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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Global Health".

Deadline for manuscript submissions: closed (31 May 2024) | Viewed by 12431

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Special Issue Editors

Prof. Dr. Giuseppe Liotta

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Guest Editor

Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy
Interests: HIV infection in developing countries; community care; models of care; prevention of vertical transmission; social determinants of health; frailty; older adults care; adherence to treatment; malnutrition; ICT support to community care
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Dr. Stefano Orlando

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Guest Editor

Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
Interests: health economics; ageing

Dr. Fausto Ciccacci

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Guest Editor

Medicine and Surgery Program, Unicamillus, Saint Camillus International University of Health Sciences, 00131 Rome, Italy
Interests: clinical, social and management aspects HIV/AIDS services

Special Issue Information

Dear Colleagues,

The prevention of functional decline is the core issue of the health trajectory of many older adults. Understanding the determinants of functional decline is crucial to support active and healthy aging. It is not simply a matter of preventing specific diseases, which is, of course, important, but also preventing and managing transversal factors that are the background of many diseases or negative events. Examples of factors that are involved in the process of functional decline are malnutrition, anaemia, social isolation, limited physical activity, and mild cognitive decline. A special role is played by a combination of risk factors in a comprehensive picture that can be called pre-frailty, a condition that predisposes and precedes functional decline. Some specific events, which often represent a step down in terms of physical and/or psychological independence for older adults, are preceded by multidimensional impairment that should be identified; examples of these events are falling, even without severe consequences, the loss of a partner, or acute disease.

The aim of this Special Issue is to highlight events, processes, or specific situations that can be linked to functional decline, to identify elements that can be included in prevention strategies in the view of increasing active and healthy aging. Innovative approaches that deal with functional decline risk factors are also welcomed. Contributions from different countries would provide useful information and possible tailored applications of knowledge according to specific scenarios.

Prof. Dr. Giuseppe Liotta
Dr. Stefano Orlando
Dr. Fausto Ciccacci
Guest Editors

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Keywords

healthy ageing
frailty
prevention
functional decline
physical activities
falls
malnutrition
politherapy
social isolation
social support

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Published Papers (7 papers)

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Research

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13 pages, 715 KiB

Open AccessArticle

A Structural Equation Model for Understanding the Relationship between Cognitive Reserve, Autonomy, Depression and Quality of Life in Aging

by Maria Gattuso, Stefania Butti, Inahiá Laureano Benincá, Andrea Greco, Michela Di Trani and Francesca Morganti

Int. J. Environ. Res. Public Health 2024, 21(9), 1117; https://doi.org/10.3390/ijerph21091117 - 23 Aug 2024

Viewed by 702

Abstract

In recent years, aging has become a focal point of scientific research and health policies due to the growing demographic trend of an aging worldwide population. Understanding the protective and risk factors that influence aging trajectories is crucial for designing targeted interventions that support healthy aging and improve people’s quality of life. The aim of this study was to explore the relationships between variables of aging. A total of 103 Italian participants (55–75 years old) underwent multidimensional assessments that covered cognitive, functional, emotional, and quality of life dimensions. Structural equation modeling was used to analyze the data and elucidate the relationships between depression, quality of life, cognitive reserve, executive functions, and daily autonomy. The findings revealed that a higher quality of life was associated with reduced depressive symptoms. In addition, cognitive reserve emerged as a protective factor positively correlated with both quality of life and daily autonomy. In this study, quality of life was determined using physical health, psychological, social relationships, and environmental domains. Identifying the significant relationships between these variables in a sample of late adults and young-aged people has given us useful elements for designing psycho-educational interventions that can be aimed at preventing frailty in later old age or supporting healthy longevity. Full article

(This article belongs to the Special Issue Older Adults' Health and Wellbeing)

