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Age-Related Diseases and Clinical and Public Health Implications for the 85 Years Old and Over Population



By 2050, the American 85 years old and over population will triple. Clinicians and the public health community need to develop a culture of sensitivity to the needs of this population and its subgroups. Sensory changes, cognitive changes, and weakness may be subtle or may be severe in the heterogeneous population of people over age 85. Falls, cardiovascular disease, and difficulty with activities of daily living are common but not universal. This paper reviews relevant changes of normal aging, diseases, and syndromes common in people over age 85, cognitive and psychological changes, social and environmental changes, and then reviews common discussions which clinicians routinely have with these patients and their families. Some hearing and vision loss are a part of normal aging as is decline in immune function. Cardiovascular disease and osteoporosis and dementia are common chronic conditions at age 85. Osteoarthritis, diabetes, and related mobility disability will increase in prevalence as the population ages and becomes more overweight. These population changes have considerable public health importance. Caregiver support, services in the home, assistive technologies, and promotion of home exercise programs as well as consideration of transportation and housing policies are recommended. For clinicians, judicious prescribing and ordering of tests includes a consideration of life expectancy, lag time to benefit, and patient goals. Furthermore, healthy behaviors starting in early childhood can optimize quality of life among the oldest-old.
December 2017 | Volume 5 | Article 3351
published: 11 December 2017
doi: 10.3389/fpubh.2017.00335
Frontiers in Public Health |
Edited by:
Gerry Leisman,
University of Haifa, Israel
Reviewed by:
Eli Carmeli,
University of Haifa, Israel
Chris Fradkin,
University of California, Merced,
United States
Efraim Jaul
Specialty section:
This article was submitted to
Child Health and Human
a section of the journal
Frontiers in Public Health
Received: 03October2017
Accepted: 24November2017
Published: 11December2017
JaulE and BarronJ (2017)
Age-Related Diseases and Clinical
and Public Health Implications for the
85Years Old and Over Population.
Front. Public Health 5:335.
doi: 10.3389/fpubh.2017.00335
Age-Related Diseases and Clinical
and Public Health Implications for
the 85Years Old and Over Population
Efraim Jaul1,2* and Jeremy Barron3,4
1 Skilled Nursing Department, Herzog Hospital, Jerusalem, Israel, 2 Hebrew University of Jerusalem, Jerusalem, Israel,
3 Johns Hopkins University, Baltimore, MD, United States, 4 Herzog Hospital, Jerusalem, Israel
By 2050, the American 85years old and over population will triple. Clinicians and the
public health community need to develop a culture of sensitivity to the needs of this
population and its subgroups. Sensory changes, cognitive changes, and weakness
may be subtle or may be severe in the heterogeneous population of people over age
85. Falls, cardiovascular disease, and difficulty with activities of daily living are common
but not universal. This paper reviews relevant changes of normal aging, diseases, and
syndromes common in people over age 85, cognitive and psychological changes,
social and environmental changes, and then reviews common discussions which clini-
cians routinely have with these patients and their families. Some hearing and vision loss
are a part of normal aging as is decline in immune function. Cardiovascular disease and
osteoporosis and dementia are common chronic conditions at age 85. Osteoarthritis,
diabetes, and related mobility disability will increase in prevalence as the population
ages and becomes more overweight. These population changes have considerable
public health importance. Caregiver support, services in the home, assistive technolo-
gies, and promotion of home exercise programs as well as consideration of transpor-
tation and housing policies are recommended. For clinicians, judicious prescribing and
ordering of tests includes a consideration of life expectancy, lag time to benefit, and
patient goals. Furthermore, healthy behaviors starting in early childhood can optimize
quality of life among the oldest-old.
Keywords: oldest-old, medical decision-making, public policy, aging, longevity
e percentage of national populations over age 65 has been increasing in the last 10years and
will continue to rise for another 20years due to improved life expectancies and a post-World War
2 baby boom. Beginning in 2030, the numbers of adults over age 85 will rise quickly. By 2050, the
number of adults over age 80 around the globe will triple from 2015 numbers (1). Some nations are
aging even faster. Now is the time for the public health community to plan for the “older-older age
wave.” Many cities have begun to explore how to make themselves more “elder-friendly.” As the baby
boom-generation ages from 65 to 85, there will be a more intense need for services in the home and
in community and institutional settings.
e aging process currently encompasses more than a generation and exceeds three decades.
e common framework for describing dierent older adult populations is “young-old” (2), “old”
(3), and “old-old.” e “young-old” are people in their 60s and early 70s who are active and healthy.
Jaul and Barron Over Age 85 Population: Clinical Decision-Making
Frontiers in Public Health | December 2017 | Volume 5 | Article 335
e “old” are people in their 70s and 80s who have chronic ill-
nesses and are slowing down with some bothersome symptoms.
e “old-old” or “oldest-old” (4) are oen sick, disabled, and
perhaps even nearing death.
When caring for older adults as a clinician or as a caregiver,
predicting the future and then planning for the most likely aging
trajectories are key steps. is paper presents a model for the
clinical and public health needs of adults over age 85.
e changes associated with a chronologic age of 85 can be
divided into a few domains: normal aging, common diseases, and
functional, cognitive/psychiatric, and social changes.
Although changes can be described in every organ system,
this review will address changes with public health and clinical
decision-making implications.
Sensory Changes
Hearing Loss
Hearing loss (presbycusis) and increased cerumen production
with aging contribute to diculty hearing. e prevalence of
hearing loss increases as a function of age and accumulating risk
factors and has a high association with reduced quality of life
(5). Approximately one-half of adults over age 85 have hearing
impairment (6). Mild hearing loss can impair speech processing,
particularly if speech is rapid or if multiple talkers in large rooms
generate reverberant noise. erefore, verbal communication
diculties are most prominent in settings where people gather.
Increased social isolation mediates the observed associations
between hearing loss and depression, cognitive decline, and
reduced quality of life.
e use of hearing aids could reverse adverse eects on
the quality of life, and cognitive function in elderly adults (7).
Unfortunately, among individuals with hearing loss in one study,
only 14.6% reported currently using a hearing aid (8). Oen,
health insurance does not oer coverage for these devices.
Visual Acuity
Visual acuity decreases normally with age (presbyopia). Older
adults will oen have problems with glare, making night driving
riskier. A (strike in) longitudinal survey conducted in the UK on
the population aged 75 and older found that prevalence of severe
visual impairment was 23% at ages 85–89 and increased to 37%
at age over 90 (9). Visual acuity deteriorates faster at higher ages.
