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Howard CH Khoe, National Psychiatry Residency Programme, Singapore,Cheryl WL Chang, National University Hospital, Singapore,Cyrus SH Ho, National University Hospital, Singapore
Chapter 51 covers the topic of old age psychiatry. Through a case vignette with topical MCQs for consolidation of learning, readers are brought through the management of elderly patients with psychiatric disorders from first presentation to subsequent complications of the conditions and its treatment. Things covered include the general principles of prescribing in elderly patients with psychiatric disorders, the use of covert administration of medications, the use of medications in patients with neurocognitive disorders and variations in the presentation of depression.
Little is known about food insecurity in Asian Americans (AA). We examined age/ethnic subgroup differences in food insecurity among AA in California.
Design:
We examined associations between food insecurity and socio-demographic characteristics among AA (Chinese, Filipino, Korean, and Vietnamese) using the χ2 test. Rolling averages were calculated to examine food insecurity trends.
Setting:
California.
Participants:
We used data from the California Health Interview Survey (2011–2018) for AA categorised by age (18–39, 40–59 and 60+ years).
Results:
Food insecurity prevalence varied by subgroup, with the highest observed in older adult (aged 60+ years) Vietnamese (26 %). Between 2011–2014 and 2015–2018, food insecurity prevalence increased 20–45 % across older adults, but showed a decreasing trend among younger adults. Being foreign born and speaking a language other than English at home were associated with increased food insecurity.
Conclusions:
Community-engaged research to develop culturally appropriate strategies for mitigating food insecurity among older AA is warranted.
Physical inactivity is a leading cause globally of noncommunicable diseases such as diabetes, heart attacks, and strokes. Here, we present the results from a 4-week-long experimental test of a nudge designed to promote physical activity among 206 seniors in Abu Dhabi, United Arab Emirates—a population with one of the highest rates of physical inactivity in the world. We find that the “Forever Fit” nudge—a booklet containing a simple exercise program and information about the health benefits of physical activity—has a large positive effect on 93 previously inactive seniors. The nudge increases the time previously inactive participants spend being physically active from about 5 to about 15 minutes per day.
There are many hazards of hospitalization of the older and/or frail adult. Observation units (OUs) are a way of delivering high quality care and an appropriate level of care for older adults, while avoiding a long inpatient hospitalization. Successful intervention in a selected group of elderly patients placed in the geriatric OU from the ED can be achieved with the help of a multidisciplinary team approach.
The proportion of the US population over age 65 years has been increasing and is expected to continue to increase. Geriatric patients account for about 20% of emergency department (ED) visits and about 30% of observation unit (OU) patients. A geriatric-focused OU is well suited to serve the needs of the elderly patient. Commonly utilized services include geriatrics, physical therapy, occupational therapy, speech therapy, pharmacists, case managers, and other specialized consultants which may otherwise be difficult to access after-hours or in the ED. Arranging for a comprehensive assessment during a short observation stay avoids an unnecessary and potentially dangerous hospitalization (which exposes vulnerable patients to an increased risk of nosocomial infections, pressure ulcers, deconditioning, deep vein thrombosis, etc.) while still allowing for a period of hospital-based care and observation.
Observation units (OUs) are an ideal location for the care coordination and proper disposition of elderly patients. The availability and intensity of resources coupled with a focus on expedited disposition allows an emergency department (ED) OU to serve as the optimal location for the geriatric patient who may require placement or other geriatric-specific interventions. As many elderly patients who require placement in sub-acute or long-term care settings fail to meet established admission criteria due to chronicity of symptoms, it becomes clear that the utility of an ED OU is vital to assist with the geriatric population. By consolidating and focusing the necessary resources in one centralized location, and by placing an emphasis on value to hospital systems and patients rather than arbitrary time-points, ED OUs stand to optimize inpatient bed utilization while at the same time allow for time sensitive dispositions for these vulnerable patients.
There is a substantial difference between the housing that older Americans prefer and the housing that the market supplies. While market failures and seniors’ resource constraints explain part of this mismatch, zoning laws, Medicare and Medicaid reimbursement policies, and health law also loom large. Older Americans strongly prefer to age in place, in home-like environments. This chapter focuses on two types of housing that facilitate that manner of aging: Green House nursing homes and accessory dwelling units. The chapter discusses the substantial benefits for seniors who rely on others for care, and those who can live independently, in these respective kinds of housing. These benefits include substantial health and quality-of-life advantages as well as the ability to maintain connectedness within existing social networks. The chapter further examines the legal impediments to the proliferation of these housing types and the measures that some forward-looking jurisdictions are taking to facilitate their growth.
