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Important worldwide changes in human aging are developing rapidly. Life expectancy has doubled during the past century. Due to advances in public health, vaccines, and science, people are living longer. The increase in the elderly population is happening in varying degrees all over the world. Although heart disease and cancer rates are falling, Alzheimer’s is increasing because of its strong link to aging and lack of disease-modifying therapies. It is important to consider what can be done about the expansion of aged populations. A forward-looking approach to health care will provide resources to people throughout life to keep them healthy and enhance their four reserve factors. This is ethically and economically preferable to a health care system which only takes care of people when they’re sick and doesn’t strive to prevent illness. Recent advances in diagnosis, metagenomics (studies of gut bacteria), and artificial intelligence will hopefully assist in the growth of preventive measures. Advances in public policy and technology can help people to enhance their four reserve factors and help them to avoid disease and remain fit as they age.
Our attitude is something we carry around with us at all times. As the psychiatrist Victor Frankl said, “Our greatest freedom is the freedom to choose our attitude.” Our attitude is determined in large part by the focusing of our attention. If our attention is focused on losses and regrets, our attitude will be gloomy. If our attention is focused on opportunities, such as the opportunity of aging, our attitude will be more positive. This is a fundamental daily choice. Because the world is too multifaceted for us to process all possible perceptions, it is our attention which is critical for the quality of our experience. Our attitude is determined by the object of our attention. And our capacity of paying attention can be exercised and practiced every day. Viewing aging as an opportunity helps to focus the reality that what happens to us is determined in large part by what we do. Paying attention can enhance all of our reserves. Diet, physical and mental activities, and social and family contacts are all critical. Our enhancement of the four reserve factors will increase our chance to be healthy and fit as we age.
We need to have three goals for aging. The first two are clear; survival and avoiding disease. Equally important is a third goal, to maintain fitness and a high level of four reserve factors. These reserve factors allow us to successfully respond to the challenges we face as we age. Cognitive reserve is the capacity to maintain effective cognitive function despite age-related changes in the brain. Maintaining high cognitive reserve is not our only goal. We must also maintain high physical, psychological, and social reserves. Physical reserve reflects the capacity of all our body systems. Psychological reserve is our ability to maintain healthy mental function, and social reserve describes our interpersonal network and supports. With aging, our ability to function is dependent upon the interaction of these four reserve factors. Our capacity to respond well to adversity is called resilience and is a fundamental goal of aging. It is important to realize the critical nature of these four reserve factors because through our actions we can enhance our capacity for resilience and enhanced fitness with aging.
For most of human history few people got to be old. Older persons are not as well pepared to face stresses as younger persons because of evolutionary factors. So, it is necessary for older persons to consider the effects of their lifestyle choices on their ability to age successfully. Awareness of these factors is important for our appreciation of the impact which our activities have on our aging. For most of the past 100,000 years of human history we were living in a different environment than the one we have today. The genes we have now were chosen through natural selection because they enhanced the survival of our ancestors who were living in these different environments. This view provides valuable insights into the role environmental factors have in determining maintenance of function with aging. This chapter presents the vital perspective that what we do affects the accomplishment of our goals for aging. These goals must go beyond survival and avoidance of disease and also strive for maintenance of the highest level of fitness and resistance to loss of function (reserve capacities) so that we can resist the declines with aging, as well as the challenges which inevitably occur.
As women age, their response to ovulation induction is progressively diminished due to the continuous depletion of primordial follicles and to changes in the ovarian endocrine/paracrine microenvironment. While many couples faced with the reality of a diagnosis of low functional ovarian reserve may turn to the use of donor gametes to achieve a pregnancy, some still feel the need to try on their own, despite a poor prognosis. For such women careful preparation and hormonal priming in the months prior to beginning an IVF cycle can increase their chance of a successful outcome. Optimal treatment of these patients differs from the usual treatment of women with normal ovarian reserve in every aspect and needs to be highly individualized.
Il est essentiel d’utiliser des tests cognitifs ayant été validés et détenant des normes de référence auprès de la population cible, puisque les réalités culturelles et linguistiques différentes entre l’échantillon de validation ou auprès duquel les normes ont été créées et la population cible peuvent affecter les résultats. Cette revue systématique vise à recenser et décrire les tests cognitifs (incluant tests, questionnaires et grilles d’observation) validés et/ou présentant des normes sur la population âgée canadienne francophone. Au total, 46 articles ont été sélectionnés. Cette revue recense 9 tests validés, 20 tests avec normes de référence et 18 tests validés et avec normes, couvrant la majorité des domaines cognitifs (fonctions mnésiques, attentionnelles, exécutives, perceptivo-motrices et langagières), excepté la cognition sociale. La quasi-totalité des échantillons ont été recrutés au Québec. Les tests relevés présentent majoritairement des indices psychométriques satisfaisants et généralement des normes considérant l’âge, le sexe et l’éducation. Cette revue systématique permettra aux cliniciens et chercheurs canadiens en vieillissement d’orienter optimalement leurs choix de tests cognitifs.
