Gerontology and Geriatric Medicine最新文献

{"title":"Risk Factor Analysis in Patients Exhibiting Cerebral Microbleeds and the Correlation with Cognitive Impairment.","authors":"Yu Cui, Tong Zhao, Weifu Zhang, Rongguo Wang, Ming Hu, Xiying He, Ying Wang, Hongyan Xie","doi":"10.1177/23337214241278497","DOIUrl":"10.1177/23337214241278497","url":null,"abstract":"<p><p><b>Objective:</b> To identify the risk factors contributing to cerebral microbleeds (CMBs), analyze the correlation between the quantity and distribution of CMBs and overall cognitive performance, including specific cognitive domains in patients, and investigate the underlying mechanisms by which CMBs impact cognitive function. <b>Methods:</b> Patients diagnosed with cerebral small vessel disease were recruited between September 2022 and September 2023. Clinical baseline data were systematically gathered. The Montreal Cognitive Assessment (MoCA) was employed to evaluate patients' cognitive status. CMBs were identified via susceptibility-weighted imaging (SWI), noting their locations and quantities. Patients were categorized into two cohorts: those without CMBs and those with CMBs. This division facilitated the comparison of basic clinical data and laboratory indicators, aiming to elucidate the risk factors associated with CMBs. Within the CMBs cohort, patients were further classified based on the number of CMBs into mild, moderate, and severe groups, and according to CMBs' locations into deep, cortical-subcortical, and mixed groups. Spearman correlation analysis and ANOVA were utilized to compare the total MoCA scores, as well as scores in specific cognitive domains, across these groups. This approach enabled the analysis of the relationship between the quantity and location of CMBs and cognitive impairment. <b>Results:</b> Statistically significant differences were noted between patients with and without cerebral microbleeds (CMBs) regarding gender, age, hypertension, diabetes, history of cerebral infarction, history of alcohol consumption, glycosylated hemoglobin levels, low-density lipoprotein cholesterol, and homocysteine levels (<i>p</i> < .05). Multifactorial logistic regression analysis identified age, hypertension, diabetes, history of alcohol consumption, and elevated homocysteine as independent risk factors for the development of CMBs. Spearman correlation analysis revealed a linear correlation between the presence of CMBs and the total score of the MoCA (<i>r</i> = -.837, <i>p</i> < .001). The group with CMBs demonstrated a significant decline in visuospatial execution function and delayed recall abilities compared to the group without CMBs (<i>p</i> < .05). Specifically, deep CMBs were linked to impairments in visuospatial execution function, naming, attention, computational ability, language, delayed recall, and orientation (<i>p</i> < .05). Cortical-subcortical CMBs affected visuospatial execution function, attention, computational ability, and delayed recall ability(<i>p</i> < .05). Mixed CMBs impacted visuospatial execution function and naming (<i>p</i> < .05). <b>Conclusion:</b> Age, hypertension, diabetes, history of alcohol consumption, and elevated homocysteine levels are key independent risk factors for CMBs. There exists a linear relationship between the severity of CMBs and the extent of cognitive impairment. Patients","PeriodicalId":52146,"journal":{"name":"Gerontology and Geriatric Medicine","volume":"10 ","pages":"23337214241278497"},"PeriodicalIF":2.1,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11375650/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142141746","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Novel Protocol for the Early Detection of COVID-19 at a Skilled Nursing Facility.","authors":"Linda Mayhue, Jeong Woo Glen Choi, Sun Jong Sam Yang, Jennifer Jacobsen, Yuna Lee, Salim Ahmed","doi":"10.1177/23337214241279531","DOIUrl":"10.1177/23337214241279531","url":null,"abstract":"<p><p>Accurate measurement of vital signs are important at skilled nursing facilities (SNF). Recent technological advancements now enable automated vital sign measurements. This overcomes the limitations of traditional manual vital sign measurement, which is time-consuming and error-prone. We present a novel case where continuous vital sign measurement was used to detect meaningful vital sign changes that led to early detection of a COVID-19 outbreak at a SNF. Residents were continuously monitored for changes to baseline respiratory rate and heart rate and with a Probability of Change (POC). Variations in baseline respiratory rate and heart rate occurred in 66% and 42%, respectively, of COVID-19 positive individuals; 83% of participants had statistically significant variations in either vital sign. Clinical investigations are typically triggered by vital signs outside normal ranges. We present a novel methodology to detect subtle vital sign changes that can lead to earlier diagnosis, treatment, and recovery from infections, like COVID-19.