OBM geriatrics最新文献

{"title":"Mixed Urinary Incontinence: Diagnosis and Management","authors":"Elisabeth M. Sebesta, Roger R. Dmochowski","doi":"10.21926/obm.geriatr.2304251","DOIUrl":"https://doi.org/10.21926/obm.geriatr.2304251","url":null,"abstract":"The evaluation and treatment of mixed urinary incontinence receives relatively little attention as compared to other forms of incontinence. Mixed incontinence, however, defined as the combination of stress and urgency incontinence, accounts for the largest proportion of incontinence, with an increased incidence in older women. The condition can be very challenging to manage due to the coexistence of multiple pathologies. Treating either component can worsen the other, which means careful discussion of the risks and benefits, in addition to considerations of multimodal treatment approaches are required. In the older adult population, where this condition confers a significant impact on quality of life, there are many special considerations when evaluating and treating patients. Evaluation requires a careful assessment of the impact on QOL and goals of care and may need to involve caregivers and/or family members in the discussion, in addition to considerations of more advance evaluation on an individual basis prior to invasive treatments. Conservative treatments including behavioral and lifestyle modifications and pelvic floor physical therapy should be the mainstay of first-line treatment for older women with MUI, while taking into careful consideration how cognitive and/or physical limitations may impact treatment. Pharmacologic therapy should include a consideration of vaginal estrogen replacement, however oral medications for urgency and overactive bladder have increased risks in older women, which means more advanced treatments may want to be introduced sooner. There is really limited data on the use of third-line overactive bladder treatments in older women with mixed incontinence, however there may be some demonstrated benefits. Finally, when considering surgical interventions in this population, although the data demonstrate some benefit in mixed incontinence, providers may want to utilize a formalized assessment of frailty due to the increased morbidity associated with frailty in surgeries for incontinence.","PeriodicalId":74332,"journal":{"name":"OBM geriatrics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134975262","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Heart Failure in Elderly People: From Pathophysiology to Diagnosis and Management","authors":"Elisa Martinelli, Angelo Di Stefano, Pietro Gareri, Pasqualina Sapone, Rosaria Carlucci, Massimo Brandino, Ettore Maina, Sara Piscioneri, Giada Cagnoli, Antonino Maria Cotroneo","doi":"10.21926/obm.geriatr.2303250","DOIUrl":"https://doi.org/10.21926/obm.geriatr.2303250","url":null,"abstract":"As the older population increases, there is an increase in age-related chronic diseases, especially heart failure. It affects 25% of over 75-year-old outpatients and represents the leading cause of hospitalization and death in older people. This review aimed to point out the main characteristics concerning heart failure in older people, taking into account clinical symptoms, diagnosis, and treatment. An extensive search on heart failure was made on PubMed and Google, using the keywords older people, heart failure, epidemiology, diagnosis, clinical symptoms, and pharmacological approach. Our results underline how heart failure in older patients is a complex and multifaceted reality that requires a multidimensional assessment to frame the patient correctly, resolve the acute episode, and set a targeted therapeutic, pharmacological, and non-pharmacological approach, without neglecting the psychogeriatric aspect. The latter must be aimed at reducing the relapse rate and preserving functional autonomy and quality of life, decreasing the rate of re-hospitalization and institutionalization, the length of hospitalization, and improving predictive outcomes.","PeriodicalId":74332,"journal":{"name":"OBM geriatrics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135016252","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Redefining Hypotension in Older Adults: Implications for the Prevention of Age Related Cognitive Decline","authors":"Kenneth J. McLeod","doi":"10.21926/obm.geriatr.2303249","DOIUrl":"https://doi.org/10.21926/obm.geriatr.2303249","url":null,"abstract":"Chronically low blood pressure in older adults is associated with significantly increased long-term risks of dementia and all-cause mortality risk. Yet low blood pressure is generally not treated until an individual begins to experience the acute symptoms arising from very low cerebral perfusion. However, these acute symptoms, such as dizziness, balance difficulty, syncope, increased fall occurrence, vision impairment, and nausea, begin to occur only at very low blood pressure levels, such that mean arterial pressure levels as low as 65mmHg are often considered to be of limited concern. If the long-term consequences of chronic low blood pressure are to be prevented, an alternative approach to defining what constitutes