Aging is a subject of concern to everyone, but is widely misunderstood. If we view it as inevitable, we miss the fact that not everyone is able to grow to an old age. Realization of this reality helps us to understand that aging presents a wonderful opportunity - an opportunity to make choices about how we live which can enhance the aging process and offer a chance to live to our potential. This book clearly presents the four, multiple reserve, factors (cognitive, physical, psychological and social) which impact our ability to have healthy responses to the stresses of aging. By giving the biological basis for the advice given, you will learn the steps to take in your activities, diet and mental outlook to grasp the opportunity that aging offers. Everyone must know that what we do makes a difference.
Serial position scores on verbal memory tests are sensitive to early Alzheimer’s disease (AD)-related neuropathological changes that occur in the entorhinal cortex and hippocampus. The current study examines longitudinal change in serial position scores as markers of subtle cognitive decline in older adults who may be in preclinical or at-risk states for AD.
This study uses longitudinal data from the Religious Orders Study and the Rush Memory and Aging Project. Participants (n = 141) were included if they did not have dementia at enrollment, completed follow-up assessments, and died and were classified as Braak stage I or II. Memory tests were used to calculate serial position (primacy, recency), total recall, and episodic memory composite scores. A neuropathological evaluation quantified AD, vascular, and Lewy body pathologies. Mixed effects models were used to examine change in memory scores. Neuropathologies and covariates (age, sex, education, APOE e4) were examined as moderators.
Primacy scores declined (β = −.032, p < .001), whereas recency scores increased (β = .021, p = .012). No change was observed in standard memory measures. Greater neurofibrillary tangle density and atherosclerosis explained 10.4% of the variance in primacy decline. Neuropathologies were not associated with recency change.
In older adults with hippocampal neuropathologies, primacy score decline may be a sensitive marker of early AD-related changes. Tangle density and atherosclerosis had additive effects on decline. Recency improvement may reflect a compensatory mechanism. Monitoring for changes in serial position scores may be a useful in vivo method of tracking incipient AD.
In behavioral variant frontotemporal dementia (bvFTD) neuropsychiatric symptoms are a significant concern as they impact care management and caregiver wellbeing.
To describe change in individual neuropsychiatric symptoms and associated caregivers’ distress assessed by the Neuropsychiatry Inventory (NPI) in patients diagnosed with bvFTD and Alzheimer’s disease (AD) from baseline to a 12-month follow-up.
The sample consisted of 31 patients diagnosed with bvFTD and 28 patients with AD and their caregivers. The NPI and the Addenbrooke´s Cognitive Examination Revised (ACE-R) were applied. Descriptive statistics, Mann-Whitney U test, Wilcoxon test, Chi square (χ2) were used.
At baseline, significantly higher scores were observed for the bvFTD group for: agitation, disinhibition and eating disturbances. The latter two were also higher in the NPI Distress subdomains. At followup, there were significantly higher scores for the bvFTD group in agitation, disinhibition, eating disturbances, hallucination and irritability. For the NPI Distress subdomains, agitation, eating disturbances and hallucination scores were significantly higher for the bvFTD group.
In 12 months, neuropsychiatric symptoms increased in both bvFTD and AD groups. However, NPI subdomain and caregiver distress scores were statistically higher among bvFTD patients at both assessment points. Neuropsychiatric symptoms may be associated with care burden in bvFTD and should be a focal point in care management decisions.
COVID-19 has had a disproportionate and devastating impact on older adults. As health care resources suddenly shifted to emergency response planning, many health and community support services were cancelled, postponed, or shifted to virtual care. This rapid transformation of geriatric care resulted in an immediate need for practical guidance on decision making, planning and delivery of virtual care for older adults and caregivers. This article outlines the rapid co-design process that supported the development of a guidance document intended to support health and community support services providers. Data were collected through consultation sessions, surveys, and a rapid literature review, and analyzed using appropriate qualitative and quantitative methods. Although this work took place within the context of the COVID-19 pandemic, the resulting resources and lessons learned related to collective impact, co-design, population-based planning, and digital technologies can be applied more broadly.