</p>","PeriodicalId":52146,"journal":{"name":"Gerontology and Geriatric Medicine","volume":"10 ","pages":"23337214241279531"},"PeriodicalIF":2.1,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11372764/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142134411","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding Pandemic Increases in Long-Stay Psychotropic Prescribing for Dementia Symptoms: A Survey of Nursing Home Clinicians.","authors":"John William Kerns, Jonathan D Winter, Katherine M Winter, Rebecca Etz, Sarah Reves, C J Christian Bergman","doi":"10.1177/23337214241277052","DOIUrl":"10.1177/23337214241277052","url":null,"abstract":"<p><p><b>Objective:</b> To explore the perceptions of nursing home (NH) clinicians regarding factors underpinning known increases in psychotropic prescribing over the COVID-19 pandemic. <b>Methods</b>: Three iterative online surveys were fielded to Virginia NH prescribing clinicians (11/2021-6/2022) to assess their perspectives regarding factors driving pandemic increases in NH psychotropic use. Existing literature and emerging survey data informed survey content. Sampling was for convenience and achieved through crowdsourcing, leveraging collaborations with Virginia NH clinician professional organizations. <b>Results:</b> A total of 89 surveys were collected. Clinicians noted simultaneous surging of dementia symptoms with decreased availability of non-pharmacologic measures to remedy them, leading to increased prescribing of all psychotropics. Staff shortages and turnover, isolation from family and community, and personal protective equipment protocols were identified as key pandemic factors contributing to this mismatch. <b>Conclusions:</b> Virginia NH clinicians explicitly linked increased NH psychotropic prescribing to known pandemic phenomena, associations previously hypothesized, but not, to our knowledge, directly confirmed.</p>","PeriodicalId":52146,"journal":{"name":"Gerontology and Geriatric Medicine","volume":"10 ","pages":"23337214241277052"},"PeriodicalIF":2.1,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11366089/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142114660","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Caregiver Characteristics and Barriers to Resource Use: Findings From a Rural State Caregiver Survey.","authors":"Maija Reblin, Nancy Gell, Kelly Melekis, Christine M Proulx","doi":"10.1177/23337214241275050","DOIUrl":"10.1177/23337214241275050","url":null,"abstract":"<p><p><b>Background:</b> Despite the key role family caregivers play in the US healthcare system, they are not systematically identified and tracked, limiting our knowledge about this important group. <b>Objective:</b> Our objective was to identify caregiver characteristics and barriers to service delivery in a primarily rural state. <b>Methods:</b> As part of a quality improvement project, a cross-sectional online survey was fielded in clinical and community settings. Participants included 85 self-identified adult caregivers of another adult with an illness, condition, or disability from within a US state healthcare network. Descriptive analyses were conducted, and inferential statistics were used to compare urban versus rural respondents and older versus younger respondents. <b>Results:</b> Caregivers were responsible for a wide range of care activities and particularly older caregivers spent a significant amount of time providing care. Older caregivers also reported significantly lower levels of burden compared to younger caregivers, yet both groups had clinically high levels on average. Caregivers reported receiving helpful emotional support, but needed more tangible support and were limited by availability and cost. <b>Conclusions:</b> There is a need to fund comprehensive caregiver programing and address caregivers' own social and physical health needs to reduce caregiver burden.</p>","PeriodicalId":52146,"journal":{"name":"Gerontology and Geriatric Medicine","volume":"10 ","pages":"23337214241275050"},"PeriodicalIF":2.1,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11348341/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142082547","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient Autonomy Versus Intervention: Geriatric Care Dilemmas.","authors":"Zhongxi Gao","doi":"10.1177/23337214241276796","DOIUrl":"https://doi.org/10.1177/23337214241276796","url":null,"abstract":"<p><p><b>Background:</b> The ethical challenges faced by physicians when patients or their families refuse medical interventions are particularly complex in geriatric care. This manuscript explores the delicate balance between professional recommendations and patient autonomy, focusing on the nuanced decisions surrounding enteral nutrition in older patients. <b>Methods:</b> Two case studies are presented: a 99-year-old woman with a history of hypertension, diabetes, and coronary heart disease, and an 82-year-old man with Alzheimer's disease. Both cases involve the recommendation of a nasogastric tube for enteral nutrition, and the subsequent patient and family responses to this intervention. <b>Results:</b> In the first case, the patient and her family initially refused the tube due to personal beliefs and financial concerns, leading to a focus on psychological support and symptom management. The patient eventually agreed to the tube, but tragically passed away shortly after. In contrast, the second case resulted in the patient's family agreeing to the tube after a thorough discussion, leading to a successful recovery and the patient's ability to eat orally 6 months later. <b>Conclusions:</b> The cases underscore the importance of patient-centered care, clear communication, and empathy in geriatric medicine. They highlight the need for healthcare providers to respect patient autonomy, be aware of their own biases, and engage in open dialogue with patients and families. The manuscript advocates for a nuanced approach to medical ethics, where the patient's journey is guided with respect and care, honoring their wishes while striving for the best possible outcomes.