Cataract surgery is typically safe and sometimes helps function.
Vestibular Function
Dizziness is a common multifactorial geriatric syndrome con-
tributing to falls. Vestibular function declines subtly with age.
Vestibular rehabilitation can be an eective treatment (10).
Muscle Strength and Fat Changes
Muscle mass and strength decline starting in the fourth decade
of life. By age 85, approximately 20% of people meet criteria
for sarcopenia (meaningful loss of muscle mass and strength)
(11). Chronic inammation, declining hormone levels, impaired
muscle mitochondrial function, and impaired muscle stem
cell function all probably contribute to sarcopenia (12). is
decline in muscle mass and increase in fat mass contributes to
important changes in pharmacokinetics. Older adults may need
lower medication doses than younger adults. Muscle weakness
(13) and rapid rate of strength decline (14) both predict future
ere are a wide variety of age-related changes in the immune
system, some mediated by chronic inammation and a chronic
pro-inammatory state. ere is a decline in Bcell function, a
decline in Tcell generation, altered Tcell activation, and dysfunc-
tion of innate immunity (including impaired neutrophil function
and chemotaxis and a dysregulated proinammatory monocyte
response). ese changes (15) weaken the body’s capacity to ght
infection. For example, inuenza infections are more common
and more serious in older adults while the vaccine is less eective.
Cellular immune dysfunction also contributes to the prevalence
of herpes zoster among older adults. Vaccines are generally not
as eective for older adults. High doses of the inuenza vaccine
may be more helpful than standard doses (16). Chronically
slowed inammatory processes also contribute to slow wound
healing in older adults (17).
Urologic Changes
e urinary bladder is oen not sterile in older adults but rather
is colonized with bacteria not causing infection. Asymptomatic
bacteriuria is more common in women than men and is most
frequent among hospitalized patients and residents of long-term
care facilities (up to 50% of women in these high risk groups)
(18). Use of antibiotics in this situation is inappropriate (19) and
may contribute to antimicrobial resistance.
Cardiovascular Disease
Cardiovascular disease remains the most common cause of
death of older adults, although death rates have dropped in
the last 20years. is category includes chronic ischemic heart
disease, congestive heart failure, and arrhythmia. Ischemic heart
disease may be underdiagnosed in the oldest-old (20). Normal
aging includes vascular remodeling and vascular stiness (21).
Atherosclerosis causes inammation and further vascular
changes (22) increasing risk for cardiac events, cerebrovascular
events, peripheral vascular disease, cognitive impairment, and
other organ damage.
Hypertension, a major contributor to atherosclerosis, is the most
common chronic disease of older adults (23). Isolated systolic
hypertension is particularly common among older adults and
is associated with mortality even at advanced ages. e value of
intensive pharmacotherapy for hypertension in people over age
Jaul and Barron Over Age 85 Population: Clinical Decision-Making
Frontiers in Public Health | December 2017 | Volume 5 | Article 335
75 remains controversial. Evidence seems to suggest that aggres-
sive treatment should be oered (24) and continued as long as it
is well-tolerated and consistent with the patients goals.
Cancer is the second leading cause of death in older adults.
However, by age 85, the death rate from cancer begins to fall (25).
Slow-growing tumors seem to be common in this population.
Response to cancer treatment depends on functional status
rather than age. Individuals in their ninth or tenth decade should
not be denied aggressive cancer treatment simply due to age.
Screening is not recommended for breast cancer aer age 75,
due to insucient evidence for benet, although there may be
benet for women with a long life expectancy (26, 27). Similarly,
for people over age 75 in the US, colon cancer screening is only
recommended in cases where there is a long predicted life expec-
tancy and a perceived strong capacity to tolerate cancer treatment,
if needed (27, 28). At any age, life expectancy is quite variable in
older adults, based on comorbidities and other factors (29).
Screening for prostate cancer is not recommended due to fre-
quent false positives, which are burdensome, and to identication
of slow-growing tumors (30).
Osteoarthritis is the second most common chronic condition
(23) among American older adults and a common cause of
chronic pain and disability. Fiy-two percent of 85-year olds had
a diagnosis of osteoarthritis in one study (20). e prevalence
of osteoarthritis seems to be higher among women than men.
Obesity is a risk factor for osteoarthritis and as the population
ages (and particularly as the overweight population ages), the
rate of severe hip, and knee arthritis will increase. Pain manage-
ment will continue to be a vexing clinical and health policy
problem as virtually all analgesics have remarkable risks in older
adults. Osteoarthritis treatments also include costly joint replace-
ment surgery, which is oen accompanied by intensive reha-
bilitative therapies. Low back pain is itself a common symptom
particularly in older women and the cause is oen multifactorial.
Non-pharmacologic treatments can help.
Diabetes Mellitus
Diabetes rates have been increasing as populations age and
become more overweight. e prevalence of diabetes among
American older adults may increase more than 400% by 2050
(31). Diabetes remains a strong risk factor for cardiovascular
disease at age 85 (32). Diabetes is also associated with peripheral
arterial disease and peripheral neuropathy, contributing to dia-
betic foot ulcers and amputations. Diabetic foot ulcers occur in
6% of diabetic patients annually and amputations in about 0.5%.
Management approaches in diabetes should be individualized.
Sulfonylureas and insulin carry a substantial risk of hypo-
glycemia and use should be weighed carefully in vulnerable
older adults. Transitions from hospital to home or post-acute care
are risky times for patients treated with hypoglycemic agents as
dosing needs may uctuate (31). Regular foot examinations are
critical for people with diabetes to prevent amputations. Regular
walking can improve circulation in the legs.
Osteopenia is normal loss of bone density with aging. Many
85-year-old adults have osteoporosis, a more severe weakening
of bone density. Osteoporosis is associated with an increased rate
of bone fractures, while osteopenia is not. Bone density screen-
ing is recommended for women over age 65 (33). Although the
prevalence of fractures in men increases by age 85, the value of
osteoporosis screening for men has not been clearly demonstrated.
e eectiveness and safety of calcium and vitamin D supple-
mentation in order to prevent fractures remains controversial.
Multiple Chronic Conditions
Sixty two percent of Americans over 65 have more than one
chronic condition (34) and the prevalence of multiple chronic
conditions is increasing (35), due to aging of populations and
to increasing diabetes rates. Older adults with multiple chronic
conditions account for a large percentage of health spending (36).
Targeting this population for research and for quality improve-
ment should improve care and reduce costs.
Normal age-related changes and accumulated pathology contrib-
ute to functional changes seen with aging.
