Risk of fatal injury in older adult drivers, passengers, and pedestrians

Objectives To compare risk of fatal injury in elderly road users (drivers, passengers, pedestrians) with that of younger age groups and to assess the contribution of elderly road users to the number of reported fatalities in the population. Design Fatality age was categorized as 21 to 29, 30 to 39, 40 to 49, 50 to 59, 60 to 69, or 70 and older, and road user was categorized as driver, passenger, or pedestrian. Estimated number of trips made by each age group was used to adjust for exposure and to measure individual risk. Setting Fatalities recorded in Britain between 1989 and 2009. Participants Population-wide fatal injury counts in Britain. Measurements Age of fatally injured drivers, passengers, and pedestrians. Estimated number of trips made per year by drivers, passengers, and pedestrians. Results Risk of fatal injury, but not fatality numbers in the population, were higher for older adult (=70) drivers than for younger age groups. Risk of fatal injury was also high for older adult passengers and pedestrians, who represented the majority of older adult fatalities. Conclusion Previous emphasis on driver impairment in older age has unduly focussed attention on elderly drivers, who represent a minority of all driver fatalities. Older adults represent a much larger proportion of passenger and pedestrian fatalities. Additional policy schemes and initiatives should be targeted at safeguarding older adult passengers and making the road environment safer for elderly pedestrians. © 2012, Copyright the Authors Journal compilation © 2012, The American Geriatrics Society.

A system lifeworld perspective on dying in long term care settings for older people:Contested states in contested places

In many Western countries, older people live and die in long-term institutional care settings. Habermas's concepts of lifeworld, system and communicative action are drawn upon to illuminate the experience of living and dying in this particular place. It is proposed that dying older adults, their family and care staff occupy different contested states and long term care settings are contested places, located in a wider system. This wider system, mediated through care homes, can colonise the life world experiences of dying individuals. The development of communicative space bridges the lifeworld and system and offers a way for the lifeworld of dying individuals, and those around them to be reintegrated into, and influence the wider system. © 2010 Elsevier Ltd.

Subjective impact of minimally invasive dentistry in the oral health of older patients

OBJECTIVES: The aim of this study was to investigate if a minimally invasive oral health package with the use of atraumatic restorative treatment (ART) or a conventional restorative technique (CT) would result in any perceived benefit from the patients' perspective and if there would be any difference between the two treatment groups.

MATERIALS AND METHODS: In this randomised clinical trial, 99 independently living older adults (65-90 years) with carious lesions were randomly allocated to receive either ART or conventional restorations using minimally invasive/intervention dentistry (MID) principles. Patients completed an Oral Health Impact Profile (OHIP)-14 questionnaire before and 2 months after treatment. They were also asked to complete a global transition question about their oral health after treatment.

RESULTS: At baseline, the mean OHIP-14 scores recorded were 7.34 (ART) and 7.44 (CT). Two months after treatment intervention, 90 patients answered the OHIP-14 and the mean scores were 7.23 (not significant (n.s.)) and 10.38 (n.s.) for the ART and CT groups, respectively. Overall, 75.5 % of patients stated that their oral health was better compared to the beginning of treatment.

CONCLUSIONS: Although not shown by the OHIP-14, patients perceived an improvement in their overall oral status after treatment, as demonstrated by the global transition ratings in both groups.

CLINICAL RELEVANCE: Dental treatment using minimally invasive techniques might be a good alternative to treat older individuals, and it can improve their oral health both objectively and subjectively.

Comparison of functionally orientated tooth replacement and removable partial dentures on the nutritional status of partially dentate older patients: a randomised controlled clinical trial

OBJECTIVES: The aims of this study were to conduct a randomised controlled clinical trial (RCT) of partially dentate older adults comparing functionally orientated treatment based on the SDA concept with conventional treatment using RPDs to replace missing natural teeth. The two treatment strategies were evaluated according to their impact on nutritional status measured using haematological biomarkers.