</p>","PeriodicalId":52146,"journal":{"name":"Gerontology and Geriatric Medicine","volume":"10 ","pages":"23337214241276796"},"PeriodicalIF":2.1,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11348357/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142078278","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Promise of Ecological Momentary Assessment to Improve Depression Management for Older Adults in Primary Care.","authors":"Irina Mindlis, Thomas L Rodebaugh, Dimitris Kiosses, M Carrington Reid","doi":"10.1177/23337214241278538","DOIUrl":"10.1177/23337214241278538","url":null,"abstract":"<p><p>Among older adults, depression is a common, morbid, and costly disorder. Older adults with depression are overwhelmingly treated by primary care providers with poor rates of remission and treatment response, despite attempts to improve care delivery through behavioral health integration and care management models. Given one in 10 older adults in primary care settings meet criteria for depression, there is a pressing need to improve the efficacy of depression treatment among affected individuals. Measurement-based care (i.e., the incorporation of systematic measurement of patient outcomes into treatment) for depressed older adults in primary care has had poor uptake, which at least partly underlies the limited efficacy of depression treatments. In this perspective, we discuss the proposal that ecological momentary assessment (EMA) may increase uptake of measurement-based care for depression in primary care, enhance the quality of clinical depression data, and lead to improvements in treatment efficacy without adding to providers' burden. We describe key issues related to EMA implementation and application in routine settings for depressed older adults, along with potential pitfalls and future research directions.</p>","PeriodicalId":52146,"journal":{"name":"Gerontology and Geriatric Medicine","volume":"10 ","pages":"23337214241278538"},"PeriodicalIF":2.1,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11348361/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142082549","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Self-Perception of Mental Health and Exacerbated Social Inequalities Among Vulnerable Older Adults During the COVID-19 Pandemic in Brazil (2021-2023).","authors":"Letícia Perticarrara Ferezin, Rander Junior Rosa, Mônica Chiodi Toscano de Campos, Thaís Zamboni Berra, Heriederson Sávio Dias Moura, Ariela Fehr Tártaro, Murilo César do Nascimento, Natacha Martins Ribeiro, Juliana Soares Tenório de Araújo, Fernanda Bruzadelli Paulino da Costa, Reginaldo Bazon Vaz Tavares, Yan Mathias Alves, Titilade Kehinde Ayandeyi Teibo, Regina Celia Fiorati, Severina Alice da Costa Uchoa, Rosa Maria Pinheiro Souza, Ione Carvalho Pinto, Ricardo Alexandre Arcêncio","doi":"10.1177/23337214241274833","DOIUrl":"10.1177/23337214241274833","url":null,"abstract":"<p><p>This study analyzes the self-perception of mental health of socially vulnerable elderly people during the COVID-19 crisis in Brazil. Conducted across all state capitals from February 2021 to October 2023, it included 366 participants living in various conditions such as camps, street situations, slums, and communities. The average age was 66.7 years, with a majority being male (59.0%), of Black or Brown race/color (62.3%), and earning below one minimum wage (36.6%). Findings revealed that older adults in street situations, experiencing psychological manifestations like sleep disturbances due to the pandemic, tended to assess their mental health more negatively. In contrast, older men of white race/color without such manifestations, and those practicing strategies like physical activity or relaxation, were less likely to perceive their mental health as poor. Addressing housing, implementing health strategies, and recognizing sample and regional complexities are crucial interventions for older adults in street situations.</p>","PeriodicalId":52146,"journal":{"name":"Gerontology and Geriatric Medicine","volume":"10 ","pages":"23337214241274833"},"PeriodicalIF":2.1,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11348356/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142082548","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Experience of Caregivers for Older Adults in Rural Ethiopia: Challenges and Available Social Support for Family Caregivers in Co-Residential Living Arrangement.","authors":"Kidus Yenealem Mefteh, Shambel Desale Gashaw, Tilahun Assefa Hailu, Seid Hassen Hussien","doi":"10.1177/23337214241273165","DOIUrl":"10.1177/23337214241273165","url":null,"abstract":"<p><p>Family and kinship care is a common way of caring for older adults, particularly in rural Ethiopia, where institutional care arrangements are nonexistent. Moreover, the majority of studies on family caregivers of older adults were conducted