Can a short period of micronutrient supplementation in older institutionalized people improve response to influenza vaccine? A randomized, controlled trial

OBJECTIVES: To test the hypothesis that a micronutrient supplement can improve seroconversion after influenza immunization in older institutionalized people. DESIGN: Randomized, double-blind, placebo-controlled study. SETTING: Nursing and residential homes in Liverpool, United Kingdom. PARTICIPANTS: One hundred sixty-four residents aged 60 and older from 31 homes were initially randomized; of these, 119 (72.6%) completed the study. INTERVENTION: Participants were randomized to receive a micronutrient supplement providing the reference nutrient intake for all vitamins and trace elements or identical placebo. Tablets were taken over an 8-week period during September and October 2000; influenza vaccine was administered 4 weeks after their commencement. MEASUREMENTS: The hemagglutination-inhibiting antibody response as defined by a fourfold or greater titer rise over 4 weeks and assessed separately for each of the three antigens contained in the 2000/2001 influenza vaccine (A/New Caledonia/20/99 (H1N1), A/Moscow/10/99 (H3N2), B/Beijing/184/93 (B)). RESULTS: Despite a significant increase in serum concentrations of vitamins A, C, D-3, E, folate, and selenium in the supplemented group, there was no significant difference between groups (supplemented vs placebo, respectively) in the proportion of participants seroconverting to H1N1 (41% vs 49%, P=.374), H3N2 (49% vs 58%, P=.343), or B (41% vs 40%, P=.944). CONCLUSION: A micronutrient supplement providing the reference nutrient intake administered over 8 weeks had no beneficial effect on antibody response to influenza vaccine in older people living in long-term care.

Évaluation de l'acuité visuelle chez la personne âgée atteinte de troubles de la cognition

Objectif : L'évaluation de l'acuité visuelle (AV) chez la personne âgée atteinte de troubles cognitifs peut être limitée par le manque de collaboration ou les difficultés de communication du patient. Très peu d'études ont examiné l'AV chez les patients atteints de déficits sévères de la cognition. L’objectif de cette étude était d’évaluer l'AV chez la personne âgée vulnérable ayant des troubles cognitifs à l'aide d'échelles variées afin de vérifier leur capacité à répondre à ces échelles. Méthodes: Trois groupes de 30 sujets chacun ont été recrutés. Le premier groupe était constitué de sujets jeunes (Moy.±ET: 24.9±3.5ans) et le second, de sujets âgés (70.0±4.5ans), ne présentant aucun trouble de la cognition ou de la communication. Le troisième groupe, composé de sujets atteints de démence faible à sévère (85.6±6.9ans), a été recruté au sein des unités de soins de longue durée de l’Institut Universitaire de Gériatrie de Montréal. Le test du Mini-Mental State Examination (MMSE) a été réalisé pour chaque sujet afin de déterminer leur niveau cognitif. L’AV de chaque participant a été mesurée à l’aide de six échelles validées (Snellen, cartes de Teller, ETDRS-lettres,-chiffres,-Patty Pics,-E directionnel) et présentées selon un ordre aléatoire. Des tests non paramétriques ont été utilisés afin de comparer les scores d’AV entre les différentes échelles, après une correction de Bonferroni-Holm pour comparaisons multiples. Résultats: Le score moyen au MMSE chez les sujets atteints de démence était de 9.8±7.5, alors qu’il était de 17.8±3.7 et 5.2±4.6 respectivement, chez les sujets atteints de démence faible à modérée (MMSE supérieur ou égal à 13; n=11) et sévère (MMSE inférieur à 13; n=19). Tous les sujets des groupes 1 et 2 ont répondu à chacune des échelles. Une grande majorité de sujets avec démence ont répondu à toutes les échelles (n=19) alors qu’un seul sujet n’a répondu à aucune échelle d’AV. Au sein du groupe 3, les échelles d’AV fournissant les scores les plus faibles ont été les cartes de Teller (20/65) et les Patty Pics (20/62), quelque soit le niveau cognitif du sujet, alors que les meilleurs scores d’AV ont été obtenus avec les échelles de Snellen (20/35) et les lettres ETDRS (20/36). Une grande proportion de sujets avec démence sévère ont répondu aux cartes de Teller (n=18) mais le score d’AV obtenu était le plus faible (20/73). Au sein des trois groupes, l’échelle de lettres-ETDRS était la seule dont les scores d’AV ne différaient pas de ceux obtenus avec l’échelle de Snellen traditionnelle. Conclusions: L’acuité visuelle peut être mesurée chez la personne âgée atteinte de troubles cognitifs ou de la communication. Nos résultats indiquent que les échelles les plus universelles, utilisant des lettres comme optotypes, peuvent être utilisées avec de bons résultats chez les personnes âgées atteintes de démence sévère. Nos résultats suggèrent de plus que la mesure d’acuité visuelle doit être tentée chez toutes les personnes, peu importe leur niveau cognitif.

