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Medicina 2019Sleep is an active and cyclic physiological process that has a critical impact on health. Its functions are numerous: growth, development, learning, memory, synaptic... (Review)
Review
Sleep is an active and cyclic physiological process that has a critical impact on health. Its functions are numerous: growth, development, learning, memory, synaptic efficiency, regulation of behavior, emotion, immune strengthening and cleaning time of neurotoxic substances. During the first years of life, there are a number of important changes in development, which lead to the expected pattern of sleep and wakefulness in adults. The sleep occupies a third of the adult's life. However, sleeping during the first months of life takes up more than 50% of time. This review of the topic will describe normal sleep patterns in childhood.
Topics: Child; Humans; Sleep; Wakefulness
PubMed: 31603839
DOI: No ID Found -
Age and Ageing Dec 2022The World Health Organisation recently defined the construct of intrinsic capacity (IC), a function-based marker of older adult's health encompassing all mental and... (Randomized Controlled Trial)
Randomized Controlled Trial
Effects of a 12-week Vivifrail exercise program on intrinsic capacity among frail cognitively impaired community-dwelling older adults: secondary analysis of a multicentre randomised clinical trial.
INTRODUCTION
The World Health Organisation recently defined the construct of intrinsic capacity (IC), a function-based marker of older adult's health encompassing all mental and physical capacities of the individual. Multicomponent physical exercise (MCE) is a potential intervention capable to maintain/increase IC at older age; however, evidence is scarce on the effects of MCE on IC in cognitively impaired pre-frail/frail older adults.
METHODS
Secondary analyses of a randomised clinical trial. One hundred and eighty-eight older outpatients (age = 84.06 ± 4.77, 70.2% women) presenting with pre-frailty/frailty (according to Fried Criteria) and mild cognitive impairment (MCI)/mild dementia were recruited in the Geriatric clinics of three tertiary hospitals in Spain. Subjects were randomised to participate in the 12-week home-based individualised Vivifrail MCE or usual care. An IC index was created based on the z-score of the locomotion (Short Physical Performance Battery), cognitive (Montreal Cognitive Assessment), psychology (15-item Geriatric Depression Scale Yesavage) and vitality (handgrip strength) domains.
RESULTS
After the 3-month intervention, linear mixed models showed significant between-group differences in the evolution of the IC composite score (β=0.48; 95% confidence interval [CI] = 0.24, 0.74; P < 0.001), IC Locomotion (β = 0.42; 95% CI = 0.10, 0.74; P < 0.001), IC Cognition (β = 0.45; 95% CI = 0.03, 0.87; P < 0.05) and IC Vitality domains (β = 0.50; 95% CI = 0.25, 0.74 at 3-month) favouring the MCE group.
CONCLUSIONS
The 12-week Vivifrail multicomponent exercise program is an effective strategy to enhance IC, especially in terms of locomotion, cognition and vitality IC domains in community-dwelling older adults with pre-frailty/frailty and MCI/mild dementia, compared to usual care.
Topics: Humans; Female; Aged; Male; Frail Elderly; Independent Living; Frailty; Hand Strength; Exercise; Exercise Therapy; Dementia
PubMed: 36580558
DOI: 10.1093/ageing/afac303 -
BMC Medical Research Methodology Dec 2018In order to accurately measure and monitor levels of moderate-to-vigorous physical activity (MVPA) and sedentary behaviour (SB) in older adults, cost efficient and valid...
Validity of the International Physical Activity Questionnaire (IPAQ) for assessing moderate-to-vigorous physical activity and sedentary behaviour of older adults in the United Kingdom.
BACKGROUND
In order to accurately measure and monitor levels of moderate-to-vigorous physical activity (MVPA) and sedentary behaviour (SB) in older adults, cost efficient and valid instruments are required. To date, the International Physical Activity Questionnaire (IPAQ) has not been validated with older adults (aged 60 years plus) in the United Kingdom. The current study aimed to test the validity of the IPAQ in a group of older adults for both MVPA and SB.
METHODS
Participants wore an Actigraph GT3X+ for seven consecutive days and following the monitor wear participants were asked to complete the IPAQ. Statistical analysis included: Kolmogorov-Smirnov tests; descriptive analyses; Spearman's rho coefficients; and Bland-Altman analyses.