too low a blood pressure for older adults, i.e. hypotension, will be required. Cognitive aging is a significant health concern for many older adults as it has significant impact on quality of life, and is widely considered a precursor to dementia. Here, we utilize an FDA cleared computer aided cognitive assessment tool to identify the relationship between resting brachial blood pressure in the upright seated position, and cognitive function in a convenience sample of independently living older adult men and women. We observed that resting diastolic blood pressure is significantly and positively correlated with cognitive function in adults over the age of 60 years. Specifically, cognitive performance was found to be significantly impaired for diastolic blood pressure levels below approximately 80 mmHg. Diastolic blood pressures (DBP) below 80 mmHg in older adults have consistently been shown to increase the risk of dementia as well as all-cause mortality, but the influence of below normal DBP on quality of life (QoL) in older adults has not been extensively addressed. The present work shows that adults over age 60, with a DBP below 80 mmHg, are significantly more likely to demonstrate mild to moderate cognitive impairment, and correspondingly, the associated impacts on QoL. These results lead to the suggestion that maintenance of diastolic blood in older adults in the 80-90 mmHg range will not only improve quality of life in this population, but may also provide substantial clinical benefit in terms of preventing, or reversing, age-related cognitive decline.","PeriodicalId":74332,"journal":{"name":"OBM geriatrics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135153903","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatments and Management of Menopausal Symptoms: Current Status and Future Challenges","authors":"Ciro Comparetto, Franco Borruto","doi":"10.21926/obm.geriatr.2303248","DOIUrl":"https://doi.org/10.21926/obm.geriatr.2303248","url":null,"abstract":"In the United States (US), menopause occurs at an average age of 52. Menopausal symptoms tend to be maximal during the few years before and the year after menopause (during perimenopause), except for symptomatic vulvovaginal atrophy, which may worsen over time. Up to 20% of bone density loss occurs during the first 5 years after menopause, followed by an age-related bone loss rate similar to that in men. Menopause should be considered confirmed if an age-appropriate woman who is not pregnant has not had a menstrual period for 12 months. Regarding treatment, for vaginal dryness or dyspareunia due to menopause, vaginal stimulation and vaginal lubricants and moisturizers are recommended, and if these are ineffective, low-dose vaginal estrogen, in the form of creams, tablets, suppositories, or rings should be considered; other options include oral ospemifene or intravaginal dehydroepiandrosterone (DEHA) suppositories. Before prescribing hormone replacement therapy (HRT) and periodically while therapy continues, women should be informed of risks (e.g., deep vein thrombosis [DVT], pulmonary embolism [PE], stroke, breast cancer, gallbladder disease, and urinary incontinence); potential harms are greatest for women who start HRT after 60 years of age or who are 10-20 years past menopause onset. If women choose HRT to relieve hot flushes, estrogen plus, a progestin or conjugated estrogen/bazedoxifene could be prescribed for women who still have the uterus. Treatment with HRT should be tailored to maximize benefits and minimize harms, and periodically benefits and harms should be reassessed; low-dose transdermal HRT may lead to a lower risk of DVT and stroke. Selective serotonin reuptakereuptake inhibitors (SSRIs), selective serotonin-nor-epinephrine reuptake inhibitors (SNRIs), and gabapentin could be considered as less effective alternatives to HRT for relieving hot flushes; paroxetine 7.5 milligrams (mg) is the only non-hormonal drug approved in the US for the relief of hot flushes. Effective non-drug options include cognitive behavioral therapy and hypnosis.","PeriodicalId":74332,"journal":{"name":"OBM geriatrics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135690068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Life-Changing Bubbles: A Simple Solution That May Help Many","authors":"D. Smithard, John Mirams","doi":"10.21926/obm.geriatr.2303247","DOIUrl":"https://doi.org/10.21926/obm.geriatr.2303247","url":null,"abstract":"As the medical world continues to search for ways of improving the swallowing of many millions of Dysphagia sufferers around the world, this paper is devoted to presenting the case for carbonated water to be considered as a potential solution for many. The effectiveness of carbonated water (CW) in the rehabilitation of Dysphagia has been studied periodically over the last thirty years and some significant positive results have been recorded – but it is now proposed that further research should be directed to examine the outcomes from its use by cohorts of individual patients with a similar source of their swallowing problems and with different mental or physical conditions, within different age