BMC Geriatrics

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ISSN / EISSN : 1471-2318 / 1471-2318
Current Publisher: Springer Science and Business Media LLC (10.1186)
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Wei Qi Koh, Simone Anna Felding, Kübra Beliz Budak, Elaine Toomey, Dympna Casey
BMC Geriatrics, Volume 21, pp 1-17; doi:10.1186/s12877-021-02277-9

Abstract:
Background Psychosocial issues, such as social isolation and loneliness among older adults and people with dementia, continue to pose challenges with a rapidly aging population worldwide. Social robots are a rapidly emerging field of technology, developed to help address the psychosocial needs of this population. Although studies have reported positive findings regarding their psychosocial benefits, their implementation in real-world practice remains a challenge. Nevertheless, little is known about the factors affecting their implementation. The purpose of this review is to provide a systematic overview of the barriers and facilitators affecting the implementation of social robots for older adults and people with dementia. Method The Arksey and O’Malley approach with methodological enhancement by Levac et al. was used to guide the conduct of this review. Seven electronic databases were searched. In addition, hand searching and backward citation tracing was conducted. Three independent reviewers were involved in the screening and data charting process. Findings were synthesised and categorised into the five domains outlined in the Consolidated Framework of Implementation Research (CFIR). Results A total of 53 studies were included in the final review. Most of the included studies were based in participants’ homes and in care facilities. Barriers and facilitators were mapped onto 18 constructs in the five domains of the CFIR. The most frequently cited barriers were mapped to the constructs within the domain of “Intervention characteristics”, where issues such as the complexity of using the technology and technical obstacles impeded implementation. Most facilitators were mapped onto the domain “Patient needs and resources”. Overall, existing research are disproportionately focused on the internal validity (i.e. characteristics) of social robots, and there is significantly less research investigating their external validity, such as organisational or wider contextual factors that can affect their implementation in real-world practice. Conclusion This review has identified and synthesised the breadth of evidence on the barriers and facilitators to the implementation of social robots for older adults and people with dementia. Future research should pay more attention to investigating the contextual factors, using an implementation framework, to identify barriers and facilitators to guide the implementation of social robots.
, P. Arokiasamy
BMC Geriatrics, Volume 21, pp 1-13; doi:10.1186/s12877-021-02303-w

Abstract:
Background Cognitive functioning is an important measure of intrinsic capacity. In this study, we examine the association of life course socioeconomic status (SES) and height with cognitive functioning among older adults (50+) in India and China. The age pattern of cognitive functioning with measures of life course socioeconomic status has also been examined. Methods Cross-sectional comparative analysis was conducted using the WHO’s Study on global AGEing and adult health (SAGE) data for India and China. Multilevel mixed-effect linear regression analysis was used to examine the association of life course socioeconomic status and adult height with cognitive functioning. Results In both India and China, parental education as a measure of childhood socioeconomic status was positively associated with cognitive functioning. The association between adult socioeconomic status and cognitive functioning was positive and significant. Height was significantly and positively associated with improved cognitive functioning of older adults in India and China. Furthermore, the age-related decline in cognitive functioning score was higher among older adults whose parents had no schooling, particularly in China. The cognitive functioning score with age was much lower among less-educated older adults than those with higher levels of education in China. Wealthier older adults in India had higher cognitive functioning in middle ages, however, wealth differences narrowed with age. Conclusions The results of this study suggest a significant association of lifetime socioeconomic status and cumulative net nutrition on later-life cognitive functioning in middle-income settings.
Fatima Nari, Bich Na Jang, Selin Kim, Wonjeong Jeong, Sung-In Jang, Eun-Cheol Park
BMC Geriatrics, Volume 21, pp 1-11; doi:10.1186/s12877-021-02250-6

