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Immune response to influenza vaccination in a large healthy elderly population.

Elderly individuals not only demonstrate a greater risk of morbidity and mortality from influenza than the young, but also have greater difficulty mounting a protective response to influenza vaccine. The mechanism of the decreased efficacy of influenza vaccination in the elderly is not well understood. The present study was designed to assess the interaction between cell-mediated and humoral immune responses to influenza vaccine in a large population (n = 233) of healthy elderly individuals (mean age = 80.7) living in six continuing care retirement communities (CCRCs). While influenza vaccination resulted in significant increases in the mean anti-influenza antibody titres and mean proliferative responses of peripheral blood mononuclear cells to purified subvirion trivalent influenza vaccine one month after vaccination, only 48.9% and 30.0% of subjects had intact humoral and cell-mediated immune responses, respectively. No association was observed between intact cell-mediated and humoral responses: 14.7% of subjects had an intact cell-mediated, but not humoral response, and 32.6% of subjects had an intact humoral, but not cell-mediated response. However, IFNgamma production was significantly correlated with both antibody and cell-mediated responses to influenza vaccination, a finding not previously reported in the elderly. These results indicate that there is considerable heterogeneity among immune responses of the elderly to influenza vaccination. This heterogeneity needs to be a major consideration in evaluation of new vaccine preparations.

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Seating and wheeled mobility in the disabled elderly population.

Elderly persons constitute the largest among the populations regularly using wheelchairs. This is a review of the few studies specifically concerned with seating for the elderly; it identifies current problems, particularly in the seating for aged people who are in long-term care facilities. This review describes ways of matching currently available seating technology with the needs of disabled elderly persons. Two major barriers to greater use of newer seating technology are (1) the high cost of durable medical equipment and (2) the failure of most clinicians and institutional administrators to recognize the importance of posture and comfort to provide functional independence in wheelchair users. This review discusses seating for four groups of elderly persons: (1) the nonmobile, dependents who may be safety risks and are without energy or ability to wheel or walk by themselves; (2) mobile nonambulatory; and (3) ambulatory, but with special wheelchair needs. Research is needed in wheeled mobility in a number of areas: better matching of mobility to function, cheaper and more effective cushions, more modular seating systems, and better lifting and transfer devices. The American National Standards Institute in cooperation with Rehabilitation Engineering Society of North America has recently recommended standards for wheelchair performance that may be legislated in the next few years.

Activities of Daily Living↗

The impact of group reminiscence counseling on a depressed elderly population.

Elderly patients present an enormous challenge to the mental health care system. Statistics have shown a high rate of mental disorders, especially depression and suicide, among this population group. Reminiscing about the past has been theoretically linked to positive adjustment in old age. The purpose of this study was to assess the effect of group reminiscence counseling on the level of depression of elderly women residing in nursing homes. A sample of 60 women 65 years and older participated in this study. Subjects were randomly classified into two experimental groups and one control group. An interview schedule that included demographics and Beck's Depression Inventory was employed to collect data. Chi-square analysis was used to test the homogeneity of the three groups with respect to their demographic characteristics. Analysis of data using the analysis of variance method showed that the differences between the levels of depression before and after the reminiscence counseling sessions were statistically significant in the younger subjects (65 to 74 years), and insignificant in the older subjects (over 74 years). Findings imply that group reminiscence counseling did have an effect on the elderly's level of depression. From the findings of this study, implications and recommendations are drawn.

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Management of advanced non-small-cell lung cancer in elderly populations.