If interRAI home care information were shared with primary care providers, care provision and integration could be enhanced. The objective of this study was to co-develop an interRAI-based clinical information sharing tool (i.e., the Patient Falls Risk Report) with a sample of primary care providers. This mixed-methods study employed semi-structured interviews to inform the development of the Patient Falls Risk Report and online surveys based on the System Usability Scale instrument to test its usability. Most of the interview sample (n = 9) believed that the report could support patient care by sharing relevant and actionable falls-related information. However, criticisms were identified, including insufficient detail, clarity, and support for shared care planning. After incorporating suggestions for improvement, the survey sample (n = 27) determined that the report had excellent usability with an overall usability score of 83.4 (95% CI = 78.7–88.2). By prioritizing the needs of end-users, sustainable interRAI interventions can be developed to support primary care.
The aim of this study was to assess the effectiveness of a multidimensional exercise intervention on improving fall risk deterrent factors, such as overall strength and flexibility in nursing home residents.
A multi-centre, randomized controlled trial was finally utilized in 40 older adults (>65 years) who were randomly allocated to the intervention or the control group (20 subjects in each). The intervention group attended an exercise program twice a week for eight weeks, to improve functional mobility. The control group did not receive any intervention. Measurements before and after intervention included the Hand Grip Strength (HGS) testing, the Sit-to-Stand test (SST), the Back Scratch Test (BST), and the Sit-and-Reach test (SRT).
MANOVA revealed significant time effects, V = 0.336, F(6, 33) = 2.78, p = 0.027, partial η2 = 0.336; group effects, V = 0.599, F(6, 33) = 8.22, p < 0.001, partial η2 = 0.599; and group*time interaction, V = 0.908, F(6, 33) = 54.52, p < 0.001, partial η2 = 0.908. A subsequent univariate analysis did not reveal a significant time effect for any variable (p > 0.05). Significant group effects were observed only for SRT (p < 0.05). Significant group*time interactions were observed for all the examined variables (p < 0.05). Dependent t-tests showed that the older adults in the exercise group were significantly improved in all the examined parameters (p < 0.05). Except for SRT (p > 0.05), all the other parameters significantly deteriorated in the control group (p < 0.05).
Significant improvements were demonstrated in strength and flexibility among nursing home residents following an eight-week group exercise training program.
Immune system aging, a process known as immunosenescence, involves a striking rearrangement affecting all immune cells, resulting in an increased rate of infections and a major incidence of autoimmune diseases and cancer. Nonetheless, differences in how individuals of the same chronological age carry out this immunosenescence establishment and thus the aging rate have been reported. In the context of neuroimmunoendocrine communication and its role in the response to stress situations, growing evidence suggests that social environments profoundly influence all physiological responses, especially those linked to immunity. Accordingly, negative contexts (loneliness in humans/social isolation in rodents) were associated with immune impairments and decreased lifespan. However, positive social environments have been correlated with adequate immunity and increased lifespan. Therefore, the social context in which an individual lives is proposed as a decisive modulator of the immunosenescence process and, consequently, of the rate of aging. In this review, the most important findings regarding how different social environments (negative and positive) modulate immunosenescence and therefore the aging rate, as well as the role of stress responses, hormesis, and resilience in these environments will be explained. Finally, several possible molecular mechanisms underlying the effects of negative and positive environments on immunosenescence will be suggested.
Passive remote monitoring is a relatively new technology that may support older adults to age in place. However, current knowledge about the effectiveness of this technology in extending older adults’ independence is lacking. Therefore, we conducted a scoping review of studies examining passive remote monitoring to systematically synthesize evidence about the technology’s effectiveness as an intervention. Our initial search of Embase, CINAHL, PubMed, and Scopus databases identified 486 unique articles. Of these, 14 articles met our inclusion criteria. Results show that passive remote monitoring technologies are being used in innovative and diverse ways to support older adults aging in place and their caregivers. More high-quality research on this topic is needed.
Theories of adult development and aging suggest that older adults turn towards religion and spirituality (R/S) to increase meaning and purpose in life, and to assist in coping with adverse experience. We sought to examine the relationship between R/S and positive mental health and mental illness (i.e., psychological distress) in adulthood, and to determine the potential moderating role of age. Data from the 2012 Canadian Community Health Survey – Mental Health (CCHS-MH), a national population health study, were used. A multivariable linear regression model revealed a significant R/S by age interaction for positive mental health (p = 0.001). Although R/S was associated with positive mental health among all participants, there was a stronger relationship between R/S and positive mental health for older adults. No statistically significant relationship between R/S and psychological distress was observed. Findings highlight the importance of R/S to positive mental health across the adult lifespan. The differential relationships among R/S, positive mental health, and mental illness underscore the utility of using the dual-continua of mental health and mental illness in order to understand their respective determinants.