METHODS: A randomised controlled clinical trial (RCT) was conducted of partially dentate patients aged 65 years and older (Trial Registration no. ISRCTN26302774). Each patient provided haematological samples which were screened for biochemical markers of nutritional status. Each sample was tested in Cork University Hospital for serum Albumin, serum Cholesterol, Ferritin, Folate, Vitamin B12 and 25-hydroxycholecalciferol (Vitamin D).

RESULTS: A mixed model analysis of covariance (ANCOVA) indicated that for Vitamin B12 (p=0.9392), serum Folate (p=0.5827), Ferritin (p=0.6964), Albumin (p=0.8179), Serum Total Cholesterol (p=0.3670) and Vitamin D (p=0.7666) there were no statistically significant differences recorded between the two treatment groups. According to the mixed model analysis of covariance (ANCOVA) for Vitamin D there was a significant difference between levels recorded at post-operative time points after treatment intervention (p=0.0470). There was an increase of 7% in 25-hydroxycholecalciferol levels recorded at 6 months compared to baseline (p=0.0172). There was no further change in recorded levels at 12 months (p=0.6482) and these increases were similar within the two treatment groups (p>0.05).

CONCLUSIONS: The only measure which illustrated consistent significant improvements in nutritional status for either group were Vitamin D levels. However no significant difference was recorded between the two treatment groups.

CLINICAL SIGNIFICANCE: Functionally orientated prosthodontic rehabilitation for partially dentate older patients was no worse than conventional removable partial dentures in terms of impact on nutritional status.

Cost-effectiveness of ART restorations in elderly adults: a randomized clinical trial

BACKGROUND: As the world population ages, the requirement for cost-effective methods of treating chronic disease conditions increases. In terms of oral health, there is a rapidly increasing number of dentate elderly with a high burden of maintenance. Population surveys indicate that older individuals are keeping their teeth for longer and are a higher caries risk group. Atraumatic Restorative Treatment (ART) could be suitable for patients in nursing homes or house-bound elderly, but very little research has been done on its use in adults.

OBJECTIVES: To compare the cost-effectiveness of ART and a conventional technique (CT) for restoring carious lesions as part of a preventive and restorative programme for older adults.

METHODS: In this randomized clinical trial, 82 patients with carious lesions were randomly allocated to receive either ART or conventional restorations. Treatment costs were measured based on treatment time, materials and labour. For the ART group, the cost of care provided by a dentist was also compared to the cost of having a hygienist to provide treatment. Effectiveness was measured using percentage of restorations that survived after a year.

RESULTS: Eighty-two patients received 260 restorations, that is, 128 ART and 132 conventional restorations. 91.1% of the restorations were on one surface only. After a year, 252 restorations were assessed in 80 patients. The average cost for ART and conventional restorations was €16.86 and €28.71 respectively; the restoration survival percentages were 91.1% and 97.7%, respectively. This resulted in a cost-effectiveness ratio of 0.18 (ART) and 0.29 (CT). When the cost of a hygienist to provide ART was inserted in the analysis, the resulting ratio was 0.14.

CONCLUSIONS: Atraumatic restorative treatment was found to be a more cost-effective alternative to treat older adults after 1 year, compared to conventional restorations, especially in out of surgery facilities and using alternative workforce such as hygienists. Atraumatic restorative treatment can be a useful tool to provide dental care for frail and fearful individuals who might not access dental treatment routinely.

The subjective numeracy scale as a tool for assessing statistical numeracy in older adult populations

BACKGROUND:
Statistical numeracy, necessary for making informed medical decisions, is reduced among older adults who make more decisions about their medical care and treatment than at any other stage of life. Objective numeracy scales are a source of anxiety among patients, heightened among older adults.
OBJECTIVE:
We investigate the subjective numeracy scale as an alternative tool for measuring statistical numeracy with older adult samples.
METHODS:
Numeracy was assessed using objective measures for 526 adults ranging in age from 18 to 93 years, and all participants provided subjective numeracy ratings.
RESULTS:
Subjective numeracy correlated highly with objective measurements among oldest adults (70+ years; r = 0.51, 95% CI 0.32, 0.66), and for younger age groups. Subjective numeracy explained 33.2% of age differences in objective numeracy.
CONCLUSION:
The subjective numeracy scale provides an effective tool for assessing statistical numeracy for broad age ranges and circumvents problems associated with objective numeracy measures.