groups.","PeriodicalId":74332,"journal":{"name":"OBM geriatrics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49640492","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"US State Hospital Regulations Rarely Include Malnutrition but Could Provide a Future Policy Framework for Improving Malnutrition Quality of Care","authors":"Laura E Borth, Meredith Whitmire, JD","doi":"10.21926/obm.geriatr.2303246","DOIUrl":"https://doi.org/10.21926/obm.geriatr.2303246","url":null,"abstract":"Malnutrition is a problem that is often not identified in hospitals as 8% of hospital patients are diagnosed but malnutrition is estimated to affect 20-50% of patients. Federal programs such as Joint Commission accreditation and the new, optional, global malnutrition composite score from CMS may improve inpatient malnutrition diagnosis, but there may be an opportunity to do more from a regulatory side. It’s unknown how many states are considering malnutrition from this standpoint. The study’s goal was to collect baseline information on mentions of malnutrition-related terms in state hospital regulations. State hospital regulations were identified in July 2022 using this website https://www.hortyspringer.com/list-links-state-hospital-regulations/ with each regulation double checked each to ensure the most updated guidelines. Hospital regulations from each state plus Washington D. C. (n = 51) were searched for number of mentions of nutrition and malnutrition and whether terms were included in a nutrition care section. Nutrition was mentioned in 82% of plans, but only 49% included nutrition in a nutrition care process section. Malnutrition was mentioned infrequently, with only three states (6%) mentioning malnutrition and only two states (4%) mentioning malnutrition in a nutrition care section. There was only one significant difference in frequency of term mentions by US region (average in Midwest 4.69, in Southeast 24). Incorporating malnutrition and nutrition care processes into state hospital regulations and defining enforcement of regulations may help increase inpatient identification of malnutrition.","PeriodicalId":74332,"journal":{"name":"OBM geriatrics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44455679","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comprehensive Geriatric Assessment of Elderly Adults","authors":"Hülya Çakmur","doi":"10.21926/obm.geriatr.2303245","DOIUrl":"https://doi.org/10.21926/obm.geriatr.2303245","url":null,"abstract":"The geriatric population is increasing all over the world. Aging people have special health requirements and comprehensive medical checkups prevent physical, functional and mental decline during the aging period. This study aimed to examine the fitness level and identify problems with the well-being of elderly persons. In this context, the study also attempted to determine the relationship between socio-demographic factors and the health status of elderly adults. In this cross-sectional study, 168 elderly adults (≥65 years old) from 12 central villages of Kars, Turkey were examined. The home home comprehensive geriatric assessment was performed by a family physician in participant. In this study group, more than half of the participants reported urinary incontinence problems (51.2%) and a very high rate of generalized pain (58.3%). The most frequently observed chronic disease was hypertension (45.2%). The percentage of chronic dental oral problems was 57.1% in the current study group. Comorbidity and polypharmacy rate among the participants was 19.0%. The reported health problems in order to frequency in the study group were; heart disease: 17.3%, benign prostatic hypertrophy:16.7%, gastric diseases: 16.3%, diabetes mellitus (type II): 13.1%, chronic obstructive pulmonary disease: 11.6%, depression: 10.9%, the audio impairment:10.7%, visual impairment: 8.3%. There was a statistically significant relationship between advanced age, low economic level, low education level, lack of social support, co-morbidities, polypharmacy, depression, and impaired health status. Comprehensive geriatric assessment of elderly adults is essential for managing geriatrics health problems. With the comprehensive geriatric assessment, pre-frail individuals could be detected and early medical care would be planned for this population.","PeriodicalId":74332,"journal":{"name":"OBM geriatrics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46686445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vascular Risks, Aging, and Late-Onset Dementia: Overlapping Etiologies Point to 'Scavenger Receptor'-Mediated Therapeutics","authors":"J. D’Arrigo","doi":"10.21926/obm.geriatr.2303244","DOIUrl":"https://doi.org/10.21926/obm.geriatr.2303244","url":null,"abstract":"Early changes in systemic vascular stiffness and endothelial function can contribute to altered cerebrovascular hemodynamics and impaired cognitive function; additionally, these vascular changes point to potential targets for prevention and treatment strategies in people with mild cognitive impairment. Although the pathogenic mechanisms underlying these vascular changes are heterogeneous and complex, one common feature