In the past, we did not worry much about elderly poverty because retirement was short for most Americans – a brief jaunt of post-work life was soon met with death. But with the 100-year life becoming a reality for more Americans, an elderly poverty crisis looms. The American dream of abundant retirement savings remains elusive for many, particularly low-wage workers. While government initiatives emphasize individual responsibility and financial education as a way toward retirement success, the reality is that governmental policies are barriers, including asset limitations that prevent those who receive public benefits from saving. This chapter urges reform in order to ensure the financial stability of the elderly. If we want to focus on individual responsibility for savings, we should repeal asset limitations while providing benefits and structures, early and often, that allow even our lowest-wage workers to save and at a rate that would support them in retirement. Or, social security could be reformed to be truly progressive so that all workers are secure in their golden years. Ultimately, change is needed to circumvent an elderly poverty epidemic.
To assess for differences in low score frequency on cognitive testing amongst older adults with and without a self-reported history of traumatic brain injury (TBI) in the National Alzheimer’s Coordinating Center (NACC) dataset.
Method:
The sample included adults aged 65 or older who completed the Uniform Data Set 3.0 neuropsychological test battery (N = 7,363) and was divided by individuals with and without a history of TBI, as well as cognitive status as measured by the CDR. We compared TBI- and TBI + groups by the prevalence of low scores obtained across testing. Three scores falling at or below the 2nd percentile or four scores at or below the 5th percentile were criteria for an atypical number of low scores. Nonparametric tests assessed associations among low score prevalence and demographics, symptoms of depression, and TBI history.
Results:
Among cognitively normal participants (CDR = 0), older age, male sex and greater levels of depression were associated with low score frequency; among participants with mild cognitive impairment (CDR = 0.5-1), greater levels of depression, shorter duration of time since most recent TBI, and no prior history of TBI were associated with low score frequency.
Conclusions:
Participants with and without a history of TBI largely produced low scores on cognitive testing at similar frequencies. Cognitive status, sex, education, depression, and TBI recency showed variable associations with the number of low scores within subsamples. Future research that includes more comprehensive TBI history is indicated to characterize factors that may modify the association between low scores and TBI history.
Background: Clinical outcome is one of the indicators for treatment effect in specific populations such as the elderly. Depression is manifested as the result of biological, psychological, and social factors which are interrelated in the symptoms of low mood, energy, and motivation. In specific population of elderly, depression is related to the issue of loneliness and may impact the quality of life, as well as the progression of other medical comorbidities. Therefore, it is important to monitor the progress of treatment among theelderly.
Objectives: The Objectives of this study is to observe clinical improvement of depressive symptoms through the Montgomery-Åsberg Depression Rating Scale (MADRS).
Methods: This is an observational cohort study conducted in the outpatient clinic setting. The data was collected after one month of follow-up. Each patient was assessed using the MADRS questionnaire in every clinical encounter. The MADRS scores were analysed statistically using descriptive and dependent variableanalysis.
Results: We collected 304 data of patients using MADRS as part of the clinical measurement. The average age is 69.98±6.6 years old. From gender distribution, 57.6% are female and 42.4% are male. From one-month follow-up, 37.8% of patients showed improvement of MADRS score and 39.1% remains the same from the previous visit.
Statistical analysis showed significant change of MADRS score after follow-up, indicating the importance of routine visit and monitoring for elderly showing symptoms of depression.
Conclusions: Psychometric evaluation is an essential component for observing the clinical improvement for elderly with symptoms of depression.
The World Health Organization (WHO) proclaimed September 21 as World Alzheimer’s Disease Awareness Day and extended the observance to the entire month. Various awareness campaigns are being conducted around the world, with special emphasis on the importance of education to improve the quality of life for patients, families, and the community at large, and to eliminate stigma and ageism.
It is estimated that there are approximately 44 million people worldwide with some form of dementia, while in the United States it reaches 5.4 million. In Puerto Rico, it is estimated that there are approximately 60,000 people with Alzheimer’s disease. An AARP study (2021) showed that there are over 500,000 caregivers of older adults, making Puerto Rico one of the top three countries with the largest aging population and the 6th country in the world. While in Latin America and the Caribbean there is a prevalence between 6.2 and 6.5 per 100 adults aged 60 years or older (WHO).
This health and social situation require an educated and empowered society to meet the challenges. Muñoz et. al (2023) conducted a qualitative study with caregivers and found that 91% of the participants stated that training would help them provide better care to the elderly. Social work is one of the main disciplines dealing with this social phenomenon and should therefore play a leading role in education and therapeutic intervention.