Abstract:
Background The importance of SA (Successful aging) has been emphasized in recent years, with focus shifting towards attaining healthier aging rather than longevity. However, the influence of SA and its changes on mental health such as depression remains a relatively unexplored area in gerontology. Therefore, we investigated the longitudinal association between changes in SA and depressive symptoms in Korean older adults. Methods This study comprised a longitudinal sample of older adults aged ≥ 45 years, drawn from the Korean Longitudinal Study of Aging (2006–2018). Changes in SA status was determined using the Rowe and Kahn model over two consecutive years. Using an adjusted generalized estimating equation model, we examined the association between changes in successful aging status, namely SA and NSA (Non-successful aging), and depressive symptoms. Results Compared to the SA→SA group, depressive symptom risk in the NSA→NSA and SA→NSA groups were higher in men [(OR, 1.16; 95 % CI, 1.13–1.18), (OR, 1.11; 95 % CI, 1.08–1.13), respectively] and in women [(OR, 1.15; 95 % CI, 1.13–1.18), (OR, 1.11; 95 % CI, 1.09–1.14), respectively]. Subgroup analysis of the dimensions of successful aging revealed that low or worsening criteria of successful aging status in men and women were associated with depressive symptoms. Conclusions Korean older adults who continuously failed to attain or maintain successful aging status had the highest risk of depressive symptoms. These results could further assist in establishing policies and interventions that promote successful aging and subsequently protect the mental health of the Korean older adult population.
Yi-Chang Chen, , Chen-Jung Chen, Shu-Hui Yeh, Ay-Woan Pan, Hao-Ling Chen, Chih-Hung Wang
BMC Geriatrics, Volume 21, pp 1-12; doi:10.1186/s12877-021-02297-5

Abstract:
Background Joint contractures, which affect activity, participation, and quality of life, are common complications of neurological conditions among elderly residents in long-term care facilities. This study examined the reliability and validity of the Chinese version of the PaArticular Scales in a population with joint contractures. Methods A cross-sectional study design was used. The sample included elderly residents older than 64 years with joint contractures in an important joint who had lived at one of 12 long-term care facilities in Taiwan for more than 6 months (N = 243). The Chinese version of the PaArticular Scales for joint contractures was generated from the English version through five stages: translation, review, back-translation, review by a panel of specialists, and a pretest. Test-retest reliability, internal consistency reliability, construct validity, and criterion validity were evaluated, and the results were compared with those for the World Health Organization Quality of Life scale and the World Health Organization Disability Assessment Schedule. Results The Chinese version of the PaArticular Scales had excellent reliability, with a Cronbach α coefficient of 0.975 (mean score, 28.98; standard deviation, 17.34). An exploratory factor analysis showed three factors and one factor with an eigenvalue > 1 that explained 75.176 and 62.83 % of the total variance in the Activity subscale and Participation subscale, respectively. The subscale-to-total scale correlation analysis showed Pearson correlation coefficients of 0.881 for the Activity subscale and 0.843 for the Participation subscale. Pearson’s product-moment correlation revealed that the correlation coefficient (r) between the Chinese version of the PaArticular Scales and the World Health Organization Disability Assessment Schedule was 0.770, whereas that for the World Health Organization Quality of Life scale was − 0.553; these values were interpreted as large coefficients. Conclusions The underlying theoretical model of the Chinese version of the PaArticular Scales functions well in Taiwan and has acceptable levels of reliability and validity. However, the Chinese version must be further tested for applicability and generalizability in future studies, preferably with a larger sample and in different clinical domains.
, Tianxue Hou, Yuxiao Li, Xiaocao Sun, Sarah L. Szanton, Lindy Clemson, Patricia M. Davidson
BMC Geriatrics, Volume 21, pp 1-9; doi:10.1186/s12877-021-02305-8

Abstract:
Background Fear of falling and previous falls are both risk factors that affect daily activities of older adults. However, it remains unclear whether they independently limit daily activities accounting for each other. Methods We used the data from Round 1 (Year 1) to Round 5 (Year 5) of the National Health and Aging Trends Study. We included a total of 864 community-dwelling participants who provided data on previous falls, fear of falling and limited activities from Year 1 to Year 5 and had no limited daily activities at Year 1 in this study. Previous falls and fear of falling were ascertained by asking participants how many falls they had in the past year and whether they had worried about falling in the last month. Limited daily activities included any difficulties with mobility (e.g., going outside), self-care (e.g., eating), and household activities (e.g., laundering). Generalized estimation equation models were used to examine whether previous falls and fear of falling independently predicted development of limited daily activities adjusting covariates. Results Participants were mainly between 65 and 79 years old (83 %), male (57 %), and non-Hispanic White (79 %). Among participants who had multiple falls in Year 1, 19.1-31 %, 21.4-52.4 %, and 11.9-35.7 % developed limitations in mobility, self-care, and household activities during Year 2 to Year 5, respectively. Among those who had fear of falling in Year 1, 22.5-41.3 %, 30.0-55.0 %, and 18.8-36.3 % developed limitations in mobility, self-care, and household activities during Year 2 to Year 4, respectively. Fear of falling independently predicted limitations in mobility (Incidence rate ratio [IRR]: 1.79, 95 % CI: 1.44, 2.24), self-care (IRR: 1.25, 95 % CI: 1.08, 1.44) and household activities (IRR: 1.39, 95 % CI: 1.08, 1.78) after adjusting for previous falls and covariates. Multiple previous falls independently predicted limitations in mobility (IRR: 1.72, 1.30, 2.27), self-care (IRR: 1.40, 95 % CI: 1.19, 1.66) and household activities (IRR: 1.36, 95 % CI: 1.01, 1.83) after adjusting fear of falling and covariates. Conclusions Fear of falling seems to be as important as multiple previous falls in terms of limiting older adults’ daily activities.
Chia-Ter Chao, Szu-Ying Lee, Jui Wang, Kuo-Liong Chien, Jenq-Wen Huang
BMC Geriatrics, Volume 21, pp 1-12; doi:10.1186/s12877-021-02299-3