Walking Speed
Walking speed declines with normal aging but will decline addi-
tionally due to disease. Walking speed measurements can be used
to predict future community ambulation, falls, disability (37), and
risk of mortality (38). Measurement of walking speed is quick,
safe, requires no special equipment, and adds no signicant cost
to clinical care. In one study, the average walking speed for the age
group of 85–89 is 1.1m/s for men and 0.8m/s for women. Aer
age 90years, mean waking speed decreased to 0.9 m/s for men
and 0.8m/s for women (39). Physical activity interventions can
improve walking speed.
Mobility Disability
Seventy-three percent of Americans over age 85 have some dif-
culty with walking according to a US Census study. Mobility
disability is associated with social isolation, falls, and depres-
sion. One-third of people over age 85 with a disability live
alone (40).
Disability in Activities of Daily Living
Disability rates are relatively high among adults over age 85.
Rates of disability in activities like dressing and bathing, and dis-
ability in instrumental activities of daily living such as cooking,
all rise with age over 80. Diculty with bathing typically pre-
cedes diculty with dressing or diculty with using the toilet.
In one study, 75% of people aged 85 had diculty or disability
with bathing and 25% had diculty or disability with using
the toilet (41). People with disabilities oen also struggle with
chronic pain, depression, and complex medication regimens
(42). e percentage of older adults with disabilities has modestly
decreased in recent decades.
Jaul and Barron Over Age 85 Population: Clinical Decision-Making
Frontiers in Public Health | December 2017 | Volume 5 | Article 335
Falls are a major cause of morbidity and disability among older
adults. 30–40% of adults over age 70 fall each year and rates are
particularly high for older adults in long-term care facilities.
Falls account for more than half of injuries among older adults.
Fall-related death rates are higher for adults over age 85 than for
other age groups (43). Physical activity, vitamin D supplementa-
tion, balance exercise, and home safety assessment as a part of
a multifactorial fall prevention program have been shown to
reduce the incidence of falls (44). Individuals with balance prob-
lems or falls should have a multifactorial falls risk assessment (45).
Frailty is dened as special vulnerability to stressors and is sug-
gested by weakness, slowness, exhaustion, and weight loss (46).
In one study, 38% of people aged 85–89 were frail (47). Frailty
status can be assessed easily and the frail state predicts future
disability, falls, hospitalizations, and poor surgical outcomes.
Targeted interventions for frail populations would likely include
physical activity and nutritional components (48) as well as
medication reviews.
irty percent of women over age 65 and 50% of older adults in
nursing facilities have urinary incontinence (49). Common causes
for incontinence among women include overactive bladder, stress
incontinence, and functional incontinence. Urinary incontinence
reduces well-being and quality of life (50). However, common
incontinence medications cause burdensome side eects.
Cognitive Aging
Mild short-term memory loss, word-nding diculty, and
slower processing speed are normal parts of aging that are oen
noticeable by age 85. Changes from normal brain aging can aect
driving safety and increase risk for nancial exploitation. ese
changes can also reduce capacity to understand complicated
medical information. Brain aging does not happen at a uniform
rate and genetic and social factors (like education and occupa-
tion) may be protective (51). Normal cognitive aging does not
lead to dementia.
Not all brain functions decline with age. Wisdom and knowl-
edge are known to increase with normal aging, contributing to
the appropriate respect aorded to community elders. Empathy
and altruism also may increase with age (52).
Rates of dementia increase with age. Death rates from Alzheimer’s
disease have been rising while death rates for cardiovascular dis-
ease have been falling. Worldwide dementia prevalence may rise
from 47 million in 2015 to 131 million in 2050. e estimated cost
of dementia worldwide was $818 billion in 2015 and is expected
to grow to $2 trillion by 2030 (53). Although dementia screening
may have limited clinical benet because medications are only
marginally eective, screening may have public health benet.
Many older adults with dementia have unmet needs and may be
living or driving unsafely (54). e Folstein Mini-Mental State
Examination is the most commonly used instrument to diagnose
dementia but has several limitations including an educational
adjustment. For example, in the Irish Longitudinal Study on
Aging, mean MMSE scores for 85-year olds with poor education
was 25.2 while mean score for 85-year olds with good education
was 28.0 (55). People with dementia need opportunities for
cognitive stimulation, caregiver support, and possibly assistive
technologies to improve safety and independence.
Depression is not a normal consequence of aging. Grief can be
a normal response to life events that occur with aging such as
bereavement; retirement/loss of income; and loss of physical,
social, or cognitive function from illness. Major depression is
common throughout adulthood but incidence rates drop aer
age 60 and then rise again aer age 80. Depression prevalence
for adults over age 85 is double the rate seen at age 70–74 (23).
Depression is even more common among institutionalized older
adults and those with disabilities (56). Aggressive approaches
to diagnosis and treatment are warranted to minimize suer-
ing, improve overall functioning, and prevent suicide. Suicide
among older American adults is most common in 85-year-old
white men (57).
Being married and being wealthy predict longer survival. e
benet of marriage seems stronger for men than women. Alter-
natively, social isolation predicts mortality and other adverse
outcomes in older adults (58). Five percent of older adults are
home bound, rarely leaving the home except for important medi-
cal appointments (59). Most of these older adults are >80. ese
older adults who live alone and are in poor health are vulnerable
during a natural disaster (60).
Most older adults, even at advanced ages, live in the commu-
nity. By 2035, the number of American households with someone
over age 80 will double (61).
Approximately 13% of women and 8% of men over age 85 live
in nursing facilities or other institutional settings (62). ese rates
have fallen in recent decades presumably due to less disability and
better care options in the home. Support for home caregivers and
promotion of home medical and social work services can further
minimize institutionalization. More than 17 million Americans
served as family caregivers to an older adult in 2011 (63). Being
a caregiver is typically a prolonged responsibility although the
number of hours of work involved markedly varies based on the
needs of the care recipient. Older adults with dementia have the
highest needs for caregiver time. Opportunities to support family
caregivers can include formal training, peer counseling, stress
management, legal advice, and employment-exibility (64).
Starting or stopping medications, ordering screening tests, send-
ing people to the hospital, and advising families about placement
Jaul and Barron Over Age 85 Population: Clinical Decision-Making
Frontiers in Public Health | December 2017 | Volume 5 | Article 335
or end of life care are complex discussions which health provid-
ers have with people over age 85. Oen, family members play a
central role in these complex discussions. e patient may have
hearing impairment, cognitive impairment, or communication
impairment. Life expectancy is oen a major consideration;
however, many patients are skeptical of life expectancy estimates
and don’t like to talk about it (65).