is the development of cerebral blood flow (CBF) dysregulation, resulting in chronic cerebral hypoperfusion (CCH) and subsequently an insufficient blood supply to the brain. However, the incorporation of drugs, or other bioactive molecules, into specifically a \"high density lipoprotein-like\" (\"HDL-like\") lipid nanocarrier can result in the production of a multitasking \"combination therapeutic\" – capable of targeting cell-surface scavenger receptors (mainly SR-BI). Such targeting behavior of this proposed (biomimetic-nanocarrier) therapeutic vehicle can facilitate the nanocarrier's enhanced endocytosis into various target cells which, in turn, increases the likelihood that this multitasking \"combination therapeutic\" provides some enhanced efficacy at different stages of dementia.","PeriodicalId":74332,"journal":{"name":"OBM geriatrics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41658062","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"AI Literacy for an Ageing Workforce: Leveraging the Experience of Older Workers","authors":"K. Chetty","doi":"10.21926/obm.geriatr.2303243","DOIUrl":"https://doi.org/10.21926/obm.geriatr.2303243","url":null,"abstract":"This study delves into the potential benefits of Artificial Intelligence (AI) literacy training for late-career-stage workers approaching retirement. These workers often possess extensive experience but may lack the necessary digital and AI skills. AI literacy training can empower them to leverage their experience and become proficient contributors to the digital economy. Furthermore, the article describes how these workers might benefit from AI training, particularly when employing practical applications of AI in their specific field or industry. The article argues that these workers’ knowledge, insights and experience are valuable assets that can be exploited to benefit the business. Their abilities allow them to calibrate the prompts used in Generative-AI systems, maximizing the quality of the AI-generated content. Prompt engineering is a new career path that has followed the rapid emergence of Generative AI content creation. Late-career-stage workers are well suited to act in this role, leveraging their business knowledge to produce quality outputs. The study argues that employers should integrate domain-specific knowledge into the training program's structure, allowing late-career-stage workers to understand the relevance of Generative AI systems and calibrate prompts based on their experience and knowledge. Developing their AI skills can ultimately lead to increased productivity and efficiency. Moreover, this article emphasizes the potential benefits for these workers and businesses in providing AI literacy training. It not only enables late-career-stage workers to enhance their skills, but it can also bring valuable insights and experience to the business, ultimately leading to the growth and success of the business. These opportunities empower such workers to access more strategic positions in their institutions and gain a sense of fulfillment in their roles. The methodology for this study will follow a scoping literature review of academic articles. This approach allows for examining existing research on AI literacy training for late-career-stage workers. Articles were sourced through a comprehensive search of academic databases such as ScienceDirect, EbscoHost and Scopus. Search terms included AI literacy, digital literacy, aging workforce and prompt engineering.","PeriodicalId":74332,"journal":{"name":"OBM geriatrics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45820020","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cross-Temporal Patterns of Care Provision by Older Adults during COVID-19 Pandemic: Lessons for Resilience","authors":"D. Rosenberg, Sharon Shiovitz-Ezra","doi":"10.21926/obm.geriatr.2303242","DOIUrl":"https://doi.org/10.21926/obm.geriatr.2303242","url":null,"abstract":"The current study aimed to examine the link between cross-temporal patterns of care provision and loneliness in older adults. Social capital and caregiver stress perspectives served as a theoretical framework for the study. The data were obtained from the two COVID-19 waves of the Survey of Health, Ageing, and Retirement in Europe (SHARE) conducted in 2020 and 2021. The data were analyzed using logistic regression models. The analytical sample consisted of 48,722 older adults residing in Europe and Israel. The analysis results show that both starting and continuing to provide instrumental care between the survey waves negatively related to loneliness. In contrast, all cross-temporal patterns of personal care (starting, ceasing, and resuming) were positively associated with loneliness. The results suggest that cross-temporal patterns of care provision correspond differently to loneliness while supporting both theoretical perspectives. The results also suggest that the studied link exhibits different directions depending on the type of care provided.","PeriodicalId":74332,"journal":{"name":"OBM geriatrics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48578522","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}