Inadequate management of medicines by the older-aged living in a retirement village

BACKGROUND: A comparison of the management of medicines by the older-aged living in freehold (fully owned) and rental homes in retirement villages has suggested that the older-aged living in rental, but not freehold, retirement villages may require help to manage their medicines. OBJECTIVE: The objective of this study was to investigate the management of medicines by the older-aged living independently in a leasehold (partly owned) home in retirement village to determine whether they also need help in managing their medicines. METHOD: Semi-structured interviews were conducted with 22 older-aged residents living in a leasehold retirement village. MAIN OUTCOME MEASURE: The main outcome measure was the perception of present and ongoing adherence. RESULTS: Amongst participants in the leasehold retirement village, with an average age of 82.9 years, the perceptions of present and ongoing adherence indicated that only 55 % of older-aged participants were adherent at the time of the study, and not likely to have problems with adherence within the next 6-12 months. Participants from the leasehold retirement village had a good understanding of 58 % of their illnesses. A mean of 9.8 medicines per person were prescribed. Cardiovascular medicines were the most commonly prescribed at 86 %. CONCLUSION: The older-aged living in leasehold retirement villages may require extra assistance/resources to manage their medicines.

Self-reported use of natural health products:A cross-sectional telephone survey in older Ontarians

Background: The self-reported use of natural health products (NHPs) (herbal products and vitamin and mineral supplements) has increased over the past decade in Canada. Because the elderly population might have comorbidities and concurrently administered medications, there is a need to explore the perceptions and behaviors associated with NHPs in this age group. Objective: The goal of this study was to assess the use of NHPs in a cohort of older Canadian residents and the characteristics, perceptions, and behaviors associated with NHP use. Methods: Survey participants aged =60 years were randomly selected from telephone listings in the area of greater Hamilton, Ontario, Canada. Data were collected using a standardized computer-assisted telephone interview system. Self-reported data covering 7 domains were collected: (1) demographics; (2) self-reported 12-month NHP use; (3) reasons for NHP use; (4) self-reported 12-month prescription medication use; (5) expenditures on NHPs; (6) patient-reported adverse events and drug-NHP interactions; and (7) perceptions of physicians' attitudes regarding NHPs. Descriptive statistics were used to compare the characteristics of NHP users with those of nonusers and to assess the characteristics of NHP users across these 7 domains. Multivariate regression analysis was conducted to determine the demographic variables that might be associated with NHP user status. Results: Of 2528 persons identified as age =60 years, 1206 (48%) completed the telephone interview. Six hundred sixteen of these respondents (51%) reported the use of =1 NHP during the previous 12 months. On the initial univariate analysis, younger age and higher income were significantly associated with reporting NHP use (mean age, users vs nonusers, 71.1 vs 72.7 years, respectively; 95% CI, 1.02-1.06; P <0.001; income more than Can $26,000 was 28% and 22% in users and nonusers, respectively; P = 0.028). One hundred seventy of 616 users (28%) used an NHP to treat the same condition for which they were concurrently receiving a prescription medication, and 43 (25%) had not informed their physicians about their NHP use. Patients' characteristics such as sex, education, smoking status, and self-reported health status did not differ significantly between users and nonusers. In individuals who regularly spent money to purchase NHPs (n = 394), the mean cost was $20.38/mo. NHP expenditure was not significantly associated with age, sex, or income. Conclusion: Based on these findings, a substantial proportion of those Ontarians aged =60 years reported NHP use, and there is a need for greater communication with physicians to avoid potential drug-NHP interactions. © 2009 Excerpta Medica Inc. All rights reserved.

An in-depth pilot study on patterns, destinations, and purposes of walking in Hong Kong older adults

Walking is a suitable activity for older adults and has physical and mental health benefits. To devise interventions that impact on levels of walking it is necessary to first understand the purposes for which people walk and the destinations to which they walk. Using a 7-day diary and accelerometry, this study investigated destinations and purposes of walking in older adult residents of an ultra-dense Asian city. Participants reported an average of 17.1 walking trips per week and total weekly accelerometer/diary determined trip walking time averaged 735 minutes per week, much higher than reported for older adults in non-Asian settings. The most common destinations were within the neighborhood: parks and streets for recreation walking and shops and eating places for transport-related walking. Errands and eating were the most common purposes for transportation trips. The study results can help inform urban design to encourage walking.