Polypharmacy is dened as the use of concomitant use of ve or
more medications by a single patient. When taking ve medica-
tions, the risk of an adverse drug event or drug-drug interaction
is very high. Polypharmacy increases the risk of falls, disability
(66), and other negative outcomes. Providers must weigh time to
benet, burden, risks of adverse eects, and goals of care when
choosing to start or stop medications in people over age 85 (67).
Hospitalizations are common among people over age 85 (68) and
associated with functional decline (69). Providing more acute
care in the home could help to prevent hospital complications
such as functional decline and iatrogenic infection. Attention to
transitional care and rapid post-hospital medical follow-up visits
can minimize medication errors and rehospitalization.
Institutional Placement
Many older adults value their ability to continue living in their
own homes as they age. Home-based interventions may slow the
progression of disability and prevent the need for institutionaliza-
tion (70). Discussions with families review all of the options for
living arrangements and then assess safety and preferences.
Advance Directives and End of Life Care
Many 85-year olds with multiple chronic conditions will die within
a few years. Advance directives on life-sustaining therapies such
as cardiopulmonary resuscitation, mechanical ventilation, and
tube feeding enable patients to exert some control over their end
of life care. Every 85-year-old adult should appoint a health-care
agent who can make complicated decisions in an emergency.
As people approach the end of life, medical discussions tend
to focus more on quality of life and symptom management.
However, thes e “palliative” conversations are not only appropriate
near the end of life. Clinicians should routinely assess symptoms
and evaluate which problems aect a persons quality of life.
e aging process is universal but not uniform. Awareness of
age-related physiological changes, such as reduced acuity of
vision and hearing, slow reaction time, and impaired balance, will
prepare patients and caregivers to manage risks, make informed
decisions, and perhaps prevent falls and medication adverse
Functional deterioration in an elderly person can also arise
from social and mental health problems. Awareness of these
problems may prevent age-related deterioration, such as atten-
tion to depression and suicide risk in men during the rst year
following the death of a spouse or depression aer hip fracture
or stroke.
Optimizing vision and hearing can prevent isolation, depression,
and cognitive impairment. Lower extremity strength especially
of the quadriceps muscle is critical for basic activities of daily
living, especially bathing, walking, and performing transfers.
People over age 85 need these muscles for stability and preventing
falls. Walking speed is a helpful measure. Resistance exercise such
as regular walking is recommended to help maintain strength
and prevent cardiovascular disease. Maintaining a healthy body
weight throughout the life span likewise can prevent diabetes,
osteoarthritis, and other chronic diseases.
Decisions to prescribe medications or order screening tests
should take into account goals of care, burden, risks, and lag time
to benet. In the future, more adults over age 85 will benet from
home-based services and technologies and will benet from crea-
tive transportation and housing services opportunities for social
participation, as well as programs to support family caregivers.
EJ and JB both contributed to the conception and writing of the
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Conict of Interest Statement: e authors declare that the research was con-
ducted in the absence of any commercial or nancial relationships that could be
construed as a potential conict of interest.
e reviewer EC and handling editor declared their shared aliation.
Copyright © 2017 Jaul and Barron. is is an open-access article distributed under the
terms of the Creative Commons Attribution License (CC BY). e use, distribution or
reproduction in other forums is permitted, provided the original author(s) or licensor
are credited and that the original publication in this journal is cited, in accordance
with accepted academic practice. No use, distribution or reproduction is permitted
which does not comply with these terms.
... The risk of wound infection due to ageing and age-related disorders like diabetes has increased in recent years, mirroring the worldwide trend toward an ageing population. 24 Despite numerous experiments conducted by researchers, no fool-proof method of preventing wound infections has yet been identified. ...
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Objective: To determine whether or not closed wound irrigation and suction therapy can reduce post-hysterectomy surgical site infections in middle-aged diabetic women without increasing pain, causing complications or lowering patient satisfaction. Method: The prospective randomised controlled study was conducted from April 2017 to March 2022 at Lady Willingdon Hospital, Lahore, Pakistan, and comprised women aged >40 years with body mass index >25kg/m2 who were scheduled for hysterectomy. The subjects were randomised into intervention group A and control group B. In the irrigation and suction group A, subcutaneous drains were inserted for daily closed wound saline irrigation followed by full-day suction for 3 days. In control group B, wound closure was done without drains and irrigation and suction. Wounds were assessed daily during hospitalisation and at 4, 8 and 12 weeks postoperatively. Primary outcome was surgical site infection rate, fever, white blood cell count, pain score and length of hospital stay. Secondary outcomes were readmission rate, wound pain during follow-up other complications and patient satisfaction. Data was analysed using SPSS 20. Results: Of the 334 patients, 300(89.8%) were included; 150(50%) in group A with mean age 56.66±9.264 years, and 150(50%) in group B with mean age 55.77±9.394 years. However, the study was completed by 274(91.3%) subjects; 138(50.4%) in group A and 136(49.6%) in group B. Group A had significantly fewer surgical site infections (p<0.0001), lower white blood cell count (p<0.0001), fever (p<0.001) and pain scores (p<.0001), shorter hospital stay (p<.0001) and higher patient satisfaction (p<.0001) compared to group B. Follow-up pain scores and other complications did not differ significantly between the groups (p>0.05). Conclusion: Irrigation and suction strategy reduced surgical site infection rates without increasing pain, causing complication or compromising patient satisfaction. Key Words: Surgical site infection, Elderly, Diabetic women, Abdominal hysterectomy, Suction, Irrigation, Satisfaction.
... As people aged, they often become more aware of the relationship between their diet and various health issues, motivating them to prioritize healthier food choices. Furthermore, dietrelated chronic diseases are more prevalent among the older age group [43], which may lead to greater awareness of health status and potential risks, encouraging them to adopt healthier eating habits and to follow specific dietary guidelines. Lastly, adults often have more access to resources such as nutritional information, culinary skills and financial means to afford healthier food choices. ...