RESULTS
A sample of 253 older adults were recruited (mean age 71.8 years (SD 6.6) and 57% male). In total, 226 had valid accelerometer and IPAQ data for MVPA and 228 had valid data for SB. Results showed the IPAQ had moderate/acceptable levels of validity (r = .430-.557) for MVPA. For SB, there was substantial levels of validity on weekdays (r = .702) and fair levels of validity (r = .257) on weekend days. Bland-Altman analysis showed inherent measurement error with the majority of participants tending to under-report both MVPA and SB. Results showed the majority of older adult's under-report their level of MVPA and SB when completing the IPAQ and the linear relationship above the mean shows an error from under to over reporting as the mean increases.
CONCLUSIONS
Findings from the current study suggest that the IPAQ is better implemented in larger surveillance studies comparing groups within or between countries rather than on an individual basis. Findings also suggest that the IPAQ validity scores could be strengthened by providing additional detail of types of activities older adults might do on a daily basis, improving recall; and it may also be necessary to provide an example of a daily break down of typical activities performed. This may enable older adults to more fully comprehend the amount of time they may spend active, sitting and/or lying during waking hours.
Topics: Actigraphy; Aged; Aged, 80 and over; Exercise; Female; Humans; Internationality; Male; Middle Aged; Monitoring, Physiologic; Reproducibility of Results; Sedentary Behavior; Surveys and Questionnaires; Time Factors; United Kingdom
PubMed: 30577770
DOI: 10.1186/s12874-018-0642-3 -
BMC Geriatrics Jul 2022Falls represent important drivers of intrinsic capacity losses, functional limitations and reduced quality of life in the growing older adult's population, especially...
Effect of a multicomponent exercise program and cognitive stimulation (VIVIFRAIL-COGN) on falls in frail community older persons with high risk of falls: study protocol for a randomized multicenter control trial.
BACKGROUND
Falls represent important drivers of intrinsic capacity losses, functional limitations and reduced quality of life in the growing older adult's population, especially among those presenting with frailty. Despite exercise- and cognitive training-based interventions have shown effectiveness for reducing fall rates, evidence around their putative cumulative effects on falls and fall-related complications (such as fractures, reduced quality of life and functional limitations) in frail individuals remains scarce. The main aim of this study is to explore the effectiveness program combining an individualized exercise program and an executive function-based cognitive training (VIVIFRAIL-COGN) compared to usual care in the prevention of falls and fall-related outcomes over a 1-year follow-up.
METHODS
This study is designed as a four-center randomized clinical trial with a 12-week intervention period and an additional 1-year follow-up. Three hundred twenty frail or pre-frail (≥ 1 criteria of the Frailty Phenotype) older adults (≥ 75 years) with high risk of falling (defined by fall history and gait performance) will be recruited in the Falls Units of the participating centers. They will be randomized in a 1:1 ratio to the intervention group (IG) or the control group (CG). The IG will participate in a home-based intervention combining the individualized Vivifrail multicomponent (aerobic, resistance, gait and balance and flexibility) exercise program and a personalized executive function-based cognitive training (VIVIFRAIL-COGN). The CG group will receive usual care delivered in the Falls Units, including the Otago Exercise Program. Primary outcome will be the incidence of falls (event rate/year) and will be ascertained by self-report during three visits (at baseline, and 6 and 12 weeks) and telephone-based contacts at 6, 9 and 12 months after randomization. Secondarily, effects on measures of physical and cognitive function, quality of life, nutritional, muscle quality and psychological status will be evaluated.
DISCUSSION
This trial will provide new evidence about the effectiveness of an individualized multidomain intervention by studying the effect of additive effects of cognitive training and physical exercise to prevent falls in older frail persons with high risk of falling. Compared to usual care, the combined intervention is expected to show additive effects in the reduction of the incidence of falls and associated adverse outcomes.
TRIAL REGISTRATION
NCT04911179 02/06/2021.
Topics: Aged; Cognition; Exercise; Exercise Therapy; Frail Elderly; Frailty; Humans; Multicenter Studies as Topic; Quality of Life; Randomized Controlled Trials as Topic
PubMed: 35870875
DOI: 10.1186/s12877-022-03214-0 -
Morbidity and Mortality Weekly Report.... May 2021Adults are at risk for illness, hospitalization, disability and, in some cases, death from vaccine-preventable diseases, particularly influenza and pneumococcal disease....
PROBLEM/CONDITION
Adults are at risk for illness, hospitalization, disability and, in some cases, death from vaccine-preventable diseases, particularly influenza and pneumococcal disease. CDC recommends vaccinations for adults on the basis of age, health conditions, prior vaccinations, and other considerations. Updated vaccination recommendations from CDC are published annually in the U.S. Adult Immunization Schedule. Despite longstanding recommendations for use of many vaccines, vaccination coverage among U.S. adults remains low.