People’s perceptions about the importance of forests on Borneo

We ascertained villagers’ perceptions about the importance of forests for their livelihoods and health through 1,837 reliably answered interviews of mostly male respondents from 185 villages in Indonesian and Malaysian Borneo. Variation in these perceptions related to several environmental and social variables, as shown in classification and regression analyses. Overall patterns indicated that forest use and cultural values are highest among people on Borneo who live close to remaining forest, and especially among older Christian residents. Support for forest clearing depended strongly on the scale at which deforestation occurs. Deforestation for small-scale agriculture was generally considered to be positive because it directly benefits people’s welfare. Large-scale deforestation (e.g., for industrial oil palm or acacia plantations), on the other hand, appeared to be more context-dependent, with most respondents considering it to have overall negative impacts on them, but with people in some areas considering the benefits to outweigh the costs. The interviews indicated high awareness of negative environmental impacts of deforestation, with high levels of concern over higher temperatures, air pollution and loss of clean water sources. Our study is unique in its geographic and trans-national scale. Our findings enable the development of maps of forest use and perceptions that could inform land use planning at a range of scales. Incorporating perspectives such as these could significantly reduce conflict over forest resources and ultimately result in more equitable development processes.

Beyond Bingo: A phenomenographic exploration of leisure in aged care

How do older adults living in residential aged care experience leisure activities? What restricts and facilitates participation? These two research questions guided this semi-longitudinal qualitative research, tracking the lived experience of aged care from the perspective of twenty new aged care residents over 18 months (average age, 80 years) through repeated in-depth semi-structured interviews. Interview data were analyzed using phenomenography, an under-utilized qualitative analysis technique that identifies the variations in how people experience, understand, or conceive of a phenomenon. Phenomenography revealed three qualitatively different ways of understanding residents’ leisure experience: - (1) as a structure for living, - (2) creating social connections, and; - (3) maintaining ability. By illustrating the variation and similarities in how these older Australian residents conceptualise and experience leisure in aged care, the findings may help facilitate a more thoughtful understanding that informs theory, policy and practice.

Comportements sexuels à risque, VIH/ITS et violence dans les milieux prostitutionnels de St-Marc et Gonaïves, Haïti

Les clients de TS sont considérés comme un groupe à risque de VIH et aussi agiraient comme un « pont de transmission » entre les TS et les femmes de la population générale. En dépit de leurs comportements sexuels à risque, les clients de TS ont été rarement étudiés. En conséquence, les objectifs spécifiques de cette thèse étaient : 1) estimer la prévalence du VIH, de la syphilis, du VHS-2 (virus de l’herpès simplex et 2) des facteurs de risque associés chez les clients de TS en Haïti, 2) examiner les déterminants de l’intention d’utilisation du condom, et 3) estimer la prévalence des comportements de violence et ses conséquences. Pour ce faire, une enquête transversale a été effectuée en 2006 auprès de 378 clients fréquentant les milieux de prostitution de St-Marc et de Gonaïves, en Haïti. Un questionnaire structuré ainsi que des échantillons de sang séché sur papier filtre ont été utilisés pour la collecte de données comportementales et biologiques. Notre premier article a montré une prévalence élevée du VIH et des ITS chez les clients. Ces hommes avaient plusieurs partenaires sexuelles avec lesquelles l’utilisation du condom variait. Les clients qui avaient déjà consommé de la marijuana, pratiquaient le vaudou, avaient des antécédents d’ITS ou étaient infectés par le VHS-2, avaient plus de chances d’être positifs au VIH. Le fait d’habiter Gonaïves, de ne pas être protestant, d’être employé et d’avoir déjà essayé la marijuana était associé à l’infection à la syphilis. Tandis que les clients plus vieux, ceux résidants à Gonaïves ainsi que ceux pratiquant le vaudou étaient plus souvent infectés par le VHS-2. Dans notre second article, nous avons démontré que les normes subjectives, le contrôle comportemental perçu et les attitudes étaient des déterminants importants de l’intention d’utilisation du condom. Les clients qui avaient des antécédents d’ITS ou avaient utilisé le condom lors de la dernière relation sexuelle avec la TS étaient aussi plus susceptibles d’avoir l’intention d’en faire usage dans le futur. Les résultats du dernier article ont montré que la prévalence des comportements de violence envers les partenaires intimes était élevée. De plus, la violence émotionnelle et physique était associée à l’utilisation inconstante du condom avec les différentes partenaires sexuelles. En conclusion, cette étude suggère que les clients de TS agiraient comme un pont de transmission facilitant la propagation du VIH/ITS dans la population générale en Haïti et que la violence semblerait également jouer un rôle dans la transmission de ces infections. Nos résultats soulignent le besoin d’interventions en prévention du VIH et des ITS ciblant cette population vulnérable, incluant la problématique de la violence.