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A healthy lifestyle and proper nutrition have a major impact on the well-being of a population. Therefore, the aim of this research is to describe the behavior of these habits in relation to sociodemographic variables to provide data on the development of effective training and awareness-raising actions. Methods: An observational, descriptive and cross-sectional study was carried out. To study the behavior of a series of variables related to eating habits and lifestyle, a questionnaire was designed and validated and subsequently disseminated online, by means of nonprobabilistic snowball sampling, relying on social networks. The sample collected consisted of 18,070 young adults of Spanish nationality. Bivariate comparative analyses were performed using t-test independent samples, and the effect size (ES) was calculated by determining Cohen’s D coefficient. A multivariate analysis were conducted using linear regression and principal component analysis. Results: Adults eat better but have a poorer quality of rest and are more sedentary than young people. No gender differences were found in nutritional habits; however, men engage in more sports and sleep better. People with a higher educational level have better nutritional and sleep habits, but are more sedentary, as are people of a higher socioeconomic level. Conclusions: Higher socioeconomic and educational levels seem to favor a healthier lifestyle. The Spanish population aged 18–45 years needs to make dietary changes but leads an active lifestyle.
... This lack of consensus in the literature highlights the complex nature of the underlying timing mechanism. The effects of aging on time perception are not well known and often attributed to cognitive changes (Jual and Barron, 2017). Turgeon et al. (2016) reviewed age-related effects on time perception. ...
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Our perception of time plays a critical role in nearly all daily activities and especially in sports. There are no studies that have investigated and compared time perception during exercise in young and older adults. Thus, this study aimed to compare the effects of exercise on time perception between younger and older adult populations. Thirty-three recreationally active participants were recruited and assigned to either the younger (university students, 9 males and 10 females) or older adults (>60 years, 8 males and 6 females). All participants completed four exercise conditions over two sessions on separate days: approximately 30-seconds of knee extensors 100%, 60% and 10% of maximum voluntary isometric contraction (MVIC), and control (no contractions). Prospective time perception was estimated (at 5-, 10-, 20-, and 30-seconds) at the beginning of each session and while performing the exercise. A main effect for condition (p < 0.001, d = 1.06) with subsequent post-hoc tests indicated participants significantly underestimated (estimated time was shorter than chronological time) time in all three exercise conditions compared to the control. There were no significant age group differences. In conclusion, exercise underestimated time estimates regardless of intensity or age. This questions the postulated intensity-dependent relationship between exercise and time perception. While older adults were expected to be less accurate in their time estimates, they may have been able to adopt alternative strategies for age-related changes in their internal clock, resulting in no significant age group differences.
... As people age, there are a variety of psychological, biological, and social changes in life. Compared to those in the first two age groups, individuals at an advanced age are more likely to experience obvious ageing symptoms, overall health decline and multiple comorbidities, falls and fall-related injuries, and losses (Jaul & Barron, 2017;Wang et al., 2020). Staying at home, the primary manifestation of ageing in place, is the strong preference of many older adults to spend later life (Han et al., 2020;Molina-Mula et al., 2020). ...
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Purpose Older adults aged ≥ 80 years living alone at home are more likely to experience challenges. Daily life experiences regarding living alone are still limited in the Asian context. This study explored the everyday life experiences of older Chinese residents living alone at home. Research questions included: (1) How do Chinese community-dwelling old people describe everyday life experiences related to living alone? (2) What kind of difficulties and needs do Chinese community-dwelling older people living alone face in everyday lives? (3) How do Chinese community-dwelling older people cope with challenges faced in their everyday lives related to living alone? Methods This was qualitative descriptive research. Purposive sampling was adopted to recruit 13 participants aged 80–92 years of age from communities and one hospital. Semi-structured interviews were conducted to collect data which was analysed by conventional content analysis. Results Three themes were identified: theme 1–difficulty in finding a sense of belonging, theme 2–striving to maintain independence, theme 3–hard to gain a sense of control. Conclusions This study provided novel insights into understanding the difficulties and needs of Chinese older people living alone at home. Three key challenges and associated strategies they used to cope with in daily lives were presented.
... The prevalence of chronic conditions rises with age, with approximately 62% of Americans aged 65 and above having at least one chronic condition [1][2][3] . Fatigue is a common and complex symptom reported by individuals with various chronic conditions (e.g., cancer, Parkinson's Disease, inflammatory arthritis, and fibromyalgia) [4][5][6][7] . ...
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Fatigue is barrier of physical activity participation in adults with chronic conditions. However, physical activity alleviates fatigue symptoms. This systematic review and meta-analysis aimed to (1) synthesise evidence from randomised controlled trials (RCTs) exploring the effects of physical activity interventions on fatigue reduction and (2) evaluate their effectiveness. Medline/CINAHL/EMBASE/Web of Science and Scopus were searched up to June 24th, 2023. Two reviewers independently conducted study screening and selection (RCTs), extracted data and assessed risk of bias (RoB2). Outcome was the standardised mean difference (SMD) with 95% confidence intervals in fatigue between experimental and control groups. 38 articles met the inclusion criteria. Overall, physical activity interventions moderately reduced fatigue (SMD = 0.54, p < 0.0001). Interventions lasting 2–6 weeks demonstrated a larger effect on fatigue reduction (SMD = 0.86, p < 0.00001). Interventions with 18–24 sessions showed a large effect on fatigue reduction (SMD = 0.97, p < 0.00001). Aerobic cycling and combination training interventions had a large to moderate effect (SMD = 0.66, p = 0.0005; SMD = 0.60, p = 0.0010, respectively). No long-term effects were found during follow-up. Physical activity interventions moderately reduced fatigue among adults with chronic conditions. Duration, total sessions, and mode of physical activity were identified as key factors in intervention effectiveness. Further research is needed to explore the impact of physical activity interventions on fatigue.
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Objectives: This study aims to determine the prevalence, characteristics and determinants of polypharmacy among elderly patients in Bahrain. Methods: A cross-sectional study was conducted in the period between March and April 2022 in all primary healthcare centres in Bahrain. A simple random sample was obtained. An elderly patient was defined as a patient aged 60 years or above. In addition, polypharmacy was defined as the concomitant use of 5 medications or more and excessive polypharmacy was defined as the concomitant use of 10 medications or more. Results: A total of 977 patients were included, more than half of them were females (n=533, 54.44%) and the mean age of the participants was 67.90 ±6.87 years. Essential hypertension, hyperlipidemia and diabetes mellitus were the most common comorbidities among the participants (61.51%, 57.63% and 53.22%, respectively). Of the cohort, 443 were on 5 or more medications i.e., polypharmacy (45.34%), and around 7% were on at least 10 medications (n=66, 6.76%). A multivariate analysis revealed that patients with diabetes (OR=5.836, CI 4.061-8.385, P<0.001), hypertension (OR=6.231, CI= 4.235-9.168, P<0.001), hyperlipidemia (OR 3.999, 95% CI 2.756-5.802, P<0.001), cardiovascular diseases (OR 3.589, 95 CI 1.787-7.205, P<0.001) and asthma (OR 3.148, 95% CI 1.646-6.019, P<0.001) were significantly more likely to suffer from polypharmacy. Conclusion: Polypharmacy was prevalent among elderly patients in Bahrain, particularly among those with non-communicable diseases. Polypharmacy should be considered while delivering elderly healthcare services, especially in patients with non-communicable diseases. Keywords: Aged, Bahrain, Elderly, Polymorbidity, Polypharmacy.
