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QJM : Monthly Journal of the... Oct 2023Even though frailty has been extensively measured in the acute care setting, relatively little is known about the frailty of younger adult inpatients.
BACKGROUND
Even though frailty has been extensively measured in the acute care setting, relatively little is known about the frailty of younger adult inpatients.
AIM
This study aimed to measure frailty in a sample of hospitalized adults aged 18 years and over and to examine how frailty in younger adult inpatients differs from middle-aged and older adult inpatients.
DESIGN
Secondary analyses of prospectively collected cohort data.
METHODS
Research nurses assessed 910 patients at admission to four Australian hospitals using the interRAI Acute Care instrument. Comparison of frailty index (FI) scores and domains was conducted across three age groups: younger (18-49 years), middle-aged (50-69 years) and older adults (≥70 years). Multivariable logistic regression examined risk of prolonged length of stay and unfavourable discharge destination.
RESULTS
Younger adults (n = 214; 23.5%) had a mean (SD) FI of 0.19 (0.10). Approximately 27% (n = 57) of younger adults were frail (FI > 0.25). Mood and behaviour, health symptoms and syndromes, nutrition and pain were the most frequently affected domains in younger adults and 50% had ≥3 comorbidities. Frailty increased the risk of long length of stay (odds ratio (OR) = 1.77, P < 0.001) but not the risk of an unfavourable discharge (OR = 1.40, P = 0.20) in younger adults.
CONCLUSIONS
This study showed that frailty is prevalent in younger patients admitted to acute care and is associated with adverse outcomes. This study was a critical first step towards establishing an understanding of frailty in younger hospitalized adults.
Topics: Aged; Humans; Adolescent; Adult; Middle Aged; Young Adult; Frailty; Frail Elderly; Length of Stay; Australia; Hospitals; Geriatric Assessment
PubMed: 37467071
DOI: 10.1093/qjmed/hcad173 -
The International Journal of Behavioral... May 2022Walkability indices have been developed and linked to behavioural and health outcomes elsewhere in the world, but not comprehensively for Europe. We aimed to 1) develop...
BACKGROUND
Walkability indices have been developed and linked to behavioural and health outcomes elsewhere in the world, but not comprehensively for Europe. We aimed to 1) develop a theory-based and evidence-informed Dutch walkability index, 2) examine its cross-sectional associations with total and purpose-specific walking behaviours of adults across socioeconomic (SES) and urbanisation strata, 3) explore which walkability components drive these associations.
METHODS
Components of the index included: population density, retail and service density, land use mix, street connectivity, green space, sidewalk density and public transport density. Each of the seven components was calculated for three Euclidean buffers: 150 m, 500 m and 1000 m around every 6-digit postal code location and for every administrative neighbourhood in GIS. Componential z-scores were averaged, and final indices normalized between 0 and 100. Data on self-reported demographic characteristics and walking behaviours of 16,055 adult respondents (aged 18-65) were extracted from the Dutch National Travel Survey 2017. Using Tobit regression modelling adjusted for individual- and household-level confounders, we assessed the associations between walkability and minutes walking in total, for non-discretionary and discretionary purposes. By assessing the attenuation in associations between partial indices and walking outcomes, we identified which of the seven components drive these associations. We also tested for effect modification by urbanization degree, SES, age and sex.
RESULTS
In fully adjusted models, a 10% increase in walkability was associated with a maximum increase of 8.5 min of total walking per day (95%CI: 7.1-9.9). This association was consistent across buffer sizes and purposes of walking. Public transport density was driving the index's association with walking outcomes. Stratified results showed that associations with minutes of non-discretionary walking were stronger in rural compared to very urban areas, in neighbourhoods with low SES compared to high SES, and in middle-aged (36-49 years) compared to young (18-35 years old) and older adults (50-65 years old).
CONCLUSIONS
The walkability index was cross-sectionally associated with Dutch adult's walking behaviours, indicating its validity for further use in research.