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17 pages, 611 KiB

Open AccessArticle

Which Variables Are Associated with the Magnitude of the Physical Fitness Response in Older Adults? An Analysis of Their Development and Influence

by Andressa Crystine da Silva Sobrinho, Larissa Chacon Finzeto, Mariana Luciano de Almeida, Guilherme da Silva Rodrigues, João Gabriel Ribeiro de Lima, Karine Pereira Rodrigues, Átila Alexandre Trapé, Lais Prado and Carlos Roberto Bueno Júnior

Int. J. Environ. Res. Public Health 2024, 21(8), 1075; https://doi.org/10.3390/ijerph21081075 - 16 Aug 2024

Cited by 1 | Viewed by 674

Abstract

Regular physical exercise has proven to be an effective strategy for enhancing the health and well-being of older adults. However, there are still gaps in our understanding of the impacts of exercise on older adults with different health conditions, as well as in the customization of training programs according to individual capabilities. This study aimed to analyze the variables that influence the response of physical capabilities in older adults, considering their development over the aging process, with the goal of assisting professionals in creating personalized training programs. To achieve this, we conducted a cohort study involving 562 previously inactive adults and older adults who underwent anthropometric assessments, blood pressure measurements, and comprehensive physical tests. These assessments were conducted before and after a 14-week training program. Results indicated no significant variations in variables such as waist circumference (p = 0.0455, effect size = 0.10), body mass index (p = 0.0215, effect size = 0.15), systolic (p < 0.0001, effect size = 0.35) and diastolic blood pressure (p < 0.0001, effect size = 0.25) pre- and post-intervention. Strength tests, agility, the 6 min walk test (6MWT), and the back scratch test (BS) showed significant improvements post-intervention, with p-values all below 0.0001 and effect sizes ranging from 0.30 to 0.50. Multiple linear regression analyses revealed that lower initial values in physical capabilities were associated with more significant improvements during training (R² = 0.73, p < 0.001). These results underscore that individualized guidance in training can lead to clinically meaningful improvements in physical performance and health among older adults, with effect sizes indicating moderate-to-large benefits (effect size range = 0.30 to 0.50). Therefore, personalized training programs are essential to maximize health benefits in this population. Full article

(This article belongs to the Special Issue Older Adults' Health and Wellbeing)

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15 pages, 320 KiB

Open AccessArticle

Social Participation and Loneliness in Older Adults in a Rural Australian Context: Individual and Organizational Perspectives

by Leah Wilson, Carrigan Rice and Sandra Thompson

Int. J. Environ. Res. Public Health 2024, 21(7), 886; https://doi.org/10.3390/ijerph21070886 - 8 Jul 2024

Viewed by 1190

Abstract

A rise in aging populations globally calls attention to factors that influence the well-being and health of older adults, including social participation. In Australia, rural older adults face cultural, social, and physical challenges that place them at risk for isolation. Thus, research surrounding social participation and healthy aging is increasingly relevant, especially in rural areas. This qualitative study in a remote town in Western Australia explores barriers and facilitators to older adults’ social participation. To investigate multiple perspectives, 23 adults aged 50+ and 19 organizations from a rural town were interviewed. A stakeholder reference group was engaged to refine the research design and validate the findings. Feedback from early interviews was used to refine the data collection process, thus enhancing the validity of the findings. Thematic analysis showed that health and mobility issues, inadequate infrastructure, poor sustainability, and cultural tensions commonly impacted social participation. Themes of rural town culture, cultural power dynamics, and rural stoicism were identified as cultural aspects that inhibited participation. Based on results of this study and the supporting literature, recommendations for inclusive activities include supporting community-designed programs, utilizing culturally sensitive language and personnel, expanding services using existing community resources, and diversifying older adults’ roles in existing groups. Full article

(This article belongs to the Special Issue Older Adults' Health and Wellbeing)