in western cultures, which makes it difficult to understand family caregivers in the Ethiopian context. This study aims at exploring the experience of family caregivers for older adults in a co-residential setting. Specifically, it focuses on answering caregiving challenges and available social supports for family caregivers in a co-residential living arrangement. This study used a qualitative research method employing phenomenology to understand the lived experience of family caregivers for older adults in rural northwestern Ethiopia. Data were collected through a semi-structured interview with eight purposefully selected family caregivers of rural older adults. Regarding family caregivers's challenges and available social supports, four themes emerged from the collected data. These are economic challenges, the incongruence of older adult needs and caregiving capacity, work-caregiving conflict, work-social life conflict, and the presence of social support from different individuals and community-based institutions. In addition to strengthening caregiver support environments, it's critical to develop the capacity of family caregivers through training, economic support, and the integration of family caregivers with health extension workers.</p>","PeriodicalId":52146,"journal":{"name":"Gerontology and Geriatric Medicine","volume":"10 ","pages":"23337214241273165"},"PeriodicalIF":2.1,"publicationDate":"2024-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11345734/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142074537","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Well-Being Outcomes from the Delivery of <i>RASCALs</i>, a Group Activity Intervention Using Nature-Focused Livestream Broadcasts.","authors":"Rebecca L Mauldin, Megan R Westmore, Anna Tulloh, Keith A Anderson","doi":"10.1177/23337214241273230","DOIUrl":"10.1177/23337214241273230","url":null,"abstract":"<p><p>Group activities and connection with nature are associated with improved well-being for older adults. This quasi-experiment tests the effectiveness of <i>RASCALs</i>, an innovative program of group activities using nature-focused livestream broadcasts. Assisted living residents in the experimental group (<i>n</i> = 16) lived in buildings that received <i>RASCALs</i> programming twice a week for 3 months. Compared to residents in the comparison group (<i>n</i> = 17) who received regular group activity programming, they experienced significant positive change in the Positive Relations with Others domain of well-being (β = .873, <i>p</i> = .008). Combining nature-focused livestream broadcasts with groups activities for older adults in assisted living communities may be an innovative and effective way to overcome barriers to accessing nature and improve residents' well-being.</p>","PeriodicalId":52146,"journal":{"name":"Gerontology and Geriatric Medicine","volume":"10 ","pages":"23337214241273230"},"PeriodicalIF":2.1,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11342327/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142057312","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Monkeypox Emergence Post-COVID: Insight into Egyptian Older Adult's Awareness, Concern, and Mental Health.","authors":"Fatma Magdi Ibrahim, Doaa Abd Elhameed Abd Elmawla, Safaa Mabrouk Abdel Aziz Elgarhy, Ateya Megahed Ibrahim, DoaaE Fadila","doi":"10.1177/23337214241273292","DOIUrl":"10.1177/23337214241273292","url":null,"abstract":"<p><p><b>Aim:</b> To identify Egyptian older adults' awareness, concerns, and mental health about the monkeypox outbreak. <b>Background:</b> In light of the ongoing COVID-19 pandemic, monkeypox disease is receiving more attention. The monkeypox virus outbreak has posed a global concern, especially to older adults with comorbidities. Natural disasters, and endemic affect older persons' mental health. <b>Design:</b> A cross-sectional descriptive design was followed. <b>Methods:</b> 254 older adults were recruited from three outpatient clinics using consecutive sampling using four tools. <b>Results:</b> 74.0% of older study participants were unaware of monkeypox. Gender, level of education, residence, worry about contracting monkeypox infection, and mental distress are predictors of awareness about monkeypox (<i>p</i> < .001). Worry of contracting monkeypox infection was common among female participants (<i>p</i> = .038), highly educated (<i>p</i> = .001), who had a low level of awareness and high level of mental distress (<i>p</i> = .001 for both). <b>Conclusion:</b> Awareness of monkeypox was associated with worry and mental distress. Gerontological nurses have a vital role in contacting older adults and providing care and education that decreases worry and preserves minds and feelings, improving their quality of life. Establishing a national strategic planning and crisis prevention framework to alleviate psychological distress and prevent mental health issues from deteriorating in this group is crucial.</p>","PeriodicalId":52146,"journal":{"name":"Gerontology and Geriatric Medicine","volume":"10 ","pages":"23337214241273292"},"PeriodicalIF":2.1,"publicationDate":"2024-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11337175/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142019547","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}