Care utilisation in the last years of life in relation to age and time to death: results from a Swedish urban population of the oldest old.
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ABSTRACT:
SUBMITTER: Larsson K
PROVIDER: S-EPMC5547275 | biostudies-other | 2008 Dec
REPOSITORIES: biostudies-other
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Project description:The oldest old generally have worse health and more comorbidities than the general population of older adults, and they are more likely to be exposed to polypharmacy. Reliable investigation of polypharmacy among the oldest old (?80 years of age) in China are lacking. So this study aims to describe the polypharmacy status of oldest old patients ?80 years of age and to assess the factors influencing medication compliance.This was a cross-sectional study of 258 oldest old patients ??80 years of age and hospitalized at a tertiary hospital in Beijing between December 1, 2014 and June 30, 2015. They completed three validated questionnaires to assess their pre-admission status (general demographics, medication knowledge, and medication adherence). Potentially inappropriate medications (PIM) use was evaluated by physicians.The majority of the patients (55.4%) took <?10 types of drugs. The numbers of drugs taken ranged from 8 to 60 drugs (median of 22.9). Patients taking 11-20 drugs accounted for 46.1% of the patients. Subjects with a history of adverse drug reactions accounted for 40.3%. The proportion of PIMs was 27.1%. Compliance was only 32.6% among the oldest old patients with polypharmacy. Age and medication classes were independently negatively associated with compliance, and medication knowledge was independently positively associated with compliance.Oldest old patients (??80 years of age) had a poor medication knowledge. Age, medication classes, and medication knowledge were independently associated with medication compliance.
| S-EPMC5834886 | biostudies-other
Project description:Contrary to common stereotypes, loneliness is not restricted to old age but can occur at any life stage. In this study, we used data from a large, nationally representative German study (N = 16,132) to describe and explain age differences in loneliness from late adolescence to oldest old age. The age distribution of loneliness followed a complex nonlinear trajectory, with elevated loneliness levels among young adults and among the oldest old. The late-life increase in loneliness could be explained by lower income levels, higher prevalence of functional limitations, and higher proportion of singles in this age group. Consistent with an age-normative perspective, the association of income, relationship status, household size, and work status with loneliness differed between different age groups. In contrast, indicators of the quantity of social relationships (social engagement, number of friends, contact frequency) were universally associated with loneliness regardless of age. Overall, these findings show that sources of loneliness in older adults are well understood. Future research should focus on understanding the specific sources of loneliness in middle-aged adults. (PsycINFO Database Record
| S-EPMC8015413 | biostudies-literature
Project description:Background:To estimate the prevalence of disability during the last 3 years prior to death among the oldest-old (?80 years) in China. Methods:We used data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), a nationally representative study of the oldest-old in China. The analytic sample included 23,934 decedents who died between 1998 and 2014 and had at least one interview within the last 3 years of life. Disability was defined as being incontinent or needing assistance in performing one or more of five other essential activities (bathing, transferring, dressing, eating, and toileting). Results:About 57.8% (weighted) of the study decedents were female. The prevalence of disability increased modestly from 36 months to 24 months prior to death (20% to 23%), more rapidly from 24-months to 12-months before death (23% to 31%), and substantially from 12 months before death to the last month of life (31% to 48%). The disability rates were lowest for participants who died between 80 and 89 years, intermediate for those who died between 90 and 99 years, and highest for those who died at age 100 or older, although the patterns over the 3-year period were comparable for the three age groups. At each time point prior to death, a higher percentage of women was disabled than men. Conclusions:In this large nationally representative sample of the oldest-old in China, the prevalence of disability during the 3 years prior to death is high and is greater in women than men and those who die at the oldest ages.
| S-EPMC6230206 | biostudies-literature
Project description:The aim of this study was to explore how very old people consider and arrive at decisions on relocation, with specific attention to housing and health relationships during the process of ageing. The sample included 13 very old participants of an 11-year longitudinal study of relationships between housing and health. Applying a mixed-methods approach, data from qualitative interviews and quantitative survey data from three data collection waves were utilised. The quantitative data were interwoven with the qualitative findings into a coherent body of text. The core theme "Negotiating and effectuating relocation is a long process" indicates a non-linear process consisting of five phases constituting the main categories of our findings. In the first phase, some informants considered relocation while others avoided thinking about it. Next, relations between health and home changed and led to turning points triggering relocation, i.e. when dependence in everyday activities reached critical points or when sudden illness forced an involuntary move. In the third phase, once the decision to relocate was made it was set in stone by the individual, but often questioned by the authorities, leading to a situation causing much frustration. While waiting for the relocation, doubts as well as expectations about the new home were expressed. Finally, even though the actual move caused different feelings, it was most often a positive experience and resulted in subjective health improvement and increased social contacts. The results can be used for the development of positive, proactive strategies for improved housing provision along the ageing process.