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This comprehensive review delves into the intricate relationship between aging, chronic diseases, and the application of mathematical reliability theory. With global demographics shifting towards an increasingly aged population, understanding the impact of longevity and the growing prevalence of chronic ailments is paramount. We explore various theories of aging, emphasizing the multifactorial nature of the aging process. Furthermore, we discuss the clinical consequences of population aging and the need for proactive preventive strategies. Physical inactivity and sedentary behavior are examined as key contributors to chronic diseases among older adults. Finally, we highlight the relevance of reliability theory in comprehending the development and progression of chronic health conditions in aging populations. This review provides valuable insights into the challenges and opportunities presented by global population aging and underscores the importance of holistic approaches to promote both lifespan and health span.
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Lipids can be of endogenous or exogenous origin and affect diverse biological functions, including cell membrane maintenance, energy management and cellular signalling. Here, we report >800 lipid species, many of which are associated with health-to-disease transitions in diabetes, ageing and inflammation, as well as cytokine–lipidome networks. We performed comprehensive longitudinal lipidomic profiling and analysed >1,500 plasma samples from 112 participants followed for up to 9 years (average 3.2 years) to define the distinct physiological roles of complex lipid subclasses, including large and small triacylglycerols, ester- and ether-linked phosphatidylethanolamines, lysophosphatidylcholines, lysophosphatidylethanolamines, cholesterol esters and ceramides. Our findings reveal dynamic changes in the plasma lipidome during respiratory viral infection, insulin resistance and ageing, suggesting that lipids may have roles in immune homoeostasis and inflammation regulation. Individuals with insulin resistance exhibit disturbed immune homoeostasis, altered associations between lipids and clinical markers, and accelerated changes in specific lipid subclasses during ageing. Our dataset based on longitudinal deep lipidome profiling offers insights into personalized ageing, metabolic health and inflammation, potentially guiding future monitoring and intervention strategies.
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Introduction Chronic diseases constitute a major public health challenge. The prevalence of multiple chronic conditions (MCC) has increased. The objective of our study was to describe the prevalence, correlates, and time trends of MCC in the Israeli population and among the nation’s 2 main population groups (Jewish and Arab). Methods To describe the prevalence of correlates of MCC, we used data from the 2014–2015 Israeli National Health Interview Survey-III (INHIS-III). MCC was defined as having 2 or more of the following 10 self-reported physician-diagnosed chronic conditions: asthma, arthritis, cancer, diabetes, dyslipidemia, heart attack, hypertension, migraine, osteoporosis, or thyroid disease. For trend analysis, we used data from INHIS-I (2003–2004) and INHIS-II (2007–2010). Logistic regression was used for multivariate analysis. Estimates were weighted to the 2014 Israeli population. P for trend was calculated by using the Cochran–Armitage test for proportions. Results In 2014–2015, the prevalence of MCC was 27.3% (95% confidence interval, 25.7%–28.8%). In multivariate analysis, MCC was associated with older age, female sex, a monthly household income of USD$3,000 or less, current and past smoking, and overweight or obesity. After adjusting for age, sex, income, smoking status, and body mass index, differences in MCC between Jewish and Arab populations disappeared. Dyslipidemia and hypertension were the most prevalent dyad among both men and women. Dyslipidemia, hypertension, and diabetes were the most prevalent triad among both men and women. The age-adjusted prevalence of MCC increased by 6.7% between 2003–2004 and 2014–2015. Conclusion With the increase in the prevalence of MCC, a comprehensive approach is needed to reduce the burden of chronic conditions. Of special concern are the groups most prone to MCC.
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Background: frailty impacts older adults' ability to recover from an acute illness, injuries and other stresses. Currently, a systematic synthesis of available interventions to prevent or reduce frailty does not exist. Therefore, we conducted a scoping review of interventions and international policies designed to prevent or reduce the level of frailty in community-dwelling older adults. METHODS AND ANALYSIS: we conducted a scoping review using the framework of Arksey and O'Malley. We systematically searched articles and grey literature to identify interventions and policies that aimed to prevent or reduce the level of frailty. Results: fourteen studies were included: 12 randomised controlled trials and 2 cohort studies (mean number of participants 260 (range 51-610)), with most research conducted in USA and Japan. The study quality was moderate to good. The interventions included physical activity; physical activity combined with nutrition; physical activity plus nutrition plus memory training; home modifications; prehabilitation (physical therapy plus exercise plus home modifications) and comprehensive geriatric assessment (CGA). Our review showed that the interventions that significantly reduced the number of frailty markers present or the prevalence of frailty included the physical activity interventions (all types and combinations), and prehabilitation. The CGA studies had mixed findings. Conclusion: nine of the 14 studies reported that the intervention reduced the level of frailty. The results need to be interpreted with caution, as only 14 studies using 6 different definitions of frailty were retained. Future research could combine interventions targeting more frailty markers including cognitive or psychosocial well-being.
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Introduction: Recognition that an older person has sarcopenia is important because this condition is linked to a range of adverse outcomes. Sarcopenia becomes increasingly common with age, and yet there are few data concerning its descriptive epidemiology in the very old (aged 85 years and above). Our aims were to describe risk factors for sarcopenia and estimate its prevalence and incidence in a British sample of the very old. Methods: We used data from two waves (2006/07 and 2009/10) of the Newcastle 85+ Study, a cohort born in 1921 and registered with a Newcastle/North Tyneside general practice. We assessed sarcopenia status using the European Working Group on Sarcopenia in Older People (EWGSOP) definition. Grip strength was measured using a Takei digital dynamometer (Takei Scientific Instruments Ltd., Niigata, Japan), gait speed was calculated from the Timed Up and Go test, and lean mass was estimated using a Tanita-305 body fat analyzer. We used logistic regression to examine associations between risk factors for prevalent sarcopenia at baseline and incident sarcopenia at follow-up. Results: European Working Group on Sarcopenia in Older People sarcopenia was present in 21% of participants at baseline [149/719 participants, mean age 85.5 (0.4) years]. Many participants had either slow gait speed or weak grip strength (74.3%), and hence measurement of muscle mass was frequently indicated by the EWGSOP definition. Incidence data were available for 302 participants, and the incident rate was 3.7 cases per 100 person years at risk. Low Standardized Mini-Mental State Examination, lower occupational social class, and shorter duration of education were associated with sarcopenia at baseline, while low muscle mass was associated with incident sarcopenia. Low body mass index (BMI) was a risk factor for both in a graded fashion, with each unit decrease associated with increased odds of prevalent [odds ratio (OR) 1.29, 95% confidence interval (CI): 1.21, 1.37] and incident (OR 1.20, 95% CI: 1.08, 1.33) sarcopenia. Conclusions: To our knowledge, this is the first study to describe prevalence and incidence of EWGSOP sarcopenia in the very old. Low BMI was a risk factor for both current and future sarcopenia; indeed, there was some evidence that low BMI may be a reasonable proxy for low lean mass. Overall, the high prevalence of sarcopenia among the very old suggests that this group should be a focus for future research.