Mindful Living in Older Age: a Pilot Study of a Brief, Community-Based, Positive Aging Intervention

Although mindfulness-based interventions have been successfully used with older adults, there have been few interventions that, (a) are created specifically for older adults, (b) are delivered in the community, and (c) aim to promote ‘successful aging’ (rather than just treating dysfunction/disorder). To this end, the current study piloted a brief ‘positive aging’ intervention, comprising two 150 minute sessions, with six female older adults living in the community. Data were gathered through focus groups that were interwoven throughout the intervention. Using thematic analysis, four main themes were identified: (a) aging as a mixed blessing; (b) understanding mindfulness; (c) the challenges of mindfulness; and (d) the benefits of mindfulness. Overall, the intervention was successful in introducing participants to mindfulness and potentially forming the basis of a longer term practice. However, the study also highlighted important points on the challenges of practising mindfulness, in relation to which the paper makes recommendations pertaining to the teaching of mindfulness with older adults.

AB1258­HPR pilot study: does a mediterranean diet­based weight loss programme improve health outcomes in overweight older women with knee osteoarthritis?

Osteoarthritis (OA) is one of the leading causes of pain and disability among older adults, particularly women. Pain and mobility disability are major consequences of knee OA which and can interfere with the functional autonomy of elderly and thus, making it difficult to perform activities of daily living. Evidence suggests that obesity is strongly linked to knee OA and that non­pharmacological therapy should be based on physical activity and weight loss in case of overweight and obesity. A positive relationship between adherence to the Mediterranean diet and health outcomes has been widely discussed in scientific literature, including its potential benefits in weight loss.

A Community Hub Approach to Older People’s Housing

Purpose. This paper explores the potential of housing with care schemes to act as community hubs. The analysis highlights a range of benefits, barriers and facilitators. Design/methodology/approach. Data is presented from the ASSET project (Adult Social Services Environments and Settings) which used a mixed methods approach including a review of the literature, surveys and in-depth case study interviews. Findings. Most housing with care schemes have a restaurant or café, communal lounge, garden, hairdresser, activity room and laundrette, while many also have a library, gym, computer access and a shop. Many of these facilities are open not just to residents but also to the wider community, reflecting a more integrated approach to community health and adult social care, by sharing access to primary health care and social services between people living in the scheme and those living nearby. Potential benefits of this approach include the integration of older people’s housing, reduced isolation and increased cost effectiveness of local services through economies of scale and by maximising preventative approaches to health and wellbeing. Successful implementation of the model depends on a range of criteria including being located within or close to a residential area and having on-site facilities that are accessible to the public. Originality and Value. This paper is part of a very new literature on community hub models of housing with care in the UK. In the light of new requirements under the Care Act to better coordinate community services, it provides insights into how this approach can work and offers an analysis of the benefits and challenges that will be of interest to commissioners and providers as well as planners. This was a small scale research project based on four case studies. Caution should be taken when considering the findings in different settings.

Risk factors for head and neck cancer in young adults: a pooled analysis in the INHANCE consortium.

