Individual differences in some (but not all) medial prefrontal regions reflect cognitive demand while regulating unpleasant emotion.

The present study investigated the premise that individual differences in autonomic physiology could be used to specify the nature and consequences of information processing taking place in medial prefrontal regions during cognitive reappraisal of unpleasant pictures. Neural (blood oxygenation level-dependent functional magnetic resonance imaging) and autonomic (electrodermal [EDA], pupil diameter, cardiac acceleration) signals were recorded simultaneously as twenty-six older people (ages 64–66 years) used reappraisal to increase, maintain, or decrease their responses to unpleasant pictures. EDA was higher when increasing and lower when decreasing compared to maintaining. This suggested modulation of emotional arousal by reappraisal. By contrast, pupil diameter and cardiac acceleration were higher when increasing and decreasing compared to maintaining. This suggested modulation of cognitive demand. Importantly, reappraisal-related activation (increase, decrease > maintain) in two medial prefrontal regions (dorsal medial frontal gyrus and dorsal cingulate gyrus) was correlated with greater cardiac acceleration (increase, decrease > maintain) and monotonic changes in EDA (increase > maintain > decrease). These data indicate that these two medial prefrontal regions are involved in the allocation of cognitive resources to regulate unpleasant emotion, and that they modulate emotional arousal in accordance with the regulatory goal. The emotional arousal effects were mediated by the right amygdala. Reappraisal-related activation in a third medial prefrontal region (subgenual anterior cingulate cortex) was not associated with similar patterns of change in any of the autonomic measures, thus highlighting regional specificity in the degree to which cognitive demand is reflected in medial prefrontal activation during reappraisal.

Excess burden of constipation in Parkinson's disease: A pilot study

An analysis was undertaken of clinic-based questionnaires that asked people with Parkinson's disease and a control group of older people without a known neurological condition about their experiences of constipation. People with Parkinson's disease report higher constipation on a validated objective measure, the Rome criterion (59% vs. 20.9%); a behavioral indicator, laxative-taking (38.4% vs. 14.2%); and subjective self-report of being always or often concerned by it (33.4% vs. 6.1%). Many people with Parkinson's disease experience constipation problems but they may not bring these to the attention of their healthcare providers. More research is required to understand the causes and management options. (C) 2006 Movement Disorder Society.

EQUAL: New horizons for ageing research

The Engineering and Physical Sciences Research Council (EPSRC) extending quality of life (EQUAL) initiative, specifically supports interdisciplinary user-focused design, engineering and technology research concerned with enhancing the independence and quality of life of older and disabled people. This paper briefly describes a recent programme to encourage the adoption of a broader perspective on the lives and needs of older people that have been pursued by EPSRC through its extending quality life (EQUAL) initiative. EPSRC is the principle supporter design, engineering and technology research in UK universities. The paper illustrates the scope of EQUAL.

The incidence of oral Gram-negative bacteria in patients with Parkinson's disease

Background: Parkinson's disease is a common neurodegenerative disorder that affects an increasing number of older people every year. Dysphagia is not only a common feature, but one that results in poor nutrition and an increased risk of bronchopneumonia. Previous work has suggested that the oral flora is altered in patients with oral pathology. Methods: Fifty patients were assessed to quantify the incidence of oral Gram-negative bacteria. Results: Sixteen of the patients with Parkinson's disease were found to have six different Gram-negative bacilli in their oral cavities. The 20 different Gram-negative bacteria present were Escherichia coli (n=7), Klebsiella spp. (n=3), Kluyvera spp. (n=3), Serratia spp. (n=3), Proteus spp. (n=2) and Enterobacter spp. (n=2). We found that the oral cavity of 16 (32%) of the patients with Parkinson's disease was abnormally colonised with Gram-negative bacteria and that Gram-negative bacteria were more likely to occur in those patients in whom oromuscular dysfunction was present (88% vs. 21%; p<0.05). Conclusion: Further work is required to determine the association between oral flora and the pathogenic organisms found in aspiration pneumonia as well as work on innovative treatments to reduce oral Gram-negative bacteria in those patients at particular risk of aspiration pneumonia.