Abstract:
Background Patients with diabetic mellitus (DM) and chronic kidney disease (CKD) are at an increased risk of urinary tract infection (UTI) due to their altered immunological integrity. These patients are similarly prone to developing frailty, a state of cumulative health deficits involving multiple domains and leading to adverse outcomes. Whether frailty predisposes affected individuals to UTI among patients with DM and CKD remains unclear. Methods A population-based cohort of patients with DM and CKD (n = 79,887) were assembled from the Longitudinal Cohort of Diabetes Patients, with their baseline frailty status measured by a modified FRAIL scale. We analyzed their risk of developing UTI depending on their severity of frailty, after accounting demographic profiles, lifestyle factors, comorbidities, concurrent medications, and major interventions. A secondary analysis focused on the risk of urosepsis related to frailty. Results Among all participants, 36.1 %, 50.3 %, 12.8 %, and 0.8 % did not have or had 1, 2, and ≥ 3 FRAIL items, respectively, at baseline. After 3.51 years, 11,175 UTI events occurred. Kaplan-Meier analysis showed that participants with DM, CKD and an increasing number of FRAIL items had successively higher incidence of UTI than those without any FRAIL items (log rank p < 0.001). Cox proportional hazard modeling revealed that after accounting for all confounders, those with more severe frailty exhibited a significantly higher risk of incident UTI (for groups of 1, 2, and ≥ 3 FRAIL items, hazard ratio 1.19, 1.24, and 1.43, respectively; all p < 0.001) than those without. An 11 % risk elevation for UTI could be observed for every FRAIL item increase. Participants with more severe frailty exhibited a trend of having higher risk of urosepsis as well. Conclusions Having frailty predicted a higher risk of developing UTI in the future in patients with DM and CKD. It would be prudent to screen for frailty in these patients and provide optimal frailty-directed management to attenuate their risk of UTI and improve their outcomes.
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, Berit Cronfalk Seiger, Monica Hermann, Arvid Rongve, Jörg Aßmus, Lars Kvinge, Åke Seiger, Knut Skaug, Anne-Marie Boström
BMC Geriatrics, Volume 21, pp 1-1; doi:10.1186/s12877-021-02269-9

, Petra Kozma, Friedrich Borchers, Simone J. T. van Montfort, Jochen Kruppa, Georg Winterer, Claudia Spies, Tobias Pischon
BMC Geriatrics, Volume 21, pp 1-10; doi:10.1186/s12877-021-02290-y