| S-EPMC5547368 | biostudies-other
Project description:BackgroundGlobally, the population of oldest-old (those aged ≥80 years) is rapidly growing. This change is likely to have a deep impact on societies. Resilience is a key concept related to facilitating adaptation, and can be applied, to aging-related change and losses, as well as promoting health and well-being in this population. However, no existing scales have been developed to measure resilience among oldest-old people. To address this, we developed a resilience scale for oldest-old age (RSO), and examined its reliability and validity.MethodsThe RSO is a self-administered questionnaire developed via a literature review, interviews with oldest-old individuals, and interviews with experts. The survey included 3000 community-dwelling oldest-old people who were recruited via random sampling in Yokohama city, Japan. Construct validity was determined using confirmatory factor analysis. Internal consistency was calculated using Cronbach's alpha. The revised Philadelphia Geriatric Center Morale Scale (PGC) and the self-anchoring scale to measure the feeling that life is worth living (SAS-WL) were used to assess the criterion-related validity of the RSO.ResultsWe received 1283 valid participant responses. Confirmatory factor analysis identified nine items from one factor of the RSO with a goodness of fit index of 0.979, adjusted goodness of fit index of 0.963, comparative fit index of 0.973, and root mean square error of approximation of 0.049. Cronbach's alpha was 0.800. The total RSO score was positively correlated with the PGC (r = .492, p < 0.001) and the SAS-WL (r = .559, p < 0.001).ConclusionsThe RSO demonstrated adequate reliability and validity for assessing individual resilience among oldest-old people. Thus, the scale is potentially useful for promoting health and well-being in oldest-old age.
| S-EPMC7944912 | biostudies-literature
Project description:Aging is known to have deleterious effects on cerebral white matter, yet little is known about these white matter alterations in advanced age. In this study, 94 oldest-old adults without dementia (90-103 years) underwent diffusion tensor imaging to assess relationships between chronological age and multiple measures of integrity in 18 white matter regions across the brain. Results revealed significant age-related declines in integrity in regions previously identified as being sensitive to aging in younger-old adults (corpus callosum, fornix, cingulum, external capsule). For the corpus callosum, the effect of age on genu fractional anisotropy was significantly weaker than the relationship between age and splenium fractional anisotropy. Importantly, age-related declines in white matter integrity did not differ in cognitively normal and cognitively impaired not demented oldest-old, suggesting that they were not solely driven by cognitive dysfunction or preclinical dementia in this advanced age group. Instead, white matter in these regions appears to remain vulnerable to normal aging processes through the 10th decade of life.
| S-EPMC5647141 | biostudies-literature
Project description:BACKGROUND:Despite the growing epidemic of heart failure (HF), there is limited data available to systematically compare non-cardiac comorbidities in the young-old, old-old, and oldest-old patients hospitalized for HF. The precise differences will add valuable information for better management of HF in elderly patients. METHODS:A total of 1053 patients aged 65 years or older hospitalized with HF were included in this study. Patients were compared among three age groups: (1) young-old: 65 to 74 years, (2) old-old: 75 to 84 years, and (3) oldest-old: ?85 years. Clinical details of presentation, comorbidities, and prescribed medications were recorded. RESULTS:The mean age was 76.7 years and 12.7% were 85 years or older. Most elderly patients with HF (97.5%) had at least one of the non-cardiac comorbidities. The patterns of common non-cardiac comorbidities were different between the young-old and oldest-old group. The three most common non-cardiac comorbidities were anemia (53.6%), hyperlipidemia (45.9%), and diabetes (42.4%) in the young-old group, while anemia (73.1%), infection (58.2%), and chronic kidney disease (44.0%) in the oldest-old group. Polypharmacy was observed in 93.0% elderly patients with HF. Additionally, 29.2% patients were diagnosed with infection, and 67.0% patients were prescribed antibiotics. However, 60.4% patients were diagnosed with anemia with only 8.9% of them receiving iron repletion. CONCLUSIONS:Non-cardiac comorbidities are nearly universal in three groups but obviously differ by age, and inappropriate medications are very common in elderly patients with HF. Further treatment strategies should be focused on providing optimal medications for age-specific non-cardiac conditions.