Topics: Adolescent; Adult; Aged; Cross-Sectional Studies; Environment Design; Humans; Middle Aged; Netherlands; Residence Characteristics; Walking; Young Adult
PubMed: 35501815
DOI: 10.1186/s12966-022-01270-8 -
Medical Journal of the Islamic Republic... 2019The Cognitive Orientation to daily Occupational Performance (CO-OP) approach, top-down, client-centered and goal-oriented approach originally developed for children... (Review)
Review
The Cognitive Orientation to daily Occupational Performance (CO-OP) approach, top-down, client-centered and goal-oriented approach originally developed for children with Developmental Coordination Disorder (DCD) in 2001 and since used in other populations and settings. The purpose of this scoping review was to examine the extent (number) and nature (features and characteristics) of the literature on CO-OP in adult's populations. In this scoping review, 8 online databases were searched up to April 2018 to identify articles that addressed CO-OP in adult's populations. The articles were selected based on inclusion and exclusion criteria. Two raters reviewed all documents independently. Articles were categorized according to diagnosis. Fifteen studies were identified. To examine application and effectiveness of CO-OP in adult's populations we included individuals with chronic stroke (>6 months post-stroke; n=7), with TBI (n=3), with acute stroke (<6 months post-stroke; n=4) and the older adult populations comprised those with self-reported cognitive difficulties but no diagnosis of dementia, depression, or cognitive impairment (n=1). In all cases, CO-OP showed to be useful and efficient. CO-OP has been applied in TBI, stroke and age-related executive changes appropriately. The results have shown that CO-OP efficiently improved performance and satisfaction in trained and not trained client chosen goals.
PubMed: 31696093
DOI: 10.34171/mjiri.33.99 -
Systematic Reviews May 2018Of various chronic diseases, low back pain (LBP) is the most common and debilitating musculoskeletal condition among older adults aged 65 years or older. While more... (Review)
Review
BACKGROUND
Of various chronic diseases, low back pain (LBP) is the most common and debilitating musculoskeletal condition among older adults aged 65 years or older. While more than 17 million older adults in the USA suffer from at least one episode of LBP annually, approximately six million of them experience chronic LBP that significantly affects their quality of life and physical function. Since many older adults with chronic LBP may also have comorbidities and are more sensitive to pain than younger counterparts, these older individuals may face unique age-related physical and psychosocial problems. While some qualitative research studies have investigated the life experiences of older adults with chronic LBP, no systematic review has integrated and synthesized the scientific knowledge regarding the influence of chronic LBP on the physical, psychological, and social aspects of lives in older adults. Without such information, it may result in unmet care needs and ineffective interventions for this vulnerable group. Therefore, the objective of this systematic review is to synthesize knowledge regarding older adults' experiences of living with chronic LBP and the implications on their daily lives.
METHODS/DESIGN
Candidate publications will be sought from databases: PubMed, CINAHL, and PsycINFO. Qualitative research studies will be included if they are related to the experiences of older adults with chronic LBP. Two independent reviewers will screen the titles, abstracts, and full-text articles for eligibility. The reference lists of the included studies will be checked for additional relevant studies. Forward citation tracking will be conducted. Meta-ethnography will be chosen to synthesize the data from the included studies. Specifically, the second-order concepts that are deemed to be translatable by two independent reviewers will be included and synthesized to capture the core of the idiomatic translations (i.e., a translation focusing on salient categories of meaning rather than the literal translation of words or phrases).
DISCUSSION
This systematic review of qualitative evidence will enable researchers to identify potential unmet care needs, as well as to facilitate the development of effective, appropriate, person-centered health care interventions targeting this group of individuals.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO 2018: CRD42018091292.
Topics: Activities of Daily Living; Aged; Anthropology, Cultural; Chronic Pain; Humans; Low Back Pain; Qualitative Research; Quality of Life
PubMed: 29793522
DOI: 10.1186/s13643-018-0742-5 -
Scientific Reports Jan 2023Lifespan development of postural control shows as an inverted U-shaped function with optimal performance in young adults and similar levels of underperformance in...