Elderly patients, defined as those >or= 70 years of age, represent approximately 40% of all patients diagnosed with non-small-cell lung cancer in the United States. Nonetheless, elderly patients have been underrepresented in national cooperative group trials, and many do not receive appropriate treatment. Whereas the benefit of systemic chemotherapy in younger patients is accepted by most clinicians, there remains a great deal of skepticism with respect to older patients, who are often labeled unfit for chemotherapy. More recent studies with a special focus on elderly patients demonstrate that these patients indeed benefit from chemotherapy. The landmark Elderly Lung Cancer Vinorelbine Italian Study Group trial and the Multicentre Italian Lung Cancer in the Elderly Study clarified the role of vinorelbine in the treatment of elderly patients. Retrospective and prospective subgroup analyses from selected North American trials suggested that elderly patients also benefit from platinum-based combinations. Whether elderly patients should be treated with single-agent versus combination chemotherapy is discussed in this review. The available data suggest that patients should be evaluated for chemotherapy based on their performance status and comorbidities rather than age alone. For elderly patients judged fit to receive combination chemotherapy, carboplatin-based regimens are a reasonable option. In elderly patients with less than optimal performance status or significant comorbid conditions, single-agent therapy may be more appropriate.

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Clinical use of tai chi in elderly populations.

Tai chi, a type of low-intensity exercise, has received growing attention in both eastern and western cultures, especially its use with the most rapidly increasing segment of the population-elders. Previous research findings further supported the idea that tai chi is appropriate for elderly populations and helps promote their well-being. In this article, the beneficial effects of tai chi for elders are summarized, resources to increase awareness about the exercise are provided, and ways to promote tai chi in elderly populations are suggested.

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[Prevalence of anal incontinence in the elderly population: an epidemiological study of the elderly population served at the geriatric ambulatory service of the Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo].

The aim of the present work was to assess the prevalence of anal incontinence in the elderly population attended in the "Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo". The method employed was of individual interviews with patient attended in the Geriatric Ambulatory. As part of the assessment patients were classified as to sex, age, color, social-economical class and education, and compared to available data on the elderly population of the State and the City of São Paulo. Besides the question on signs and symptoms related to anal incontinence, associated factors such as bowel habit, sensation of incomplete evacuation, urgency to evacuate and soiling were also analysed, as well as, factors possibly related to anal incontinence such as urinary incontinence, use of medication as laxatives, associated diseases, such as neurological affections and diabetes mellitus, number of child births, and assistance received, previous anorectal or perineals operations, and locomotions limiting factor. The statistical method of test of proportion was used to analyse the proportions of the populations interviewed, as to sex and literacy compared to the elderly population of the State and City of São Paulo. To analyse the social-economical class of the population interviewed compared to the elderly population economically and non economically active, of the State of São Paulo, the test of qui-square adjusted was used. The test of qui-square was used to verify if the population of incontinent and continent, by sex; incontinent and continent in relation to bowel habit, by sex; incontinence sufferer of continuous and descontinuous anal incontinence, by sex; incontinent sufferer of anal incontinence to gas, liquid or solid, and the association of these manifestations, by sex; patients who complained of soiling, by sex; incontinent and continent, previously submitted to anorectal or perineal operations; and continent and incontinent with diabetes mellitus, are equal. To verify the proportions of women who had vaginal delivery in the continent and incontinent group, the test of Mann-Whitney was used. One hundred fourty six patients were interviewed, 43 men of an average 75 years old (62 to 91) and 103 women of an average 72 years old (60 to 88); as to colours, 69.9% were white, 18.5% were mullato, 9.6% were black and 2% were yellow. The comparative analysis with populational data indicated that the population interviewed was representative of the elderly population of the State and the City of São Paulo, as to age, color, social-economical class and education. The prevalence of anal incontinence was of 10.9% with no difference between the sexes, intestinal obstipation referred by 15.4% of the men and 28.1% of the women, sensation of incomplete evacuation referred by 21.2% of the patients, and the association of both referred by 13.7% were the most frequently observed functional gastrointestinal alterations. Soiling was referred by 10.3% of the patients with no difference related to sex. The use of medication or laxatives, the presence of diabetes mellitus, neurological affections, previews anorectal or perineal operations, or locomotion limiting factors, have no relation to anal incontinence. The prevalence of urinary incontinence was of 30.1%, and double continence of 6.3% with no statistical difference between sexes. There was statistical evidence of association between childbearing and anal incontinence.

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Epidemiology of paranoid symptoms in an elderly population.