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Moral decision making involves affective and cognitive functions like emotional empathy, reasoning and cognitive empathy/theory of mind (ToM), which are discussed to be subject to age-related alterations. Additionally, sex differences in moral decision making have been reported. However, age-related changes in moral decision making from early to late adulthood and their relation to sex and neuropsychological functions have not been studied yet. One hundred ninety seven participants (122 female), aged 1986 years, were tested with a moral decision making task comprising forced choice "everyday life" situations in which an altruistic option that favors a socially accepted alternative had to be considered against an egoistic option that favors personal benefit over social interests. The percentage of altruistic decisions was analyzed. A structural equation model (SEM) was calculated to test the hypothesis whether age and sex predict altruistic moral decision, and whether relevant neuropsychological domains mediate these hypothesized relationships. A significant relationship between age and moral decision making was found indicating more frequent altruistic decisions with increasing age. Furthermore, women decided more altruistically than men. The SEM showed that both age and sex are significant predictors of altruistic moral decision making, mediated by emotional empathy but not by reasoning. No cognitive empathy and ToM scores were correlated to age and moral decision making at the same time and thus were not included in the SEM. Our data suggest that increasing age and female sex have an effect on altruistic moral decisions, but that this effect is fully mediated by emotional empathy. The fact that changes of moral decision making with age are mediated by emotional empathy can be interpreted in the light of the so-called "positivity effect" and increasing avoidance of negative affect in aging. The mediated sex effect might represent both biological aspects and socialized sex roles for higher emotional empathy leading to more altruistic decisions.
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Purpose: To identify the factors associated with disability across many domains using a large powered sample in the activities of daily living (ADL) and instrumental activities of daily living (IADL). Methods: Those aged ≥65 years from the Irish longitudinal study on ageing (TILDA) were included in this cross sectional analysis. Three logistic regression models were used to examine the relationships between 25 health, psychological and sociodemographic variables and difficulties in ADL, IADL and ADL/IADL combined. Results: The proportion of those reporting combined ADL/IADL difficulties was 18%. More individuals reported difficulty with ADLs (13%) than IADLS (11%). The main model showed that after age, the top three factors associated with difficulty in ADL/IADL combined were pain, taking five or more medications and depression. After age, the factors with the highest impact on ADL disability were pain, taking five or more medications and body mass index (BMI); the factors with the highest impact on IADL were being separated or divorced, living with others (non-spouse) and self-rated memory. Conclusions: Awareness of sociodemographics and early interventions for pain and cognitive deficits could reduce ADL/IADL disability and promote successful ageing. Identification of variables that influence ADL/IADLs can be used to inform policy and practice. Implications for rehabilitation After age, pain and taking five or more medications were the strongest factors associated with difficulty in ADL/IADL combined and ADL alone. Practice therefore needs to be cognizant that it is not the disease label but the symptoms of a disease that affect ADL and IADL activities. Given the strong influence of pain on difficulties with ADL and IADL, there is a need for early interventions from a multidisciplinary perspective for pain reduction, control, and self-management. These interventions should include development of pain-coping strategies and exercises to maintain mobility. After age, being separated/divorced or living with non-spouse others are the strongest factors associated with IADL difficulties. Awareness of these social factors can be used to inform support mechanisms, such as development of community services and suitable housing for those with these changing sociodemographics. Unsurprisingly, cognitive impairments were strongly associated with IADL difficulties. Simple cognitive screening assessments could be used for early detection of cognitive changes. In order to maintain optimal cognitive functioning, rehabilitation professionals should facilitate older adults' engagement in activities that are cognitively demanding and socially interactive.
Importance Older adults with limited life expectancy are frequently screened for cancer even though it exposes them to risks of screening with minimal benefit. Patient preferences may be an important contributor to continued screening. Objective To examine older adults’ views on the decision to stop cancer screening when life expectancy is limited and to identify older adults’ preferences for how clinicians should communicate recommendations to cease cancer screening. Design, Setting, and Participants In this semistructured interview study, we interviewed 40 community-dwelling older adults (≥ 65 years) recruited at 4 clinical programs affiliated with an urban academic medical center. Main Outcomes and Measure We transcribed the audio recorded discussions and analyzed the transcripts using standard techniques of qualitative content analysis to identify major themes and subthemes. Results The participants’ average age was 75.7 years. Twenty-three participants (57.5%) were female; 25 (62.5%) were white. Estimated life expectancy was less than 10 years for 19 participants (47.5%). We identified 3 key themes. First, participants were amenable to stopping cancer screening, especially in the context of a trusting relationship with their clinician. Second, although many participants supported using age and health status to individualize the screening decision, they did not often understand the role of life expectancy. All except 2 participants objected to a Choosing Wisely statement about not recommending cancer screening in those with limited life expectancy, often believing that clinicians cannot accurately predict life expectancy. Third, participants preferred that clinicians explain a recommendation to stop screening by incorporating individual health status but were divided on whether life expectancy should be mentioned. Specific wording of life expectancy was important; many felt the language of “you may not live long enough to benefit from this test” was unnecessarily harsh compared with the more positive messaging of “this test would not help you live longer.” Conclusions and Relevance Although research and clinical practice guidelines recommend using life expectancy to inform cancer screening, older adults may not consider life expectancy important in screening and may not prefer to hear about life expectancy when discussing screening. The described communication preferences can help inform future screening discussions. Better delineating patient-centered approaches to discuss screening cessation is an important step toward optimizing cancer screening in older adults.