REPORTING PERIOD
August 2017-June 2018 (for influenza vaccination) and January-December 2018 (for pneumococcal, herpes zoster, tetanus and diphtheria [Td]/tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis [Tdap], hepatitis A, hepatitis B, and human papillomavirus [HPV] vaccination).
DESCRIPTION OF SYSTEM
The National Health Interview Survey (NHIS) is a continuous, cross-sectional national household survey of the noninstitutionalized U.S. civilian population. In-person interviews are conducted throughout the year in a probability sample of households, and NHIS data are compiled and released annually. NHIS's objective is to monitor the health of the U.S. population and provide estimates of health indicators, health care use and access, and health-related behaviors. Adult receipt of influenza, pneumococcal, herpes zoster, Td/Tdap, hepatitis A, hepatitis B, and at least 1 dose of HPV vaccines was assessed. Estimates were derived for a new composite adult vaccination quality measure and by selected demographic and access-to-care characteristics (e.g., age, race/ethnicity, indication for vaccination, travel history [travel to countries where hepatitis infections are endemic], health insurance status, contacts with physicians, nativity, and citizenship). Trends in adult vaccination were assessed during 2010-2018.
RESULTS
Coverage for the adult age-appropriate composite measure was low in all age groups. Racial and ethnic differences in coverage persisted for all vaccinations, with lower coverage for most vaccinations among non-White compared with non-Hispanic White adults. Linear trend tests indicated coverage increased from 2010 to 2018 for most vaccines in this report. Few adults aged ≥19 years had received all age-appropriate vaccines, including influenza vaccination, regardless of whether inclusion of Tdap (13.5%) or inclusion of any tetanus toxoid-containing vaccine (20.2%) receipt was measured. Coverage among adults for influenza vaccination during the 2017-18 season (46.1%) was similar to the estimate for the 2016-17 season (45.4%), and coverage for pneumococcal (adults aged ≥65 years [69.0%]), herpes zoster (adults aged ≥50 years and aged ≥60 years [24.1% and 34.5%, respectively]), tetanus (adults aged ≥19 years [62.9%]), Tdap (adults aged ≥19 years [31.2%]), hepatitis A (adults aged ≥19 years [11.9%]), and HPV (females aged 19-26 years [52.8%]) vaccination in 2018 were similar to the estimates for 2017. Hepatitis B vaccination coverage among adults aged ≥19 years and health care personnel (HCP) aged ≥19 years increased 4.2 and 6.7 percentage points to 30.0% and 67.2%, respectively, from 2017. HPV vaccination coverage among males aged 19-26 years increased 5.2 percentage points to 26.3% from the 2017 estimate. Overall, HPV vaccination coverage among females aged 19-26 years did not increase, but coverage among Hispanic females aged 19-26 years increased 10.8 percentage points to 49.6% from the 2017 estimate. Coverage for the following vaccines was lower among adults without health insurance compared with those with health insurance: influenza vaccine (among adults aged ≥19 years, 19-49 years, and 50-64 years), pneumococcal vaccine (among adults aged 19-64 years at increased risk), Td vaccine (among all age groups), Tdap vaccine (among adults aged ≥19 years and 19-64 years), hepatitis A vaccine (among adults aged ≥19 years overall and among travelers aged ≥19 years), hepatitis B vaccine (among adults aged ≥19 years and 19-49 years and among travelers aged ≥19 years), herpes zoster vaccine (among adults aged ≥60 years), and HPV vaccine (among males and females aged 19-26 years). Adults who reported having a usual place for health care generally reported receipt of recommended vaccinations more often than those who did not have such a place, regardless of whether they had health insurance. Vaccination coverage was higher among adults reporting ≥1 physician contact during the preceding year compared with those who had not visited a physician during the preceding year, regardless of whether they had health insurance. Even among adults who had health insurance and ≥10 physician contacts during the preceding year, depending on the vaccine, 20.1%-87.5% reported not having received vaccinations that were recommended either for all persons or for those with specific indications. Overall, vaccination coverage among U.S.-born adults was significantly higher than that of foreign-born adults, including influenza vaccination (aged ≥19 years), pneumococcal vaccination (all ages), tetanus vaccination (all ages), Tdap vaccination (all ages), hepatitis B vaccination (aged ≥19 years and 19-49 years and travelers aged ≥19 years), herpes zoster vaccination (all ages), and HPV vaccination among females aged 19-26 years. Vaccination coverage also varied by citizenship status and years living in the United States.