Older adults have an increased risk of complications or death from influenza. Despite the benefits of vaccination for older adults, vaccination coverage among older adults ages 65 years and over is still below Canada’s national target of 80 per cent. As health–care-seeking behaviours are influenced by several factors, including life satisfaction, we investigated the relationship between life satisfaction and influenza vaccination among older adults. A sample (n = 22,424) from the 2015–2016 Canadian Community Health Survey data was analysed using descriptive and multinomial logistic regression analyses. Higher life satisfaction was associated with a more recent influenza vaccination history. Vaccination differed by gender, age, and self-reported health status, as women, much older adults, and those with the poorest health status were more likely to be vaccinated. The study suggests an association between life satisfaction and influenza vaccination. More research into the factors that impact influenza vaccination in older adults is needed to increase vaccination coverage in the older adult population.
Social participation has tremendous implications for the physical and mental health of older adults. A growing body of Canadian literature has examined social participation among older adults, including frequency of participation; gender, age, and regional differences in participation; and associations with self-perceived health, loneliness, and life dissatisfaction. The current study adds to this important body of research, using a large, nationally representative sample of adults 45–85 years of age (Canadian Longitudinal Study on Aging [CLSA] baseline data [n = 51,338]), to examine nuanced characteristics associated with social participation (socio-demographics, social support, cognitive ability, mental health, physical conditions), frequency of participation, and the relationship between the aforementioned characteristics and frequency of participation. Findings indicated that compared with those who reported infrequent/no participation, more frequent participation was associated with greater social support, higher cognitive abilities, increased satisfaction with life, fewer depressive symptoms, reduced odds of self-reported mood and anxiety disorders, and fewer self-reported physical conditions. Findings highlight the importance of active social participation, and have important implications for the development and implementation of accessible community programs across Canada.
Preventive health is a broad term encompassing screening tests (e.g., for cancer, cardiovascular risk, or geriatric syndromes), healthy lifestyle counseling (e.g., nutrition and physical activity), immunizations, and safety considerations (e.g., falls, driving). These discussions become more important with age as a clinician considers an individual patient's goals and values, prognosis and life expectancy, and whether a patient is likely to benefit. The 4Ms (what Matters, Medications, Mentation, and Mobility) provide a useful framework for thinking about how to frame discussions with older adults in the primary care setting, and the Medicare Annual Wellness Visit provides an opportunity to review screening and prevention with an older adult and to update goals and preferences. The overarching goal should be to follow evidence-based practice, cause no harm to our patients, and align with what matters most to the patient.
For older adults, foot problems can significantly affect mobility, function, and quality of life. Because the foot can impact overall function, the podiatric exam for either preventive or problem-related issues is an important part of geriatric care. The foot exam begins with the shoes and then includes a dermatologic, musculoskeletal, vascular, neurologic, and functional assessment. Common skin and nail conditions include hyperkeratotic lesions, ulcerations, tinea pedis, and onychomycosis. Forefoot conditions include hallux valgus (bunion), hallux limitus, hallux rigitus, digiti flexus (hammertoe), sesamoiditis, fractures, and Mortons’ neuroma (intermetatarsal neuroma). Midfoot conditions include pes planus and posterior tibial tendon dysfunction. Common heel conditions include plantar fasciitis, heel pad syndrome, Achilles tendinitis, and tarsal tunnel syndrome. Systemic disease such as diabetes and gout can also affect the foot. Treatment modalities for foot conditions can include topical, injected, or oral medications, pads or orthotics, and surgical correction. Health-care practitioners are encouraged to examine the feet of their older patients and provide education about foot care and footwear.
In the USA, the majority of people living with HIV infection are older than 50 years of age. As these individuals get older, they face many of the challenges common to the aging experience but often earlier and more often. Cardiovascular, renal, bone, and liver disease, as well as mental health and substance use disorders, are more prevalent among people living with HIV than the general population. While factors related to HIV and its therapies can contribute to the risk of comorbid conditions associated with aging, data suggests more traditional factors are the main drivers. As such, clinicians caring for those living with HIV must be attuned to these risk factors, especially those for which interventions can prevent or delay their onset. All clinicians should recognize the importance of screening for HIV infection, starting with a good sexual and substance use history. Pre-Exposure Prophylaxis (PrEP) is a safe and effective biomedical intervention that can prevent HIV acquisition and should not be avoided or neglected as an option for those over 50, a population that makes up 15% of new diagnoses of HIV.