistical significance, the results indicate that a practical difference may exist, as walking was approximately 20% more functionally demanding on the lumbar spine in the OG compared to the YG. Therefore, older adults may employ modified gait strategies to reduce mechanical load whilst walking to fall within the limits of their maximal force-producing capacity in the lumbar spine, which may have implications for injury risk. Full article