INTERPRETATION
NHIS data indicate that many adults remain unprotected against vaccine-preventable diseases. Coverage for the adult age-appropriate composite measures was low in all age groups. Individual adult vaccination coverage remained low as well, but modest gains occurred in vaccination coverage for hepatitis B (among adults aged ≥19 years and HCP aged ≥19 years), and HPV (among males aged 19-26 years and Hispanic females aged 19-26 years). Coverage for other vaccines and groups with Advisory Committee on Immunization Practices vaccination indications did not improve from 2017. Although HPV vaccination coverage among males aged 19-26 years and Hispanic females aged 19-26 years increased, approximately 50% of females aged 19-26 years and 70% of males aged 19-26 years remained unvaccinated. Racial/ethnic vaccination differences persisted for routinely recommended adult vaccines. Having health insurance coverage, having a usual place for health care, and having ≥1 physician contacts during the preceding 12 months were associated with higher vaccination coverage; however, these factors alone were not associated with optimal adult vaccination coverage, and findings indicate missed opportunities to vaccinate remained.
PUBLIC HEALTH ACTIONS
Substantial improvement in adult vaccination uptake is needed to reduce the burden of vaccine-preventable diseases. Following the Standards for Adult Immunization Practice (https://www.cdc.gov/vaccines/hcp/adults/for-practice/standards/index.html), all providers should routinely assess adults' vaccination status at every clinical encounter, strongly recommend appropriate vaccines, either offer needed vaccines or refer their patients to another provider who can administer the needed vaccines, and document vaccinations received by their patients in an immunization information system.
Topics: Adult; Aged; Female; Health Care Surveys; Humans; Male; Middle Aged; Population Surveillance; United States; Vaccination Coverage; Vaccines; Young Adult
PubMed: 33983910
DOI: 10.15585/mmwr.ss7003a1 -
Revista Espanola de Quimioterapia :... Apr 2022Adults with lung diseases, comorbidities, smokers, and elderly are at risk of lung infections and their consequences. Community-acquired pneumonia happen in more than 1%... (Review)
Review
Adults with lung diseases, comorbidities, smokers, and elderly are at risk of lung infections and their consequences. Community-acquired pneumonia happen in more than 1% of people each year. Possible pathogens of community-acquired pneumonia include viruses, pneumococcus and atypicals. The CDC recommend vaccination throughout life to provide immunity, but vaccination rates in adults are poor. Tetravalent and trivalent influenza vaccine is designed annually during the previous summer for the next season. The available vaccines include inactivated, adjuvant, double dose, and attenuated vaccines. Their efficacy depends on the variant of viruses effectively responsible for the outbreak each year, and other reasons. Regarding the pneumococcal vaccine, there coexist the old polysaccharide 23-valent vaccine with the new conjugate 10-valent and 13-valent conjugate vaccines. Conjugate vaccines demonstrate their usefulness to reduce the incidence of pneumococcal pneumonia due to the serotypes present in the vaccine. Whooping cough is still present, with high morbidity and mortality rates in young infants. Adult's pertussis vaccine is available, it could contribute to the control of whooping cough in the most susceptible, but it is not present yet in the calendar of adults around the world. About 10 vaccines against SARS-CoV-2 have been developed in a short time, requiring emergency use authorization. A high rate of vaccination was observed in most of the countries. Booster doses became frequent after the loss of effectiveness against new variants. The future of this vaccine is yet to be written.
Topics: Adult; Aged; COVID-19; COVID-19 Vaccines; Community-Acquired Infections; Humans; Infant; Pneumonia, Pneumococcal; Prognosis; SARS-CoV-2; Vaccination; Vaccines, Conjugate; Whooping Cough
PubMed: 35488837
DOI: 10.37201/req/s01.22.2022 -
British Journal of Hospital Medicine... Nov 2022Accurate radiological assessment of the cervical spine is vital in the management of the child presenting with trauma. Compared to an adult's spine, the significant... (Review)
Review
Accurate radiological assessment of the cervical spine is vital in the management of the child presenting with trauma. Compared to an adult's spine, the significant differences in the developmental anatomy (variants or synchondrosis), biomechanics and fracture patterns in the paediatric cervical spine makes assessment difficult, even for experienced radiologists. This review discusses the unique biomechanical factors, developmental anatomy, patterns of injury and imaging strategy in the paediatric population.