A Gentle/S approach to robot assisted neuro-rehabilitation

Movement disorders (MD) include a group of neurological disorders that involve neuromotor systems. MD can result in several abnormalities ranging from an inability to move, to severe constant and excessive movements. Strokes are a leading cause of disability affecting largely the older people worldwide. Traditional treatments rely on the use of physiotherapy that is partially based on theories and also heavily reliant on the therapists training and past experience. The lack of evidence to prove that one treatment is more effective than any other makes the rehabilitation of stroke patients a difficult task. UL motor re-learning and recovery levels tend to improve with intensive physiotherapy delivery. The need for conclusive evidence supporting one method over the other and the need to stimulate the stroke patient clearly suggest that traditional methods lack high motivational content, as well as objective standardised analytical methods for evaluating a patient's performance and assessment of therapy effectiveness. Despite all the advances in machine mediated therapies, there is still a need to improve therapy tools. This chapter describes a new approach to robot assisted neuro-rehabilitation for upper limb rehabilitation. Gentle/S introduces a new approach on the integration of appropriate haptic technologies to high quality virtual environments, so as to deliver challenging and meaningful therapies to people with upper limb impairment in consequence of a stroke. The described approach can enhance traditional therapy tools, provide therapy "on demand" and can present accurate objective measurements of a patient's progression. Our recent studies suggest the use of tele-presence and VR-based systems can potentially motivate patients to exercise for longer periods of time. Two identical prototypes have undergone extended clinical trials in the UK and Ireland with a cohort of 30 stroke subjects. From the lessons learnt with the Gentle/S approach, it is clear also that high quality therapy devices of this nature have a role in future delivery of stroke rehabilitation, and machine mediated therapies should be available to patient and his/her clinical team from initial hospital admission, through to long term placement in the patient's home following hospital discharge.

Upper limb robot mediated stroke therapy - GENTLE/s approach

Stroke is a leading cause of disability in particular affecting older people. Although the causes of stroke are well known and it is possible to reduce these risks, there is still a need to improve rehabilitation techniques. Early studies in the literature suggest that early intensive therapies can enhance a patient's recovery. According to physiotherapy literature, attention and motivation are key factors for motor relearning following stroke. Machine mediated therapy offers the potential to improve the outcome of stroke patients engaged on rehabilitation for upper limb motor impairment. Haptic interfaces are a particular group of robots that are attractive due to their ability to safely interact with humans. They can enhance traditional therapy tools, provide therapy "on demand" and can present accurate objective measurements of a patient's progression. Our recent studies suggest the use of tele-presence and VR-based systems can potentially motivate patients to exercise for longer periods of time. The creation of human-like trajectories is essential for retraining upper limb movements of people that have lost manipulation functions following stroke. By coupling models for human arm movement with haptic interfaces and VR technology it is possible to create a new class of robot mediated neuro rehabilitation tools. This paper provides an overview on different approaches to robot mediated therapy and describes a system based on haptics and virtual reality visualisation techniques, where particular emphasis is given to different control strategies for interaction derived from minimum jerk theory and the aid of virtual and mixed reality based exercises.

Household attributes and the future demand for retirement housing

Ageing populations provoke the question of how much bespoke housing should be provided for the elderly. Older people are generally reluctant to move but as they age health circumstances may encourage moves into specialised accommodation. This paper reports an exercise in estimating the future demand for specialised independent living housing and the extent to which that demand will be for owner occupied accommodation or renting, using data for England. The approach is based on a behavioral model related to health and housing issues. The forecasts indicate a substantial increase in demand, growing at a faster rate than the population as a whole. If supply does not rise to meet these demands, serious problems arise in the quality of life of, and cost of caring for, older people; with implications for health care and social services.

NANA: Novel assessment of nutrition and ageing

Purpose NANA is a 3-year project using sensitively-designed technology to improve data collection and integrate information on nutrition, physical and cognitive function and mental health to identify individuals at risk of under-nourishment and improve targeting of interventions. This research will also improve our understanding of the interactions between these factors, in order to better medical treatment and social provision. The toolkit has potential for commercial development for additional segments of the population. Method This is a multi-disciplinary program involving psychology, nutrition, engineering and software engineering. The first phase is a user needs analysis and will involve consulting with a broad cross-section of older people, caregivers, and health professionals, to establish what technical approaches would be useful and acceptable. The second phase focuses on the development of an integrated measurement toolkit. There are three inter-related subsections: (i) an iterative program to develop the assessment technology, (ii) techniques for dietary assessment in older people, and (iii) a parallel investigation of measures of cognition and mental health in older people. It includes a full validation of the assessment toolkit and will comprise a comparison of the new, integrated assessment with traditional 'pen and paper' methods with volunteers having the equipment installed in their homes.

Emotional well-being and adjustment to vision loss in later life: a meta-synthesis of qualitative studies.