Abstract:
Background Studies suggest that a higher education and occupation are each associated with a higher late-life cognitive ability, but their inter-relationships in their association with cognitive ability and the contribution of peak IQ in young adulthood (‘pre-morbid IQ’) often remain unclear. Methods Cross-sectional analysis of 623 participants aged ≥65 years of the BioCog study. Education was coded according to the International Standard Classification of Education (ISCED; range 1 to 6). Occupation was coded as ‘semi/unskilled’, ‘skilled manual’, ‘skilled non-manual’, ‘managerial’, ‘professional’. A summary score of global ability (‘g’) was constructed from six cognitive tests. Pre-morbid IQ was estimated from vocabulary. The Geriatric Depression Scale assessed symptoms of depression. Age- and sex-adjusted analyses of covariance were performed. Results Education (partial eta2 0.076; p < 0.001) and occupation (partial eta2 = 0.037; p < 0.001) were each significantly associated with g. For education, the association was attenuated but remained statistically significant when pre-morbid IQ was controlled for (partial eta2 0.036; p < 0.001) and was unchanged with additional adjustment for depression (partial eta2 0.037; p < 0.001). For occupation, the association with g was no longer significant when pre-morbid IQ (partial eta2 = 0.015; p = 0.06) and depression (partial eta2 = 0.011; p = 0.18) were entered as covariates in separate steps. When education and occupation were entered concurrently into the fully adjusted model, only education was independently associated with g (partial eta2 0.030; p < 0.001; occupation, p = 0.93). Conclusion While a higher education and a higher occupation were each associated with a higher late-life cognitive ability, only for education some unique contribution to cognitive ability remained over and above its relationship with pre-morbid IQ, depression, and occupation. Further research is needed to address whether a longer time spent in education may promote late-life cognitive ability.
, Irma H. J. Everink, Ruud J. G. Halfens, Christa Lohrmann, Aaron Abuosi, Jos M. G. A. Schols
BMC Geriatrics, Volume 21, pp 1-11; doi:10.1186/s12877-021-02262-2

Abstract:
Background Over 60% of the population in sub-Saharan Africa, live in informal settlements (slums) with little or no resources. To be prepared to meet the needs of older people living in slums, it is necessary to know more about their quality of life (QoL). The objective of this review is to identify instruments, which can be used by researchers to assess the QoL of older adults living in African countries, especially those dwelling in slums. Methods A scoping review was performed using the databases Scopus, PubMed, and ISI Web of Science to retrieve studies published from January 2008 – September 2020. Studies were included if they reported generic QoL instruments, focused on adults with a mean age ≥ 50 and were conducted in African countries. Results In total, 18 studies were included using 7 unique instruments to measure QoL (EUROHIS-QOL-8, SWLS, WHOQOL-OLD, the WHOQOL-BREF, SF-36, SF-12 and RAND-38). All instruments could be interviewer-administered and had 5–36 items. However, little is known about their psychometric properties (validity and reliability), time-investment and cultural sensitivity of the domains included in the instruments. Conclusions Even though this review retrieved instruments used to assess QoL of older adults in African countries, there is a need for further research on adjustment and validation of currently existing QoL instruments. In addition, the development and validation of a new instrument which can be used in (illiterate) older populations, living in slums in Africa should be considered.
, Xing J. Lee, Alison Farrington, Carla Shield, Nicholas Graves, Elizabeth V. Cyarto, Lynne Parkinson, Florin I. Oprescu, Claudia Meyer, Jeffrey Rowland, et al.
BMC Geriatrics, Volume 21, pp 1-10; doi:10.1186/s12877-021-02294-8

Abstract:
Background Older people living in residential aged care homes experience frequent emergency transfers to hospital. These events are associated with risks of hospital acquired complications and invasive treatments or interventions. Evidence suggests that some hospital transfers may be unnecessary or avoidable. The Early Detection of Deterioration in Elderly residents (EDDIE) program is a multi-component intervention aimed at reducing unnecessary hospital admissions from residential aged care homes by empowering nursing and care staff to detect and manage early signs of resident deterioration. This study aims to implement and evaluate the program in a multi-site randomised study in Queensland, Australia. Methods A stepped-wedge randomised controlled trial will be conducted at 12 residential aged care homes over 58 weeks. The program has four components: education and training, decision support tools, diagnostic equipment, and implementation facilitation with clinical systems support. The integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework will be used to guide the program implementation and process evaluation. The primary outcome measure will be the number of hospital bed days used by residents, with secondary outcomes assessing emergency department transfer rates, admission rates, length of stay, family awareness and experience, staff self-efficacy and costs of both implementation and health service use. A process evaluation will assess the extent and fidelity of program implementation, mechanisms of impact and the contextual barriers and enablers. Discussion The intervention is expected to improve outcomes by reducing unnecessary hospital transfers. Fewer hospital transfers and admissions will release resources for other patients with potentially greater needs. Residential aged care home staff might benefit from feelings of empowerment in their ability to proactively manage early signs of resident deterioration. The process evaluation will be useful for supporting wider implementation of this intervention and other similar initiatives. Trial registration The trial is prospectively registered with the Australia New Zealand Clinical Trial Registry (ACTRN12620000507987, registered 23/04/2020).
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