BACKGROUND: Elderly people with paranoid symptoms are a taxing group for medical and social services, but studies of the prevalence of these symptoms in the general elderly population are rare. This study aimed to estimate the community prevalence and to identify some associated variables. METHOD: A community samples of 1420 elderly people, was extensively examined by nurses and physicians. RESULTS: Paranoid ideation was found in 6.3% of the sample. The prevalence in people with cognitive dysfunction (n = 381, 12.1%) was higher than in those without (n = 1039, 2.6%). Once cognitive impairment had been controlled the associated variables were: being divorced, being female, having depressive symptoms, using psychotropic drugs, having no friends or visitors, using community care and being an immigrant. CONCLUSION: Paranoid symptoms in this elderly population were associated most strongly with cognitive impairment. Other associated variables pointed to a higher level of social isolation than others in the community.

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Using Medicare data for short-run projections of the elderly population.

As the elderly population of the United States grows in absolute number and as a proportion of total population, accurate projections of that population become increasingly important for sound policy decisions. Cohort component techniques are typically used for state and local projections of the elderly population, but are often outdated or even nonexistent for many local areas. This paper suggests an alternative approach, based on Medicare data and simple projection techniques. Projections for several base periods and projection horizons are made for all states and for counties in Florida and are compared with actual Medicare enrollment. On the basis of these comparisons it appears that Medicare data and simple projection techniques can produce very useful short-run projections of the elderly population for states and local areas.

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[Injury prevention in the elderly population].

Injuries in the elderly population have more considerable consequences (more difficult treatment, higher costs,worse outcome) than in the younger population. Therefore, the prevention is especially important. The majority of the injuries are caused by traffic accidents and falls. TRAFFIC ACCIDENTS: An analysis of the current injury situation in elderly road users (65 years and older) involved in road traffic accidents was intended to allow conclusions regarding future prophylaxis. FALLS: Falls are mostly caused by numerous factors. The most important predictors for falls are dementia,Parkinson-Syndrome and neurologic deficits after cerebrovascular insults. The most important symptoms, that indicate an increased risk for fall are gait abnormalities, balance lack and underweight. The most important anamnestic indications are more than one falls in the recent 90 days, need for assistance in daily living and prevailing medication. Another important factor is the residential setting (lighting, stairs, floor conditions,bath installations). The most affective protective interventions involve multiple factors. The incidence of falls could be reduced by 30%. The hip protector is an effective protection against proximal femur fractures. which is the most frequent fracture in the elderly population that requires treatment as an inpatient. Injury prevention in the elderly population is an interdisciplinary task as for example shown by the successful fall clinics in the anglo-american area.

Accident Prevention↗

Self-rated health assessment and development of both cardiovascular and dementing illnesses in an ambulatory elderly population: a report from the Bronx Longitudinal Aging Study.

As part of the Bronx Longitudinal Aging Study, a prospective, community-based study designed to assess risk factors for cardiovascular and cerebrovascular morbidity and mortality and all-cause dementia, the investigators sought to determine whether a self-rated health assessment (SRHA) could be used as an independent predictor of new cardiovascular events and dementia (Alzheimer type and multi-infarct). A population of elderly (mean age 79 years) outpatient, ambulatory, nondemented patients (n = 487, 65% women) participated in this longitudinal study. Clinical diagnoses were made according to established criteria. At baseline, participants were asked to rate their current SRHA as excellent, good, fair, or poor, and were evaluated annually for as long as 10 years. Baseline SRHA findings were related to development of cardiovascular events and dementia. The SRHA was reported as excellent by 45 patients (9.4%), good by 212 (44.4%), fair by 178 (37.3%), and poor by 42 (8.8%). Using a multivariate analysis, patients whose SRHA was poor were 4.5 times more likely than those whose SRHA was excellent to have a fatal cardiovascular event, 2.6 times more likely to have a nonfatal cardiovascular event, and 5.3 times more likely to develop Alzheimer type and multi-infarct dementia. Similar findings were observed with dichotomous SRHA responses (comparing excellent/good to fair/poor). In an elderly population, SRHA appears to be an independent predictor of future cardiovascular and cerebrovascular events and development of all-cause dementia, which has possible therapeutic implications for prevention and treatment.