Topics: Adult; Humans; Child; Cervical Vertebrae; Radiology; Radiologists; Biomechanical Phenomena; Family
PubMed: 36454066
DOI: 10.12968/hmed.2022.0076 -
Current Psychiatry Reports Sep 2017We review recent advances in psychotherapies for depressed older adults, in particular those developed for special populations characterized by chronic medical illness,... (Review)
Review
PURPOSE OF REVIEW
We review recent advances in psychotherapies for depressed older adults, in particular those developed for special populations characterized by chronic medical illness, acute medical illness, cognitive impairment, and suicide risk factors. We review adaptations for psychotherapy to overcome barriers to its accessibility in non-specialty settings such as primary care, homebound or hard-to-reach older adults, and social service settings.
RECENT FINDINGS
Recent evidence supports the effectiveness of psychotherapies that target late-life depression in the context of specific comorbid conditions including COPD, heart failure, Parkinson's disease, stroke and other acute conditions, cognitive impairment, and suicide risk. Growing evidence supports the feasibility, acceptability, and effectiveness of psychotherapy modified for a variety of health care and social service settings. Research supports the benefits of selecting the type of psychotherapy based on a comprehensive assessment of the older adult's psychiatric, medical, functional, and cognitive status, and tailoring psychotherapy to the settings in which older depressed adults are most likely to present.
Topics: Acute Disease; Aged; Aged, 80 and over; Chronic Disease; Cognitive Dysfunction; Depression; Health Services Accessibility; Health Services for the Aged; Humans; Primary Health Care; Psychotherapy; Suicide Prevention
PubMed: 28726061
DOI: 10.1007/s11920-017-0812-8 -
BMC Geriatrics Oct 2023Most people prefer to remain in their homes and communities as long as possible. Staying at home is widely beneficial as ageing within the home promotes independence and... (Review)
Review
BACKGROUND
Most people prefer to remain in their homes and communities as long as possible. Staying at home is widely beneficial as ageing within the home promotes independence and costs less than residential aged care. Understanding meanings and drivers of remaining at home is an area of importance.
OBJECTIVE
The objective of this systematic review of qualitative studies was to synthesise middle and older aged adult's perspective of their home environment and determine the factors that are important when making decisions about future housing.
METHODS
This review and meta-synthesis was conducted in accordance with JBI (formally known as the Joanna Briggs Institute) methodology for systematic reviews of qualitative evidence. Meta-aggregation was used as the method of synthesis. Included qualitative studies involved middle and older aged adults and their views about ageing and housing. Published studies were identified in four electronic databases and grey literature. Critical appraisal and extraction were conducted using JBI tools and findings were categorised and synthesised into findings.
RESULTS
A total of 46 papers with 5183 participants on the concept of home were included. Most of the participants were older (> 65 years old) and the perspectives of middle-aged people were largely absent. Factors impacting on future housing decisions among individuals were identified. Seven synthesized findings emerged-independence, finances, stigma, attitudes towards ageing, attachments with home, aesthetics, and family connection.
CONCLUSION
Older people have a greater sense of independence and autonomy if they remain in their own home. Multiple external factors impacted on their perspectives including a sense of stigma about ageing, fear of being a burden to others and their own financial position which in some cases restricted their options. This review provides a comprehensive description of the different factors that need to be considered when planning future housing needs; both for individuals and for communities.
Topics: Humans; Middle Aged; Aged; Adult; Systematic Reviews as Topic; Qualitative Research; Aging
PubMed: 37907851
DOI: 10.1186/s12877-023-04279-1 -
Age and Ageing Nov 2022Worldwide, falls and accompanying injuries are increasingly common, making their prevention and management a critical global challenge. The wealth of evidence to support...
Worldwide, falls and accompanying injuries are increasingly common, making their prevention and management a critical global challenge. The wealth of evidence to support interventions to prevent falls has recently (2022) been distilled in the first World Falls Guideline for Prevention and Management for Older Adults. The core of falls prevention includes (i) risk assessment and stratification; (ii) general recommendations on optimising physical function and mobility for all and (iii) offering a holistic, multidomain intervention to older adults at high risk of falls, in which the older adult's priorities, beliefs and resources are carefully considered. In recent decades, sustainable and adequately resourced falls prevention has proved challenging, although evidence suggests that suboptimal implementation of falls prevention is ineffective. Future research should focus on understanding the most successful approaches for implementation. To further optimise falls prevention, recent developments include technological innovation to identify and prevent falls, including exergaming. Further work is warranted to understand how to best incorporate the concepts of frailty and sarcopenia in falls prevention and management. This themed collection includes key articles in the field of falls prevention, covering several topics including risk factors, effective interventions, older adult's views, implementation issues and future perspectives.
Topics: Humans; Aged; Accidental Falls; Risk Assessment; Risk Factors
PubMed: 36414218
DOI: 10.1093/ageing/afac264