For the past five years, the Department of Social Work at Inter-American University, Metro Campus, has joined and supported the cause through the celebration of the Alzheimer’s Symposium: A Perspective from the Academy. This event involves the entire university community, as well as the community at large, which includes caregivers, government and non- profit agencies, and professionals from various disciplines. There will be concurrent lectures, Discussions among local and international professionals, a film forum, poster presentations, artistic expressions, and educational tables. The 6th Symposium will be held on September 20, 2024. The Symposium is promoted through various media. This activity has generated alliances, recommendations and new educational projects that contribute to the well-being of older adults.
Introduction: The elderly population presents aggravating factors for the risk of suicide that must be considered. In this sense, it is known that there is a tendency for elderly people not to reveal suicidal ideation and to make highly self-destructive attempts. Furthermore, poorly planned retirement, social isolation, death of a spouse, family and friends can make this situation worse. However, few studies address this topic and public policies regarding suicide among the elderly are still scarce.
Objectives: To analyze the prevalence of suicide among elderly people in different regions of Brazil between 2019 and 2021.
Methods: Quantitative, descriptive and exploratory, cross-sectional study. For collection, the DATASUS database was used, based on information regarding the cause of intentional self- harm codes X60 to X84, based on the 10th revision of the International Statistical Classification of Diseases and Related HealthProblems.
Results: It was observed that in Brazil, among elderly people of both sexes, the highest suicide rates are found in the age group of 60 to 69 years, with the general proportion of suicides being higher in the male population. Furthermore, the Southeast Region had the highest number of notifications, while the North Region of the country had the lowest. The age group equal to or greater than 80 years, presented the highest number of cases in the South Region.
Conclusions: Suicide notifications are an alarm for understanding the risk factors that must be carefully identified through a broader look at issues of mental health in the elderly. This information makes it possible to understand the current scenario of deaths by region to detect populations with a higher incidence and understand the binomial of mental health and aging.
Social isolation has been implicated in the development of cognitive impairment, but research on this association remains limited among racial-ethnic minoritized populations. Our study examined the interplay between social isolation, race–ethnicity and dementia.
Methods
We analyzed 11 years (2011–2021) of National Health and Aging Trends Study (NHATS) data, a prospective nationally representative cohort of U.S. Medicare beneficiaries aged 65 years and older. Dementia status was determined using a validated NHATS algorithm. We constructed a longitudinal score using a validated social isolation variable for our sample of 6,155 community-dwelling respondents. Cox regression determined how the interaction between social isolation and race–ethnicity was associated with incident dementia risk.
Results
Average longitudinal frequency of social isolation was higher among older Black (27.6%), Hispanic (26.6%) and Asian (21.0%) respondents than non-Hispanic White (19.1%) adults during the 11-year period (t = −7.35, p < .001). While a higher frequency of social isolation was significantly associated with an increased (approximately 47%) dementia risk after adjusting for sociodemographic covariates (adjusted hazard ratio [aHR] = 1.47, 95% CI [1.15, 1.88], p < .01), this association was not significant after adjusting for health covariates (aHR = 1.21, 95% CI [0.96, 1.54], p = .11). Race–ethnicity was not a significant moderator in the association between social isolation and dementia.
Conclusions
Older adults from racial-ethnic minoritized populations experienced a higher longitudinal frequency of social isolation. However, race–ethnicity did not moderate the positive association observed between social isolation and dementia. Future research is needed to investigate the underlying mechanisms contributing to racial-ethnic disparities in social isolation and to develop targeted interventions to mitigate the associated dementia risk.
The considerable literature on the value of a statistical life (VSL) documents the wage-mortality risk trade-offs for the working population. Regulatory analyses often must monetize risks to populations at the tails of the age distribution. Because of the longer life expectancy for children, there have been proposals to add a premium to their VSL, which would generate an inconsistency with revealed preference estimates of the VSL trajectory over the life cycle. The shorter life expectancy among older people has led to various arbitrary senior discounts for seniors’ life expectancy. Application of the value of a statistical life year (VSLY) can address valuation of small changes in life expectancy. Examples of inappropriate age adjustments that we discuss include practices by the Consumer Product Safety Commission (CPSC) and the Environmental Protection Agency (EPA).
The exclusion of the elderly and people with disabilities from cancer clinical research without appropriate justification is discriminatory and is at odds with the ethos of EU principles, laws and research regulations. It further limits study generalizability. Several primary EU laws fronted by the European Charter prohibit engaging in disparate impact discrimination on the grounds of age and disability in all of EU tasks.