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Transportation needs of the elderly population.

All evidence suggests that the elderly population of today and tomorrow will continue to depend on the private car to give them freedom, independence, and choice--as do younger travellers. Given the demographic changes in the United States, it seems very unlikely that other modes or options can provide anywhere near the level of mobility that the elderly want or need. Almost three fourths of those over age 65 will live in suburban or rural places after the turn of the century, places where transit and para-transit options are inherently impractical or costly. These elderly individuals will have made choices about doctors, hospitals, friends, and social and recreational options based on their lifelong access to the car. When they can no longer drive or receive rides, their mobility will drop and they may have to make drastic changes in their whole life network to be able to access just a few necessary services. Those concerned with the use of medical services by the elderly population must focus not only on transportation but on the other variables that create the need for a car. Transportation needs are clearly linked to where and how medical and social services are made available, so medical agencies must recognize the changing demographics of the elderly population by locating and programming their services accordingly. Medical and human service agencies will have to make an effort to make their programs accessible to the elderly population rather than simply locating their facilities where they please and assuming that elderly persons or transportation planners will somehow deal with the resulting loss of mobility.

Adult↗

Geriatric renal function: estimating glomerular filtration in an ambulatory elderly population.

In elderly individuals, serum creatinine may remain normal as glomerular filtration rate (gfr) declines. Therefore, the estimation of glomerular filtration utilizing mathematical models incorporates age as an important variable. In order to adjust drug dosages and diagnose renal disease earlier in the elderly, a variety of such simplified estimates of gfr have been applied. Unfortunately, no estimator is as accurate as the cumbersome gold standards (e.g. inulin or iothalamate clearance) and the reliability of each may vary with the particular clinical setting. The purpose of this study was to critically evaluate three commonly used estimators of gfr-i.e., creatinine clearance (CC), Cockroft-Gault (CG), and 100 over serum creatinine (100/SC)-comparing them to iothalamate clearance (IC) in a group of healthy ambulatory geriatric subjects (n = 41; ages 65-85). IC declined 1 ml/min per year of age in our sample. CC demonstrated a similar decline, a correlation of 0.83 with IC, and moderate error relative to IC of 17% at the mean (standard error [SE] = 12.3). In contrast, 100/SC correlated only 0.56 with IC, demonstrated a large positive bias (41 ml/min), and showed no age-related decline. An age correction to 100/SC similar to that utilized in the CG formula was clearly necessary. Despite the age and weight correction used in the CG formula, we found the estimates from it to be inaccurate (correlation = 0.5; SE = 23.8). A simpler age-corrected formula (Est. IC = 1/2 [100/SC] + 88-age) was derived and proved significantly superior to CG in our ambulatory geriatric sample, but still exhibited enough error (SE = 16.4) to question its clinical utility. It appears that serum creatinine based estimates of gfr in the elderly may not provide accurate results.

Age Factors↗

Feeding the elderly population.

The elderly are adults that have unique nutritional needs. The focus for nutrition in the elderly is on "successful aging" or living well, not just living longer. Optimal physical and cognitive function is greatly enhanced by good nutritional status combined with physical activity. Nutrition plays a pivotal role in maintaining quality of life through enhanced health benefits.

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IgE level and Phadiatop in an elderly population from the PAQUID cohort: relationship to respiratory symptoms and smoking.

BACKGROUND: In the last decades in industrialized countries, the increase of life expectancy has resulted in an increase in the population of the elderly. However, little is known about the prevalence of allergies in the elderly population. The aim of the study was to investigate the specific relationship of serum IgE and Phadiatop, with asthma, rhinitis, and smoking in a sample of an elderly population. METHODS: Subjects from the Paquid cohort living in Gironde Department (age 65 years and over) in France were followed up since 1988 (PAQUID cohort). RESULTS: Among the randomized sample of 352 subjects, there were 158 men (45%) and 194 women (55%). The lowest levels of IgE were in subjects with chronic sputum; and in normal subjects (47.1 +/- 56.4 vs 56.2 +/- 73.9, NS). Multiple linear regression was performed with log(10) IgE values as a dependent variable and age, Phadiatop test, smoking, and respiratory symptoms independently in men and in women. In men, a significant relationship was observed between IgE values and Phadiatop test (P < 0.001), asthma history (P = 0.002), and smoking (P = 0.019). CONCLUSIONS: Respiratory allergy is present in persons >65 years of age. There is an association between smoking and IgE level independent of allergic reactivity to common allergens in the elderly.