| S-EPMC6964950 | biostudies-literature
Project description:ObjectivesThe present study aimed to examine the impact of loneliness on health and social care service use in the oldest old over a 7-year follow-up.DesignProspective study.SettingUK population-based cohort.Participants713 people aged 80 years or older were interviewed at wave 3 of the Cambridge City over-75s Cohort Study. Of these, 665 provided data on loneliness. During 7 years' follow-up, 480 participants left the study, of which 389 due to death. 162 still in the study answered the loneliness question.Main outcome measureUse of health and social care services, assessed at each wave from wave 3 to wave 5.ResultsAt wave 3, of 665 participants who had data on loneliness, about 60% did not feel lonely, 16% felt slightly lonely and 25% felt lonely. Being slightly lonely at wave 3 was associated with a shorter time since last seeing a general practitioner (β=-0.5, 95% CI: -0.8 to -0.2); when examining the association between time-varying loneliness and health and social care usage, being lonely was associated with three times greater likelihood of having contact with community nurses and using meals on wheels services (community nurse contact: incidence rate ratio (IRR)=3.4, 95% CI: 1.4 to 8.7; meals on wheels service use: IRR=2.5, 95% CI: 1.1 to 5.6). No associations between loneliness and other health and social care services use were found.ConclusionLoneliness was a significant risk factor for certain types of health and social care utilisations, independently of participants' health conditions, in the oldest old. Study findings have several implications, including the need for awareness-raising and prevention of loneliness to be priorities for public health policy and practice.
| S-EPMC6549652 | biostudies-literature
Project description:Objective:This bibliometric study investigated literature pertaining to a quickly growing population worldwide: the oldest-old, individuals age eighty-five and older. The current state of research was surveyed, based on top authors, publishers, authorship networks, themes in publication titles and abstracts, and highly cited publications. Methods:Bibliographic data was abstracted from the Web of Science database. Microsoft Excel was used for data analyses related to top author, publishers, and terms. VosViewer bibliographic visualization software was used to identify authorship networks. Results:Publications pertaining to the oldest-old have increased dramatically over the past three decades. The majority of these publications are related to medical or genetics topics. Citations for these publications remain relatively low but may be expected to grow in coming years, based on the publication behavior about and increasing prominence of this population. Claudio Franceschi and the Journal of the American Geriatrics Society were found to be the author and journal with the most publications pertaining to the oldest-old, respectively. Conclusions:The oldest-old is a population of rapidly growing significance. Researchers in library and information science, gerontology, and beyond can benefit themselves and those they serve by participating in research and specialized services to marginalized populations like the oldest-old. This bibliometric study hopefully serves as a launch-point for further inquiry and research in the years to come.
| S-EPMC6919997 | biostudies-literature
Project description:Individuals who live to 85 and beyond without developing major age-related diseases may achieve this, in part, by lacking disease susceptibility factors, or by possessing resistance factors that enhance their ability to avoid disease and prolong lifespan. Healthy aging is a complex phenotype likely to be affected by both genetic and environmental factors. We sequenced 24 candidate healthy aging genes in DNA samples from 47 healthy individuals aged eighty-five years or older (the 'oldest-old'), to characterize genetic variation that is present in this exceptional group. These healthy seniors were never diagnosed with cancer, cardiovascular disease, pulmonary disease, diabetes, or Alzheimer disease. We re-sequenced all exons, intron-exon boundaries and selected conserved non-coding sequences of candidate genes involved in aging-related processes, including dietary restriction (PPARG, PPARGC1A, SIRT1, SIRT3, UCP2, UCP3), metabolism (IGF1R, APOB, SCD), autophagy (BECN1, FRAP1), stem cell activation (NOTCH1, DLL1), tumor suppression (TP53, CDKN2A, ING1), DNA methylation (TRDMT1, DNMT3A, DNMT3B) Progeria syndromes (LMNA, ZMPSTE24, KL) and stress response (CRYAB, HSPB2). We detected 935 variants, including 848 single nucleotide polymorphisms (SNPs) and 87 insertion or deletions; 41% (385) were not recorded in dbSNP. This study is the first to present a comprehensive analysis of genetic variation in aging-related candidate genes in healthy oldest-old. These variants and especially our novel polymorphisms are valuable resources to test for genetic association in models of disease susceptibility or resistance. In addition, we propose an innovative tagSNP selection strategy that combines variants identified through gene re-sequencing- and HapMap-derived SNPs.
| S-EPMC2722017 | biostudies-literature