13 pages, 1007 KiB

Open AccessArticle

Frailty in an Adult Acute Hospital Population: Predictors, Prevalence, and Outcomes

by Rónán O’Caoimh, Laura Morrison, Maria Costello, Antoinette Flannery, Cliona Small, Liam O’Reilly, Laura Heffernan, Edel Mannion, Ruairi Waters and Shaun O’Keeffe

Int. J. Environ. Res. Public Health 2024, 21(3), 273; https://doi.org/10.3390/ijerph21030273 - 27 Feb 2024

Cited by 1 | Viewed by 1875

Abstract

Frailty is common among older hospital inpatients. While studies describe frailty prevalence in acute hospitals, it is usually based upon retrospective hospital-coded data or brief screening on admission rather than comprehensive geriatric assessment (CGA). Further, little is known about differences between pre-admission and current frailty status. Given this, we investigated the prevalence of pre-frailty and frailty among adult inpatients in a large university hospital after CGA. Of the 410 inpatients available, 398 were included in the study, with a median age of 70 years; 56% were male. The median length of stay (LOS) at review was 8 days. The point prevalence of frailty was 30% versus 14% for pre-frailty. The median Clinical Frailty Scale score pre-admission was 3/9, which was significantly lower than at review, which was 4/9 (p < 0.001). After adjusting for age and sex, frailty was associated with greater odds of prolonged LOS (odds ratio [OR] 1.7, p = 0.045), one-year mortality (OR 2.1, p = 0.006), and one-year institutionalisation (OR 9, p < 0.001) but not re-admission. Frailty was most prevalent on medical and orthopaedic wards. In conclusion, CGA is an important risk assessment for hospitalised patients. Frailty was highly prevalent and associated with poor healthcare outcomes. Frailty status appears to worsen significantly during admission, likely reflecting acute illness, and it may not reflect a patient’s true frailty level. The development of frailty clinical care pathways is recommended in order to address the poor prognosis associated with a diagnosis of frailty in this setting. Full article

(This article belongs to the Special Issue Older Adults' Health and Wellbeing)

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Review

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18 pages, 1958 KiB

Open AccessReview

Diagnostic Accuracy of Frailty Screening Instruments Validated for Use among Older Adults Attending Emergency Departments: A Systematic Review and Meta-Analysis

by Elizabeth Moloney, Mark R. O’Donovan, Duygu Sezgin, Evelyn Flanagan, Keith McGrath, Suzanne Timmons and Rónán O’Caoimh

Int. J. Environ. Res. Public Health 2023, 20(13), 6280; https://doi.org/10.3390/ijerph20136280 - 3 Jul 2023

Cited by 5 | Viewed by 2358

Abstract

Early identification of frailty can prevent functional decline. Although multiple frailty screens exist for use in Emergency Departments (EDs), few are validated against diagnostic standards such as comprehensive geriatric assessment. To examine the diagnostic accuracy of ED screens for frailty, scientific databases were searched for prospective diagnostic accuracy test studies from January 2000 to September 2022. Studies were assessed for risk of bias using QUADAS-C. Psychometric properties were extracted and analysed using R. Six studies involving 1,663 participants describing seven frailty screening instruments (PRISMA-7, CFS, VIP, FRESH, BPQ, TRST, and ISAR), representing 13 unique data points, were included. The mean age of participants ranged from 76 to 86 years. The proportion that was female ranged from 45 to 60%. The pooled prevalence rate of frailty was high at 59%. The pooled estimate for sensitivity was 0.85 (95% CI: 0.76–0.91) versus 0.77 (95% CI: 0.62–0.88) for specificity. Pooled accuracy based on area under the ROC curve was 0.89 (95% CI: 0.86–0.90). Although few studies were found, limiting the ability to conduct a meta-analysis of individual instruments, available frailty screens can accurately diagnose frailty in older adults attending the ED. As specificity was comparatively low, additional assessment may be required to identify those requiring inpatient management or onward community referral. Further study is therefore required. Full article

(This article belongs to the Special Issue Older Adults' Health and Wellbeing)