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["Quality of life" of the elderly population: a survey to evaluate elderly people's self -perceived health in 11 Italian regions (Argento Study, 2002).].

Self-perception of health influences the quality of life of the elderly. In order to identify the more vulnerable elderly and guide interventions to improve health in this population group, we evaluated self-perceived health of elderly people through a set of 4 questions called the "Healthy Days Measures", which were incorporated into the Argento Study. The latter is a study performed to evaluate the health status of the elderly population in 11 Italian regions (2002). Methods. Following cluster sampling, 2,369 elderly subjects (>64 years) were interviewed at home, by trained personnel, through a standardized questionnaire. Self-rated health (on a scale from poor to excellent) was estimated, as well as the average number of days during the previous month when physical or mental health was not good and the number of activity limitation days. Multivariate analysis was performed using Sudaan software and by considering the following outcomes: self-perceived health, physical or mental problems or activity limitations for more than 1 day. Prevalence rates by gender, age, civil status, education level, home situation, place of residence, chronic diseases, dependence on a caregiver, sedentariness and social isolation, were calculated. Results. 34.7% of interviewed subjects rated their health as good to excellent. A significantly lower proportion of women, older subjects (>75 years), those with a lower education level, those residing in southern Italy, those suffering from chronic illnesses, those dependent on a caregiver, and socially isolated or sedentary subjects rated their health favorably. The mean number of physically and mentally unhealthy days (summary index) was estimated to be 11.3 per month. Multivariate analysis showed that female gender was significantly associated with all outcomes considered; age and education level did not show any significant associations with the outcomes considered; depression was significantly associated with self-rated health and with number of mentally unhealthy days; physical dependence and sedentariness were associated with an increased risk for all outcomes, especially activity limitation days. Conclusions. These results suggest that depression, physical dependence and sedentariness influence self-perceived health more so than socio-demographic characteristics. Public Health may have a relevant role in promoting and guiding interventions to prevent these factors in the elderly. The introduction of Healthy Days measures in health surveillance systems may be an important public health tool for monitoring perceived health status and in intervention planning and evaluation at both the national and local levels.

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A comparison of self-reported measures of perceived health and functional health in an elderly population.

In studies of large elderly populations, two types of measures of physical health status, perceived health and functional health, are commonly used. Although they represent very different conceptions of health, these two types of measures appear often to be used interchangeably. In this paper, we examine changes over time in self-reported measures of perceived health and functional health for a sample of Medicare beneficiaries. By investigating the patterns of change in the two measures for different subgroups of the population, we are able to draw inferences about the appropriateness of each type of measure for specific administrative and/or research situations. The perceived health status measure appears suitable for descriptive studies of the health of elderly populations, while the greater stability of functional health makes this type of measure generally more appropriate in studies investigating relationships between an individual's physical health status and subsequent behavior.

Activities of Daily Living↗

[Health and standard of living of the elderly population, with special reference to elderly physicians].

The standard of living among the elderly has been the subject of several studies carried out among Norwegians. Morbidity and health complaints are more common among the lower socioeconomic classes and the elderly than in other population groups. Wealth and good living conditions have a positive effect on health and well-being. The income gap between the working and retired population has diminished. Among the elderly good health and social relationships are rated among the most important components for a good standard of living. Mortality is lower among physicians than in most other groups of professionals. There are greater possibilities for physicians to continue working after the standard retirement age and more than half of them wished to do so. A feeling of well-being is more common among elderly physicians than among the elderly in the general population, whereas the opposite is the case among young people.

Age Factors↗