Purpose: To review perceived emotional well-being in older people with visual impairment and perceived factors that inhibit/facilitate psychosocial adjustment to vision loss. Method: The databases of MEDLINE, EMBASE, PsycINFO and CINAHL were searched for studies published from January 1980 to December 2010, which recruited older people with irreversible vision loss, and used qualitative methods for both data collection and analysis. Results sections of the papers were synthesised using a thematic-style analysis to identify the emergent and dominant themes. Results: Seventeen qualitative papers were included in the review, and five main themes emerged from the synthesis: 1) the trauma of an ophthalmic diagnosis, 2) impact of vision loss on daily life, 3) negative impact of visual impairment on psychosocial well-being, 4) factors that inhibit social well-being, and 5) factors that facilitate psychological well-being. We found the response shift model useful for explaining our synthesis. Conclusions: Acquired visual impairment can have a significant impact on older people's well-being and make psychosocial adjustment to the condition a major challenge. Acceptance of the condition and a positive attitude facilitate successful psychosocial adjustment to vision loss as well as social support from family, friends and peers who have successfully adjusted to the condition. [Box: see text].

Portals to the world: technological extensions to the boundaries of the home

This article examines the ways that technological objects inside the home are viewed and productively used by a group of older people to extend their access to environments beyond the home. Beginning with a discussion of types of domestic object, we highlight appliances and gadgets, and focus our attentions on the latter. The changes in life brought on by ageing, in particular a reduction in mobility, provide the context for our study, in which access to the outside world becomes increasingly difficult. Recognising their changing circumstances led our participants to actively and selectively engage with these objects, mitigating the shrinking of their accessible environment by using them as a gateway to the many virtual worlds now available. We coin the term ‘portal objects’ to describe the potential that this type of technological object provides, and suggest that the investigation of interiors can be enriched by recognising and including the worlds outside that become integral to occupation inside.

Evidence of immunomodulatory effects of a novel probiotic, Bifidobacterium longum bv. infantis CCUG 52486

Bifidobacterium longum bv. infantis CCUG 52486 was originally isolated from healthy elderly subjects and demonstrated to have particular ecological fitness and anti-pathogenic effects. Bifidobacteria are commonly associated with immunomodulatory properties, especially in older people, but this strain has not been investigated for effects on immune function. This study aimed to explore the immunomodulatory effects of this novel probiotic, compared with three commercial strains, B. longum SP 07/3, L. rhamnosus GG (L.GG) and L. casei Shirota (LcS). Human peripheral blood mononuclear cells (PBMCs) were isolated from fasting blood of young or older volunteers and exposed to probiotic strains or Con A. NK activity and activation, and cytokine release were enhanced by all probiotics with strain-specificities. The effect of B. infantis on NK activity was influenced by ageing. Except for L.GG, probiotics increased IFN-γ production to a much greater degree in young subjects, and increased IL-6 production to a much greater degree in older subjects. Based on IL-10/IL-12 ratios, B. infantis resulted in the most anti-inflammatory profile of all of the probiotics. These results suggest that B. infantis CCUG 52486 has strong immunomodulatory potential compared with well-known commercial strains, and that the immune response to probiotics may be influenced by ageing.

Wearable device to assist independent living

Older people increasingly want to remain living independently in their own homes. The aim of the ENABLE project is to develop a wearable device that can be used to support older people in their daily lives and which can monitor their health status, detect potential problems, provide activity reminders and offer communication and alarm services. In order to determine the specifications and functionality required for the development of the device, user surveys and focus groups were undertaken, use case analysis and scenario modeling carried out. The project has resulted in the development of a wrist-worn device and mobile phone combination that can support and assist older and vulnerable wearers with a range of activities and services both inside their home and as they move around their local environment. The device is currently undergoing pilot trials in five European countries. The aim of this paper is to describe the ENABLE device, its features and services, and the infrastructure within which it operates.

The knowledge of healthcare professionals regarding elderly persons' oral care

OBJECTIVE: The aim of this study was to compare the knowledge and views of nursing staff on both acute elderly care and rehabilitation wards regarding elderly persons' oral care with that of carers in nursing homes. SUBJECTS: One hundred nurses working on acute, sub-acute and rehabilitation wards for elderly people (Group 1) and 75 carers in nursing homes (Group 2) were surveyed. DESIGN: A semi-structured questionnaire. RESULTS: Similar percentages of each group of nurses were registered with a dentist (86% and 88% respectively), although more hospital-based nurses were anxious about dental treatment compared with the nursing home group (40% and 28% respectively). More carers in nursing homes gave regular advice about oral care than the hospital-based nurses (54% and 43% respectively). Eighteen per cent of each group thought that edentulous individuals did not require regular oral care. Eighty-five per cent of hospital-based nurses and 95% of nursing home carers incorrectly thought that dentures were 'free' on the NHS. Although trends were observed between the two groups, no comparisons were statistically significant (Chi-square; level p < 0.05). CONCLUSIONS: Deficiencies exist in the knowledge of health care workers both in hospital and in the community setting, although the latter were less knowledgeable but more likely to give advice to older people.