Objectives: To compare the cost-effectiveness of four influenza vaccines available in the United States for persons aged 65 and older: trivalent inactivated influenza vaccine (IIV3), quadrivalent inactivated influenza vaccine (IIV4), a more-expensive high-dose IIV3, and a newly approved adjuvanted IIV3. Design: Cost-effectiveness analysis using a Markov model and sensitivity analyses. Setting: A hypothetical influenza vaccination season modeled according to possible U.S. influenza vaccination policies. Participants: Hypothetical cohort of individuals aged 65 and older in the United States. Measurements: Cost-effectiveness and public health benefits of available influenza vaccination strategies in U.S. elderly adults. Results: IIV3 cost $3,690 per quality-adjusted life year (QALY) gained, IIV4 cost $20,939 more than IIV3 per QALY gained, and high-dose IIV3 cost $31,214 more per QALY than IIV4. The model projected 83,775 fewer influenza cases and 980 fewer deaths with high-dose IIV3 than with the next most-effective vaccine: IIV4. In a probabilistic sensitivity analysis, high-dose IIV3 was the favored strategy if willingness to pay is $25,000 or more per QALY gained. Adjuvanted IIV3 cost-effectiveness depends on its price and effectiveness (neither yet determined in the United States) but could be favored if its relative effectiveness is 15% greater than that of IIV3. Conclusion: From economic and public health standpoints, high-dose IIV3 for adults aged 65 years and older is likely to be favored over the other vaccines, based on currently available data. The cost-effectiveness of adjuvanted IIV3 should be reviewed after its effectiveness has been compared with that of other vaccines and its U.S. price is established.
Importance Colorectal cancer (CRC) remains a significant cause of morbidity and mortality in the United States. Objective To systematically review the effectiveness, diagnostic accuracy, and harms of screening for CRC. Data Sources Searches of MEDLINE, PubMed, and the Cochrane Central Register of Controlled Trials for relevant studies published from January 1, 2008, through December 31, 2014, with surveillance through February 23, 2016. Study Selection English-language studies conducted in asymptomatic populations at general risk of CRC. Data Extraction and Synthesis Two reviewers independently appraised the articles and extracted relevant study data from fair- or good-quality studies. Random-effects meta-analyses were conducted. Main Outcomes and Measures Colorectal cancer incidence and mortality, test accuracy in detecting CRC or adenomas, and serious adverse events. Results Four pragmatic randomized clinical trials (RCTs) evaluating 1-time or 2-time flexible sigmoidoscopy (n = 458 002) were associated with decreased CRC-specific mortality compared with no screening (incidence rate ratio, 0.73; 95% CI, 0.66-0.82). Five RCTs with multiple rounds of biennial screening with guaiac-based fecal occult blood testing (n = 419 966) showed reduced CRC-specific mortality (relative risk [RR], 0.91; 95% CI, 0.84-0.98, at 19.5 years to RR, 0.78; 95% CI, 0.65-0.93, at 30 years). Seven studies of computed tomographic colonography (CTC) with bowel preparation demonstrated per-person sensitivity and specificity to detect adenomas 6 mm and larger comparable with colonoscopy (sensitivity from 73% [95% CI, 58%-84%] to 98% [95% CI, 91%-100%]; specificity from 89% [95% CI, 84%-93%] to 91% [95% CI, 88%-93%]); variability and imprecision may be due to differences in study designs or CTC protocols. Sensitivity of colonoscopy to detect adenomas 6 mm or larger ranged from 75% (95% CI, 63%-84%) to 93% (95% CI, 88%-96%). On the basis of a single stool specimen, the most commonly evaluated families of fecal immunochemical tests (FITs) demonstrated good sensitivity (range, 73%-88%) and specificity (range, 90%-96%). One study (n = 9989) found that FIT plus stool DNA test had better sensitivity in detecting CRC than FIT alone (92%) but lower specificity (84%). Serious adverse events from colonoscopy in asymptomatic persons included perforations (4/10 000 procedures, 95% CI, 2-5 in 10 000) and major bleeds (8/10 000 procedures, 95% CI, 5-14 in 10 000). Computed tomographic colonography may have harms resulting from low-dose ionizing radiation exposure or identification of extracolonic findings. Conclusions and Relevance Colonoscopy, flexible sigmoidoscopy, CTC, and stool tests have differing levels of evidence to support their use, ability to detect cancer and precursor lesions, and risk of serious adverse events in average-risk adults. Although CRC screening has a large body of supporting evidence, additional research is still needed.
Objectives: To examine the prevalence of dementia in the absence of a reported dementia diagnosis and whether potentially unsafe activities and living conditions vary as a function of dementia diagnosis status in a nationally representative sample of older adults. Design: Observational cohort study. Setting: Community. Participants: Medicare beneficiaries aged 65 and older enrolled in the National Health and Aging Trends Study (N = 7,609). Measurements: Participants were classified into four groups based on self-report of dementia diagnosis, proxy screening interview, and cognitive testing: probable dementia with reported dementia diagnosis (n = 457), probable dementia without reported dementia diagnosis (n = 581), possible dementia (n = 996), or no dementia (n = 5,575). Potentially unsafe activities (driving, preparing hot meals, managing finances or medications, attending doctor visits alone) and living conditions (falls, living alone, and unmet needs) were examined according to dementia status subgroups in stratified analyses and multivariate models, adjusting for sociodemographic factors, medical comorbidities, and physical capacity. Results: The prevalence of driving (22.9%), preparing hot meals (31.0%), managing finances (21.9%), managing medications (36.6%), and attending doctor visits alone (20.6%) was lowest in persons with probable dementia; however, but in persons with probable dementia, the covariate-adjusted rates of driving, preparing hot meals, managing finances, managing medications, and attending doctor visits alone were significantly higher in those without reported dementia diagnosis than in those with reported diagnosis (all odds ratios ≥2.00, all P < .01). Conclusion: Older adults with probable dementia who are not aware of a dementia diagnosis are more likely to report engaging in potentially unsafe behaviors. Understanding the prevalence of potentially unsafe activities and living conditions can help clinicians focus safety screening and counseling in older adults with diagnosed or suspected dementia.
Human immune system aging results in impaired responses to pathogens or vaccines. In the innate immune system, which mediates the earliest pro-inflammatory responses to immunologic challenge, processes ranging from Toll-like Receptor function to Neutrophil Extracellular Trap formation are generally diminished in older adults. Dysregulated, enhanced basal inflammation with age reflecting activation by endogenous damage-associated ligands contributes to impaired innate immune responses. In the adaptive immune system, T and B cell subsets and function alter with age. The control of cytomegalovirus infection, particularly in the T lineage, plays a dominant role in the differentiation and diversity of the T cell compartment.