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Delirium, which is associated with adverse health outcomes, is poorly detected in hospital settings. This study aimed to determine delirium occurrence among older medical inpatients and to capture associated risk factors.
This prospective cohort study was performed at an Irish University Hospital. Medical inpatients 70 years and over were included. Baseline assessments within 72 hours of admission included delirium status and severity as determined by the Revised Delirium Rating Scale (DRS-R-98), cognition, physical illness severity and physical functioning. Pre-existing cognitive impairment was determined with Short Informant Questionnaire on Cognitive Decline (IQCODE). Serial assessment of delirium status, cognition and the physical illness severity were undertaken every 3 (±1) days during participants’ hospital admission.
Of 198 study participants, 92 (46.5%) were women and mean age was 80.6 years (s.d. 6.81; range 70–97). Using DRS-R-98, 17.7% (n = 35) had delirium on admission and 11.6% (n = 23) had new-onset delirium during admission. In regression analysis, older age, impaired cognition and lower functional ability at admission were associated with a significant likelihood of delirium.
In this study, almost one-third of older medical inpatients in an acute hospital had delirium during admission. Findings that increasing age, impaired cognition and lower functional ability at admission were associated with increased delirium risk suggest target groups for enhanced delirium detection and prevention strategies. This may improve clinical outcomes.
The purpose of this research was to investigate how informal caregivers of older adults cope with and negotiate driving safety when their loved one is no longer safe to drive. Fifteen informal caregivers of an older adult living at home took part in the present study. Participants cared for individuals with a range of health conditions that significantly impaired driving safety, including dementia, Parkinson’s disease, macular degeneration, and stroke. A thematic analysis of participants’ accounts identified the complex interpersonal, social, and organisational context they encountered when their loved one did not recognise or acknowledge limitations in their ability to drive. This analysis highlights the ethical dilemma at the heart of caregivers’ experiences and identifies stake and blame as key considerations in the development of sensitive and effective policies and practices.
It is unknown if time-restricted feeding confers a protective effect on the physical function of older adults. The aim of this study was to assess prolonged nightly fasting in association with performance-based lower-extremity function (LEF) in a large population of community-dwelling older adults. A cross-sectional study was carried out among 1,226 individuals ≥64 years from the Seniors-ENRICA-II cohort. In 2016-2017, habitual diet was assessed through a validated diet history. Fasting time was classified into the following categories: ≤9, 10-11, and ≥12hours/day, the latter being considered prolonged nightly fasting. Performance-based LEF was assessed with the Short Physical Performance Battery (SPPB). After adjusting for potential confounders, a longer fasting period was associated with a higher likelihood of impaired LEF [odds ratio (OR) and 95% confidence intervals (CI) for the second and third categories: 2.27 (1.56-3.33) and 2.70 (1.80-4.04), respectively, considering the ≤9 hours/day fasting group as reference; p-trend <0.001]. When assessing each SPPB subtest separately, fasting time showed a significant association with balance impairment (OR for highest vs. lowest fasting time: 2.48; 95% CI: 1.51-4.08; p-trend =0.001) and difficulty to rise from a chair (OR for highest vs. lowest fasting time: 1.47; 95% CI: 1.05-2.06; p-trend =0.01). The risk associated with ≥12 h fasting among those with the lowest levels of physical activity was three times higher than among those with ≤9 hours fasting with the same low level of physical activity. Prolonged nightly fasting was associated with a higher likelihood of impaired LEF, balance impairment, and difficulty to rise from a chair in older adults, especially among those with low levels of physical activity.