BACKGROUND: Increasing incidence of head and neck cancer (HNC) in young adults has been reported. We aimed to compare the role of major risk factors and family history of cancer in HNC in young adults and older patients. METHODS: We pooled data from 25 case-control studies and conducted separate analyses for adults ≤45 years old ('young adults', 2010 cases and 4042 controls) and >45 years old ('older adults', 17 700 cases and 22 704 controls). Using logistic regression with studies treated as random effects, we estimated adjusted odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: The young group of cases had a higher proportion of oral tongue cancer (16.0% in women; 11.0% in men) and unspecified oral cavity / oropharynx cancer (16.2%; 11.1%) and a lower proportion of larynx cancer (12.1%; 16.6%) than older adult cases. The proportions of never smokers or never drinkers among female cases were higher than among male cases in both age groups. Positive associations with HNC and duration or pack-years of smoking and drinking were similar across age groups. However, the attributable fractions (AFs) for smoking and drinking were lower in young when compared with older adults (AFs for smoking in young women, older women, young men and older men, respectively, = 19.9% (95% CI = 9.8%, 27.9%), 48.9% (46.6%, 50.8%), 46.2% (38.5%, 52.5%), 64.3% (62.2%, 66.4%); AFs for drinking = 5.3% (-11.2%, 18.0%), 20.0% (14.5%, 25.0%), 21.5% (5.0%, 34.9%) and 50.4% (46.1%, 54.3%). A family history of early-onset cancer was associated with HNC risk in the young [OR = 2.27 (95% CI = 1.26, 4.10)], but not in the older adults [OR = 1.10 (0.91, 1.31)]. The attributable fraction for family history of early-onset cancer was 23.2% (8.60% to 31.4%) in young compared with 2.20% (-2.41%, 5.80%) in older adults. CONCLUSIONS: Differences in HNC aetiology according to age group may exist. The lower AF of cigarette smoking and alcohol drinking in young adults may be due to the reduced length of exposure due to the lower age. Other characteristics, such as those that are inherited, may play a more important role in HNC in young adults compared with older adults.

Volunteering and Social Capital: A Case Study of Older Hospital Volunteers in Southern Ontario

Volunteering as a form of social activity can facilitate older adults’ active aging through community engagement. The purpose of this qualitative case study was to understand the views on older adults’ volunteerism in a community hospital network in Southern Ontario. Utilizing in-depth interviews with 10 older volunteers (over the age of 65), document analysis, and a key informant interview, I explored their experiences of volunteering and social capital development at six hospitals in the network. Data analyses included open and axial coding, and conceptualization of the themes. Four major themes emerged from the data: reasons to volunteer, management’s influence, negative experiences of volunteering, and connections with others. The findings of this research emphasized older volunteers’ strong commitment and enthusiasm to support the hospital in their own communities, the power of volunteering to enhance the development of bonding, bridging, and linking social capital, and the influence of two major contextual factors (i.e. the Auxiliary Factor and the Change Factor) to facilitate or hinder older volunteers’ social capital development in the hospitals. Future research directions should focus on further unpacking the different degrees to which each type of social capital is developed, placing emphasis on the benefits of social capital development for volunteers in healthcare settings. The implications for practice include the targeted recruitment of older adults as healthcare volunteers while creating volunteer positions and environments in which they can develop social capital with their peer volunteers, hospital staff, patients, and people in surrounding communities. To sustain their existing dedicated long-term volunteers, in particular their Auxiliary groups, the community hospital network can enhance facilitating factors such as the Auxiliary Factor while mitigating the negative effects of the Change Factor. By developing social capital through volunteering in their own communities, older adults can engage in active aging, while participating in the development of an age-friendly community.

Affective word priming in the left and right visual fields in young and older individuals