Promoting healthy snacking is important in addressing malnutrition, overweight and obesity among an ageing population. However, little is known about the factors underlying snacking behaviour in older adults. The present study aimed to explore within- and between-person associations between determinants (i.e. intention, visibility of snacks, social modelling and emotions) and snacking behaviours (i.e. decision to snack, health factor of the snack and portion size) in older adults (60+). Conducting a two-part intensive longitudinal design, data were analysed from forty-eight healthy older adults consisting of (1) an event-based self-report ecological momentary assessment (EMA) diary every time they had a snack and (2) a time-based EMA questionnaire on their phone five times per day. Analysis through generalised linear mixed models indicated that higher intention to snack healthily leads to healthier snacking while higher levels of social modelling and cheerfulness promote unhealthier choices within individuals. At the between-person level, similar results were found for intention and social modelling. Visibility of a snack increased portion size at both a within- and between-person level, while the intention to eat a healthy snack only increased portion size at the between-person level. No associations were found between the decision to snack and all determinants. This is the first study to investigate both within- and between-person associations between time-varying determinants and snacking in older adults. Such information holds the potential for incorporation into just-in-time adaptive interventions, allowing for personalised tailoring, more effective promotion of healthier snacking behaviours and thus pursuing the challenge of healthy ageing.
Obstructive sleep apnea (OSA) is associated with worse outcomes in stroke, Alzheimer’s disease (AD) and Parkinson’s disease (PD), but diagnosis is challenging in these groups. We aimed to compare the prevalence of high risk of OSA based on commonly used questionnaires and self-reported OSA diagnosis: 1. within groups with stroke, AD, PD and the general population (GP); 2. Between neurological groups and GP.
Methods:
Individuals with stroke, PD and AD were identified in the Canadian Longitudinal Study of Aging (CLSA) by survey. STOP, STOP-BAG, STOP-B28 and GOAL screening tools and OSA self-report were compared by the Chi-squared test. Logistic regression was used to compare high risk/self-report of OSA, in neurological conditions vs. GP, adjusted for confounders.
Results:
We studied 30,097 participants with mean age of 62.3 years (SD 10.3) (stroke n = 1791; PD n = 175; AD n = 125). In all groups, a positive GOAL was the most prevalent, while positive STOP was least prevalent among questionnaires. Significant variations in high-risk OSA were observed between different questionnaires across all groups. Under 1.5% of individuals self-reported OSA. While all questionnaires suggested a higher prevalence of OSA in stroke than the GP, for PD and AD, there was heterogeneity depending on questionnaire.
Conclusions:
The wide range of prevalences of high risk of OSA resulting from commonly used screening tools underscores the importance of validating them in older adults with neurological disorders. OSA was self-reported in disproportionately small numbers across groups, suggesting that OSA is underdiagnosed in older adults or underreported by patients, which is concerning given its increasingly recognized impact on brain health.
This chapter seeks to promote both awareness and understanding of evidence-based psychosocial factors that enhance well-being, adjustment, and recovery in older people admitted to hospital.
The chapter begins by exploring ageing from biological, psychosocial, and existential perspectives. It then focusses upon the psychological sequel of illness and disability in this population and goes on to identify components of psychological well-being drawn from both qualitative and quantitative research studies that promote recovery in older people who have been admitted to hospital.
The chapter also explores the role of culture, faith, and ethnicity in the well-being of hospitalised older people and concludes by highlighting essential components in the development of a positive, recovery-focused culture of care.
This chapter seeks to promote both awareness and understanding of anxiety-based conditions that many older people experience in acute settings and in evidence-based medical and psychosocial interventions that support recovery.
The chapter begins by exploring and identifying the conditions, difficulties, and circumstances that give rise to anxiety in hospitalised older people. This is followed by a description of common anxiety types, their symptomatic presentation, and ther causes. The chapter goes on to explore those evidence-based medical and psychosocial treatment interventions that promote recovery and adjustment
Numerous reports addressing the care of older people have highlighted deficiencies in th provision of nutrition, hydration, and personal hygiene. Healthcare organisations may inadvertently compromise dignity by prioritising measurable targets and not placing due emphasis on the core work of looking after frail older people who are at risk of having their dignity violated.
The concept of dignity draws on ideas of dignity of merit, moral stature, and Menschenwürde (human dignity) – the dignity that each individual has as an essential component of being a human being. It is argued here that older people, as a group, are particularly worthy of the dignity of merit of wisdom, by virtue of their experience and associated understanding.
A suitable environment is important to promoting dignity; the emphasis is not only on basics like nutrition, hydration, and hygiene but on the delivery of person-centred care that encourages understanding of an older person’s life story.
Dying will come to us all (with even greater certainty than old age), and all older people have a right to respect and dignity when dying. Understanding how someone lived their life, and what was important to that person allows us to co-write the final chapter with preservation of autonomy and maintenance of dignity of personal identity.