Healthy dietary patterns may protect against age-related cognitive decline but results of studies have been inconsistent and few have had extensive longitudinal follow-up with comprehensive cognitive testing. The aim of the present study was to determine associations of dietary patterns with trajectories of global and domain-specific cognitive change over a 12-year period. Data from 863 community-dwelling, dementia-free participants from the Lothian Birth Cohort 1936 study of ageing completed a food frequency questionnaire at baseline (aged 70) and underwent cognitive testing at baseline, age 73, 76, 79, and 82. Composite cognitive scores were constructed for four cognitive domains (visuospatial ability, processing speed, memory, and verbal ability) and global cognitive function. A Mediterranean-style pattern and a traditional pattern were derived using principal component analysis of self-reported dietary intakes. In fully-adjusted latent growth curve models, higher baseline adherence to the Mediterranean-style dietary pattern (β = 0.056, P = 0.009) and lower baseline adherence to the traditional dietary pattern (β = -0.087, P < 0.001) were cross-sectionally associated with better verbal ability. A slightly steeper decline in verbal ability over 12 years was observed in those with higher Mediterranean-style diet scores at baseline (β = -0.003, P = 0.008). All other associations were non-significant. Our findings in this well-characterised Scottish cohort indicate that adherence to a healthy Mediterranean-style diet is associated cross-sectionally with better verbal (crystallised) ability, with the converse being true for the traditional diet. A healthier baseline diet did not predict a reduced risk of global or domain-specific cognitive decline.
To examine the association between urban food environment and regular consumption of fruits and vegetables (FV) by older adults from a medium-sized Brazilian city.
Cross-sectional study based on data related to (1) objective assessment of establishments with predominant sale of unprocessed/minimally processed foods, mixed establishments and establishments with predominant sale of ultra-processed foods; (2) regular consumption of FV (≥ 5 times/week), health and socio-demographic variables of community-dwelling older adults. Tertiles of proximity between food establishments and older adults’ residence were calculated. Poisson generalised estimating equations with robust variance, adjusted for individual and contextual variables, were used to estimate the independent association between the proximity of establishments and regular consumption of FV.
Medium-sized Brazilian city.
Representative sample of community-dwelling older adults (n 549).
Older adults travelled the longest distances to establishments with predominant sale of unprocessed/minimally processed foods. The longer the distance to establishments with predominant sale of unprocessed/minimally processed foods, the lower the prevalence of regular consumption of FV (tertile 2: prevalence ratio (PR) = 0·86; 95 % CI = 0·74, 0·99; tertile 3: PR = 0·84; 95 % CI = 0·72, 0·97). Older adults living larger distance tertiles from establishments with predominant sale of ultra-processed foods, mixed establishments or all categories of establishments had 16 % (PR = 0·84; 95 % CI = 0·73, 0·96), 19 % (PR = 0·81; 95 % CI = 0·71, 0·93) and 19 % (PR = 0·81; 95 % CI = 0·70, 0·94) lower prevalence of regular consumption of FV, respectively.
The food environment is associated with regular consumption of FV among older adults. Longer distances from the residence of older adults to food establishments are independently associated with lower prevalence of regular consumption of FV.
Older adults receiving support services are a population at risk for self-harm due to physical illness and functional impairment, which are known risk factors. This study aims to investigate the relative importance of predictive factors of nonfatal self-harm among older adults assessed for support services in New Zealand.
interRAI-Home Care (HC) national data of older adults (aged ≥ 60) were linked to mortality and hospital discharge data between January 1, 2012 and December 31, 2016. We calculated the crude incidence of self-harm per 100,000 person-years, and gender and age-adjusted standardized incidence ratios (SIRs). The Fine and Gray competing risk regression model was fitted to estimate the hazard ratio (HR; 95% CIs) of self-harm associated with various demographic, psychosocial, clinical factors, and summary scales.
A total of 93,501 older adults were included. At the end of the follow-up period, 251 (0.27%) people had at least one episode of nonfatal self-harm and 36,333 (38.86%) people died. The overall incidence of nonfatal self-harm was 160.39 (95% CI, 141.36–181.06) per 100,000 person-years and SIR was 5.12 (95% CI, 4.51–5.78), with the highest incidence in the first year of follow-up. Depression diagnosis (HR, 3.02, 2.26–4.03), at-risk alcohol use (2.38, 1.30–4.35), and bipolar disorder (2.18, 1.25–3.80) were the most significant risk factors. Protective effects were found with cancer (0.57, 0.36–0.89) and severe level of functional impairment measured by Activities of Daily Living (ADL) Hierarchy Scale (0.56, 0.35–0.89).