Alors que les hypothèses de valence et de dominance hémisphérique droite ont longtemps été utilisées afin d’expliquer les résultats de recherches portant sur le traitement émotionnel de stimuli verbaux et non-verbaux, la littérature sur le traitement de mots émotionnels est généralement en désaccord avec ces deux hypothèses et semble converger vers celle du décours temporel. Cette dernière hypothèse stipule que le décours temporal lors du traitement de certains aspects du système sémantique est plus lent pour l’hémisphère droit que pour l’hémisphère gauche. L’objectif de cette thèse est d’examiner la façon dont les mots émotionnels sont traités par les hémisphères cérébraux chez des individus jeunes et âgés. À cet effet, la première étude a pour objectif d’évaluer l’hypothèse du décours temporel en examinant les patrons d’activations relatif au traitement de mots émotionnels par les hémisphères gauche et droit en utilisant un paradigme d’amorçage sémantique et une tâche d’évaluation. En accord avec l’hypothèse du décours temporel, les résultats obtenus pour les hommes montrent que l’amorçage débute plus tôt dans l’hémisphère gauche et plus tard dans l’hémisphère droit. Par contre, les résultats obtenus pour les femmes sont plutôt en accord avec l’hypothèse de valence, car les mots à valence positive sont principalement amorcés dans l’hémisphère gauche, alors que les mots à valence négative sont principalement amorcés dans l’hémisphère droit. Puisque les femmes sont considérées plus « émotives » que les hommes, les résultats ainsi obtenus peuvent être la conséquence des effets de la tâche, qui exige une décision explicite au sujet de la cible. La deuxième étude a pour objectif d’examiner la possibilité que la préservation avec l’âge de l’habileté à traiter des mots émotionnels s’exprime par un phénomène compensatoire d’activations bilatérales fréquemment observées chez des individus âgés et maintenant un haut niveau de performance, ce qui est également connu sous le terme de phénomène HAROLD (Hemispheric Asymmetry Reduction in OLDer adults). En comparant les patrons d’amorçages de mots émotionnels auprès de jeunes adultes et d’adultes âgés performants à des niveaux élevés sur le plan comportemental, les résultats révèlent que l’amorçage se manifeste unilatéralement chez les jeunes participants et bilatéralement chez les participants âgés. Par ailleurs, l’amorçage se produit chez les participants âgés avec un léger délai, ce qui peut résulter d’une augmentation des seuils sensoriels chez les participants âgés, qui nécessiteraient alors davantage de temps pour encoder les stimuli et entamer l’activation à travers le réseau sémantique. Ainsi, la performance équivalente au niveau de la précision retrouvée chez les deux groupes de participants et l’amorçage bilatéral observé chez les participants âgés sont en accord avec l’hypothèse de compensation du phénomène HAROLD.

Actitudes hacia el VIH/SIDA, el cáncer y la enfermedad de Alzheimer

Esta revisión de la literatura tuvo como objetivo describir las actitudes hacia el VIH/SIDA, el cáncer y la Enfermedad de Alzheimer desde el modelo tripartito. Se revisaron 109 artículos publicados entre 2005 y 2015 en algunas bases de datos especializadas y herramientas de análisis de impacto. También se incluyeron fuentes secundarias ampliándose la búsqueda a los últimos 20 años (1995-2015). Los resultados mostraron que la mayoría de los estudios realizados sobre las actitudes hacia estas tres enfermedades son de tipo cuantitativo y la información se analizó con base en los componentes del modelo tripartito. Algunos aspectos sociodemográficos como el sexo y la edad están asociados con las actitudes hacia las tres enfermedades y predominan las creencias erróneas sobre ellas respecto a sus causas, curso y tratamiento. También predominan actitudes negativas hacia las tres enfermedades y las conductas e intenciones conductuales son diversas hacia cada una de ellas. No se hallaron antecedentes empíricos del estudio de la estructura de las actitudes propuesta por el modelo tripartito hacia las tres enfermedades. La Salud Pública ha liderado la investigación con base en el modelo de conocimientos, actitudes y prácticas propuesto por la OMS.

Improving computer interaction for older people - studying mouse clicks

Interactions using a standard computer mouse can be particularly difficult for novice and older adult users. Tasks that involve positioning the mouse over a target and double-clicking to initiate some action can be a real challenge for many users. Hence, this paper describes a study that investigates the double-click interactions of older and younger adults and presents data that can help inform the development of methods of assistance. Twelve older adults (mean age = 63.9 years) and 12 younger adults (mean age = 20.8 years) performed click and double-click target selections with a computer mouse. Initial results show that older users make approximately twice as many errors as younger users when attempting double-clicks. For both age groups, the largest proportion of errors was due to difficulties with keeping the cursor steady between button presses. Compared with younger adults, older adults experienced more difficulties with performing two button presses within a required time interval. Understanding these interactions better is a step towards improving accessibility, and may provide some suggestions for future directions of research in this area.