Stages of behavior change and perceived barriers to physical activity in the elderly living in a medium size city in Brazil

The aim was to analyze the prevalence of the stages of behavior change (BCS) and the perceived barriers to physical activity in older people residents in a medium size city of São Paulo state, Brazil. Seventy-nine older people participated of the study. The BCS was assessed by the Questionnaire of Behavior Chance Stages and those on perception of barriers by the Questionnaire on Barriers to the Practice of Physical Activity in Older People (QBPPAE). Statistical analyses was comprised by the Chi-square test (p<0.05). Data showed that: a) 64,6% of the older people do not practice physical activity and only 22,8% of them have been practicing it on a regular basis for more than 6 months; b) The most perceived barriers were: "Active enough", "Too old"; "Need to rest" and; "Disease or injury"; c) The BCS seems modulate significantly the perception of barriers (p<0.05). We can conclude that: a) most of the older people are in the pre-contemplation, contemplation and preparation stages of the BCS, yet; b) gender influences almost nothing with perception of barriers and; c) the BCS interferes with the type of perceived barriers. Such conclusions support the suggestions that it is necessary to develop specific strategies for different stages of behavior change if it is to minimize the barriers. This may help to find the most effective way to change to more active lifestyle in the elderly.

The use of amenities in high density neighbourhoods by older urban Australians residents

Like other major cities, Brisbane (Australia) has adopted policies to increase residential densities to meet the liveability goal of decreasing car dependence. This objective hinges on urban neighbourhoods being amenity-rich spaces, reducing the need for residents to leave their neighbourhood for everyday living. While older people are attracted to urban settings, there has been little empirical evidence linking liveability satisfaction with older people's use of urban neighbourhoods. Using a case study approach employing qualitative (diaries, in-depth interviews) and quantitative (Global Positioning Systems and Geographical Information Systems mapping) methods,this paper explores the effect of the neighbourhood environment and its influence on liveability for older urban people. Reliance on motor vehicles and issues with availability and access to local amenities inhibit local participation for older people. Highlighting these issues furthers our understanding of the landscape planning and design factors that make urban neighbourhoods more liveable for older residents.

Quality of life for older people in residential care is related to connectedness, willingness to enter care, and co-residents

Aim: To establish associations with quality of life (QOL) of older people in long-term residential care facilities in two New Zealand cities. Methods: The outcome measure of QOL was the Life Satisfaction Index. We used multiple linear regression to explore how broad categories of factors might contribute to QOL. Results: A total of 599 people (median age of 85 years; 74% women) participated. Response rates were 85% for facilities and 83% for residents. A resident's QOL was significantly related to the QOL of co-residents. QOL was higher for people who were more positive about entry to residential care, more physically able, and not depressed, and for those with more family and emotional support. Conclusion: Attending to the circumstances around entry to residential care may enhance QOL, as may promoting physical activity, treating depression and ensuring older people remain emotionally connected to their families. In choosing a facility, noting the QOL of co-residents is important.

Potentially inappropriate prescribing in older residents in Irish nursing homes

STOPP/START was formulated to identify potentially inappropriate prescribing (PIP) and potential prescribing omissions (PPOs) in older people. The purpose of this study was to determine the prevalence of PIP and PPO in older Irish patients in residential care using STOPP/START.

Prescription medication hoarding and borrowing or sharing behaviours in older residents in the Illawarra, New South Wales, Australia

Aim: To examine prescription medication hoarding and borrowing or sharing (PMHBS) behaviours in older people, particularly which medications are subject to these behaviours and the circumstances that enable these behaviours.

Methods: A mixed methods triangulation design, using consecutive qualitative (focus groups) and quantitative (survey) methodologies in a convenience sample of people older than 65 years, living independently in the Illawarra region (New South Wales).

Results: Focus group participants (n= 28) acknowledged PMHBS behaviours were widespread; however, very few survey respondents (n= 226) admitted to engaging in these behaviours. Main findings in the study were enablers for these behaviours: the prescription medication is considered the same as that prescribed previously; and self-medicating for pain relief.

Conclusions: The prevalence of PMHBS behaviours in this study was low, although it was acknowledged such behaviours occurred in the wider community. Sharing strong pain medication and the same prescription medication appeared to be acceptable in this population.