Psychiatric factors are the most significant predictors for nonfatal self-harm among older adults receiving support services. Our results can be used to inform healthcare professionals for timely identification of people at high risk of self-harm and the development of more efficient and targeted prevention strategies, with specific attention to individuals with depression or depressive symptoms, particularly in the first year of follow-up.
Emotional cognition and effective interpretation of affective information is an important factor in social interactions and everyday functioning, and difficulties in these areas may contribute to aetiology and maintenance of mental health conditions. In younger people with depression and anxiety, research suggests significant alterations in behavioural and brain activation aspects of emotion processing, with a tendency to appraise neutral stimuli as negative and attend preferentially to negative stimuli. However, in ageing, research suggests that emotion processing becomes subject to a ‘positivity effect’, whereby older people attend more to positive than negative stimuli.
This review examines data from studies of emotion processing in Late-Life Depression and Late-Life Anxiety to attempt to understand the significance of emotion processing variations in these conditions, and their interaction with changes in emotion processing that occur with ageing.
We conducted a systematic review following PRISMA guidelines. Articles that used an emotion-based processing task, examined older persons with depression or an anxiety disorder and included a healthy control group were included.
In Late-Life Depression, there is little consistent behavioural evidence of impaired emotion processing, but there is evidence of altered brain circuitry during these processes. In Late-Life Anxiety and Post-Traumatic Stress disorder, there is evidence of interference with processing of negative or threat-related words.
How these findings fit with the positivity bias of ageing is not clear. Future research is required in larger groups, further examining the interaction between illness and age and the significance of age at disease onset.
Given the paucity of data on the use of internet and quality of life (QoL), this literature review aimed to identify the motivations and barriers for internet use and the impact on QoL on older adults using the internet.
Even though older adults are increasingly using information technology, the numbers remain quite small globally. Currently published research primarily focuses on the various ways and methods of information technology use by older adults and the factors influencing use rather than on the impact of information technology on QoL of older adults.
The studies included in this literature review were searched in three databases: WEB of Science, GoogleScholar and PubMed. English language articles were searched using the terms ‘older’, ‘elderly’, ‘senior’, ‘well-being’, ‘life satisfaction’, ‘quality of life’, ‘internet’ and “computer”.
The review demonstrated the association of internet use on QoL in older adults. The majority of the studies substantiate the advantages of internet use by older adults including the ability to communicate with family and friends, maintain a wide social network, have access to information and participate in online leisure activities. There are some studies, though less in number, which did not find a relationship between well-being and use of internet by older adults. The policy implications of this review advocate a multidimensional strategy to support internet use by the older people incorporating internet training and education, financial issues, technical support and access needs to be developed.
Older subjects are susceptible to develop gambling problems, and researchers have attempted to assess the mechanisms underlying the gambling profile in later life. The objective of this study was to identify the main stressful life events (SLE) across the lifespan which have discriminative capacity for detecting the presence of gambling disorder (GD) in older adults. Data from two independent samples of individuals aged 50+ were analysed: N = 47 patients seeking treatment at a Pathological Gambling Outpatient Unit and N = 361 participants recruited from the general population. Sexual problems (p < 0.001), exposure to domestic violent behaviour (p < 0.001), severe financial problems (p = 0.002), alcohol or drug-related problems (p = 0.004) and extramarital sex (p < 0.001) were related to a higher risk of GD, while getting married (p = 0.005), moving to a new home (p = 0.003) and moving to a new city (p = 0.006) decreased the likelihood of disordered gambling. The accumulated number of SLE was not a predictor of the presence of GD (p = 0.732), but patients who met clinical criteria for GD reported higher concurrence of SLE in time than control individuals (p < 0.001). Empirical research highlights the need to include older age groups in evidence-based policies for gambling prevention, because these individuals are at high risk of onset and/or progression of behavioural addiction-related problems such as GD. The results of this study may be useful for developing reliable screening/diagnostic tools and for planning effective early intervention programmes aimed to reduce the harm related to the onset and evolution of problem gambling in older adults.