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20 pages, 4835 KiB

Open AccessReview

Co-Creation and Co-Production of Health Promoting Activities Addressing Older People—A Scoping Review

by Anne Seneca Terkelsen, Christian Tolstrup Wester, Gabriel Gulis, Jørgen Jespersen and Pernille Tanggaard Andersen

Int. J. Environ. Res. Public Health 2022, 19(20), 13043; https://doi.org/10.3390/ijerph192013043 - 11 Oct 2022

Cited by 11 | Viewed by 2954

Abstract

The global population is aging and the promotion of health and well-being for this generation is essential. Co-creative and co-productive practices can be solutions to welfare challenges in local policies. Therefore, this scoping review aimed to understand the extent and type of evidence in relation to the co-creation and co-production of health-promoting activities addressing older people aged 60+ years and to examine the influence of co-creative and co-productive activities on health and well-being, including influential factors for co-creation and co-production. We searched for peer-reviewed and grey literature in ten scientific and five non-scientific databases. From the 2648 studies retrieved, 18 articles were included in this review. Then, an inductive thematic content analysis was applied to the analysis. Three categories related to co-creative and co-productive activities emerged: “Social and physical activities”, “Development of age-friendly environments”, and “Discussions of healthy and active aging”. Facilitating factors for co-creation and co-production were related to the planning and structure of the process and recognition of participants’ time and resources, while the recruitment of participants and their time and resources were the main barriers. Future studies should target co-creative and co-productive interventions to concrete areas and specific sub-groups and be aware of factors influencing a co-creative or co-productive relationship with older people. Full article

(This article belongs to the Special Issue Older Adults' Health and Wellbeing)

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Other

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10 pages, 932 KiB

Open AccessStudy Protocol

Digital Health Service for Identification of Frailty Risk Factors in Community-Dwelling Older Adults: The SUNFRAIL+ Study Protocol

by Vincenzo De Luca, Grazia Daniela Femminella, Lisa Leonardini, Lola Patumi, Ernesto Palummeri, Isabella Roba, Walter Aronni, Stefano Toccoli, Simona Sforzin, Fortunata Denisi, Anna Maddalena Basso, Manuela Ruatta, Paola Obbia, Alessio Rizzo, Moira Borgioli, Claudio Eccher, Riccardo Farina, Diego Conforti, Lorenzo Mercurio, Elena Salvatore, Maurizio Gentile, Marialuisa Bocchino, Alessandro Sanduzzi Zamparelli, Giulio Viceconte, Ivan Gentile, Carlo Ruosi, Nicola Ferrara, Gabriella Fabbrocini, Annamaria Colao, Maria Triassi, Guido Iaccarino, Giuseppe Liotta and Maddalena Illario Show full author list Hide full author list

Int. J. Environ. Res. Public Health 2023, 20(5), 3861; https://doi.org/10.3390/ijerph20053861 - 21 Feb 2023

Cited by 1 | Viewed by 1834

Abstract

This article reports the study protocol of a nationwide multicentric study in seven Italian regions aimed at assessing the effectiveness of a digitally supported approach for the early screening of frailty risk factors in community-dwelling older adults. SUNFRAIL+ is a prospective observational cohort study aimed at carrying out a multidimensional assessment of community-dwelling older adults through an IT platform, which allows to connect the items of the SUNFRAIL frailty assessment tool with a cascading multidimensional in-depth assessment of the bio–psycho–social domains of frailty. Seven centers in seven Italian regions will administer the SUNFRAIL questionnaire to 100 older adults. According to the answers provided by older adults, they will be subjected to one or more validated in-depth scale tests in order to perform further diagnostic or dimensional evaluations. The study aims to contribute to the implementation and validation of a multiprofessional and multistakeholder service model for the screening of frailty in community-dwelling older adult population. Full article

(This article belongs to the Special Issue Older Adults' Health and Wellbeing)

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