Lifespan development of postural control shows as an inverted U-shaped function with optimal performance in young adults and similar levels of underperformance in children and older adults. However, similarities in children and older adults might conceal differences in underlying control processes. We mapped out age-related differences in postural control using center-of-pressure trajectories of 299 participants ranging from 7 to 81 years old in three tasks: stable stance, compromised vision, and narrowed base of support. Summary statistics (path length, ellipse area) replicated the well-known U-shape function also showing that compromising vision and narrowing the base of support affected older adults more than children. Stabilogram diffusion analysis (SDA) allows to assess postural control performance in terms of diffusion at short (< 1 s) and longer timescales. SDA parameters showed the strongest short-term drift in older adults, especially under compromised vision or narrowed base of support conditions. However, older adults accommodated their poor short-term control by corrective adjustments as reflected in long-term diffusion under eyes closed conditions and initiating anti-persistent behavior earlier compared with children and young adults in tandem stance. We argue that these results highlight the adaptability of the postural control system and warrant a reinterpretation of previous postural control frameworks.
Topics: Young Adult; Child; Humans; Aged; Adolescent; Adult; Middle Aged; Aged, 80 and over; Longevity; Posture; Postural Balance; Eye
PubMed: 36631521
DOI: 10.1038/s41598-022-26934-0 -
Cognition & Emotion Dec 2021Motivational and emotional changes across adulthood have a profound impact on cognition. In this registered report, we conducted an experimental investigation of...
Motivational and emotional changes across adulthood have a profound impact on cognition. In this registered report, we conducted an experimental investigation of motivational influence on remembering intentions after a delay (prospective memory; PM) in younger, middle-aged, and older adults, using gain- and loss-framing manipulations. The present study examined for the first time whether motivational framing in a PM task has different effects on younger and older adults' PM performance ( = 180; age range: 18-85 years) in a controlled laboratory setting. Based on lifespan theories of motivation, we assumed that the prevention of losses becomes more relevant with increasing age: We expected that older adults show relatively higher PM performance in a task with loss-related consequences following PM failure than in a task in which successful PM leads to gains. The opposite pattern of performance was expected for younger adults. The findings suggest that the relevance of reward and positive gain-related consequences for successful remembering appears to decrease with age. As hypothesised, a motivational framing × age interaction indicated that age differences in memory performance were smaller with loss-related than gain-related consequences, supporting a loss-prevention view on motivated cognition.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Aging; Humans; Intention; Memory, Episodic; Mental Recall; Middle Aged; Motivation; Reward; Young Adult
PubMed: 34637692
DOI: 10.1080/02699931.2021.1986375 -
Integrative Medicine (Encinitas, Calif.) Dec 2014Phosphorus is an essential mineral for cell structure and function but, when consumed in excess of the body's requirements, has many adverse effects on metabolism and... (Review)
Review
Phosphorus is an essential mineral for cell structure and function but, when consumed in excess of the body's requirements, has many adverse effects on metabolism and health. Recently published research has revealed that the average American consumes far more phosphorus than the recommended dietary allowance (RDA) (700 mg/d for adults). Some individuals' daily phosphorus intake exceeds even an adult's tolerable upper limit (4000 mg/d). Until now, understanding of the adverse effects caused by high phosphorus intake has come from patients with chronic kidney disease (CKD), in whom high levels of serum phosphates are strongly associated with increased cardiovascular and all-cause mortality. Due to their impaired renal function, CKD patients cannot clear excess phosphorus, for which reason they must avoid processed foods, virtually all of which are laden with phosphate-containing food additives. Recently, it has become apparent that CKD patients are our canaries in the phosphate-toxicity coal mines. Excessive phosphorus consumption has now been shown to be clearly associated with cardiovascular disease, osteoporosis, and all-cause mortality in the general, healthy population.
PubMed: 26770122
DOI: No ID Found -
Revista Brasileira de Enfermagem 2023to outline the teaching of ethics in undergraduate Nursing programs in Brazilian public higher education institutions. (Review)
Review
OBJECTIVES
to outline the teaching of ethics in undergraduate Nursing programs in Brazilian public higher education institutions.
METHODS
descriptive and exploratory study, carried out through the documentary analysis of pedagogical projects of undergraduate Nursing programs in Brazil.
RESULTS
153 active undergraduate Nursing programs were found, of which 106 provide the pedagogical project. In addition to deontological teaching, the teaching of ethics was identified in a transversal way associated with themes such as Social Context, Hospital and Community Care, Pharmacology, Systematization of Nursing Care, Surgical Nursing, Epidemiology, Palliative Care, Management in Nursing, Diversity, Women's, Children's, Adolescent's, Adult's and Older People's Health, and Mental Health.
FINAL CONSIDERATIONS
the challenge in teaching nursing ethics is its integration with each action of caring, teaching and managing.
Topics: Adolescent; Adult; Aged; Child; Female; Humans; Brazil; Curriculum; Education, Nursing; Education, Nursing, Baccalaureate; Ethics, Nursing; Nursing Care; Students, Nursing; Teaching; Public Sector
PubMed: 38055529
DOI: 10.1590/0034-7167-2022-0808 -
Clinical Psychology Review Jun 2012Although the validity of adult ADHD is well established and research has identified a variety of impairments associated with the condition in adults, study of how ADHD... (Review)
Review
Although the validity of adult ADHD is well established and research has identified a variety of impairments associated with the condition in adults, study of how ADHD impacts an adult's ability to parent has been relatively neglected. Parenting is a particularly important domain of functioning given the familial nature of the disorder and emerging evidence that parenting behaviors play a role in the development or maintenance of child ADHD symptoms, comorbid psychopathologies, and other associated difficulties. In this paper, we focus on three broad categories of cognitive dysfunction proposed across models of ADHD - cognitive processes (e.g., working memory, planning, and inhibitory control), self-regulation deficits (e.g., self-monitoring of performance to detect errors or the need for regulation of behavior and/or emotions), and motivational or arousal difficulties (e.g., response to incentives, delay aversion). We consider how these deficits may lead to impairments in the parenting behaviors of effective behavioral control and emotional responsiveness, and review the available evidence regarding parenting in adults with ADHD symptoms. We conclude by noting the limitations in existing studies, and argue for further research that is theoretically grounded in how core deficits of ADHD may be related to dimensions of parenting. The implications of an improved understanding of how ADHD impacts parenting for the development of early intervention or prevention programs are outlined.
Topics: Adult; Attention Deficit Disorder with Hyperactivity; Humans; Parenting; Parents; Social Control, Informal
PubMed: 22459785
DOI: 10.1016/j.cpr.2012.01.007 -
Journal of the American Geriatrics... Apr 2023Most older adults with Alzheimer's disease and related dementias (ADRD) do not receive a timely formal diagnosis, although formal diagnosis is linked to improved...
BACKGROUND
Most older adults with Alzheimer's disease and related dementias (ADRD) do not receive a timely formal diagnosis, although formal diagnosis is linked to improved outcomes. Little is known about how a recognized formal diagnosis impacts family caregivers, who provide crucial support for older adults experiencing ADRD.
METHODS
We analyzed 2017 National Health and Aging Trends Study and linked National Study of Caregiving data for a nationally representative sample of 724 (weighted n = 5,431,551) caregivers who assisted an older adult with probable dementia. Probable dementia was determined via previously validated composite measure. We modeled caregiver experiences as a function of recognized formal ADRD diagnosis using weighted, logistic regression and adjusting for the relevant older adult and caregiver characteristics.
RESULTS
Among caregivers who assisted an older adult with probable dementia, those assisting an individual with recognized formal ADRD diagnosis were significantly more likely to report emotional difficulty (aOR: 1.77; p = 0.03) and family disagreement over the older adult's care (aOR: 5.53; p = 0.03). They were also more likely to assist with communication during doctors' visits (aOR: 9.71; p < 0.001) and to receive caregiving-related training (aOR: 2.59; p = 0.01).
CONCLUSIONS
While a timely ADRD diagnosis may help ensure access to needed supports for older adult and caregiver alike, diagnosis must be linked to support as they navigate resultant complex emotions. Formal diagnosis is linked to caregiver integration with, and support from, the older adult's team of health care providers; therefore, reducing existing disparities in timely diagnosis is necessary to ensure all caregivers have equal access to support.
Topics: Aged, 80 and over; Female; Humans; Male; Middle Aged; Alzheimer Disease; Caregivers; Delayed Diagnosis; Dementia; Family; Family Health; Logistic Models; Patient Care Team; Reproducibility of Results; Stress, Psychological; Treatment Outcome; White; Psychosocial Support Systems
PubMed: 36427288
DOI: 10.1111/jgs.18155