To examine: (1) diet quality of older adults, using the Healthy Eating Index 2010 (HEI-2010) and self-rated diet quality, (2) characteristics associated with reported awareness and use of nutrition information and (3) factors associated with HEI score and self-rated diet quality.
Cross-sectional study. Based on Day 1 and/or Day 2 dietary recalls, the Per-Person method was used to estimate HEI-2010 component and total scores. T-tests and ANOVA were used to compare means. Logistic and linear regressions were used to test for associations with diet quality, controlling for potential confounders.
National Health and Nutrition Examination Survey, 2009–2014.
Three thousand and fifty-six adults, aged 60 years and older, who completed at least one 24-h recall and answered questions on awareness and use of nutrition information.
Mean HEI score for men was significantly lower than for women (56·4 ± 0·6 v. 60·2 ± 0·6, P < 0·0001). Compared with men, more women were aware of (44·8 % v. 33·7 %, P < 0·05) and used (13·7 % v. 5·9 %, P < 0·05) nutrition information. In multivariable analyses, awareness and use of nutrition information were significant predictors of both HEI and self-rated diet quality for both women and men. Groups with lower nutrition awareness included men, non-Whites, participants in nutrition assistance programmes and those with lower education and socio-economic status.
Nutrition awareness and use of nutrition information are associated with diet quality in adults 60 years and older. Gaps in awareness of dietary guidelines in certain segments of the older adult population suggest that targeted education may improve diet quality for these groups.
Understanding the drivers of health care utilization patterns following disasters can better support health planning. This study characterized all-cause hospitalizations among older Americans after eight large-scale hurricanes.
The objective of this study was to characterize all-cause hospitalizations for any cause among older Americans in the 30 days after eight large-scale hurricanes.
A self-controlled case series study among Medicare beneficiaries (age 65+) exposed to one of eight hurricanes was conducted. The predicted probability of sociodemographic factors associated with hospitalization using logit models was estimated.
Hurricane Sandy (2012) had the highest post-hurricane admission rate, a 23% increase (incidence rate ratio [IRR] = 1.23; 95% CI, 1.22-1.24), while Hurricane Irene in 2011 had only a 10% increase (IRR = 1.10; 95% CI, 1.09-1.11). Higher likelihood of hospitalization occurring after hurricanes included being 85 or older (36.8% probability of hospitalization; 95% CI, 34.7-39.0) and being dually eligible for Medicare and Medicaid (62.8%; 95% CI, 60.7-64.9).
Planning to address the surge in hospitalization for a longer time period after hurricanes and interventions targeted to support aging Americans are needed.
Emotional intelligence (EI) is a strong predictor of negative mood. Applying emotional skills correctly can help to increase positive emotional states and reduce negative ones. This study aims to implement EI intervention designed to improve clarity, repair EI dimensions and coping strategies, and reduce negative mood in older adults.
Participants were randomly assigned to the treatment or control group.
Participants were evaluated individually before and after the intervention.
Participants included 111 healthy older adults; 51 in the treatment group and 60 in the control group.
An EI program was implemented. The program was administered over 10 sessions lasting 90 min each.
EI dimension (attention, clarity, and repair), coping strategies, hopelessness, and mood were assessed.
Analysis of variance for repeated measures was applied. In the treatment group, scores on clarity and emotional repair increased and attention to emotions decreased; problem-focused coping (problem-solving, positive reappraisal, and seeking social support) showed significant increases, whereas emotion-focused coping (negative self-focused and overt emotional expression) obtained significant decreases; scores on negative mood measures declined significantly.
An intervention based on EI is effective in older adults. After the EI intervention, the participants showed significant increases in their levels of clarity and emotional repair and intermediate levels of attention. In addition, the intervention was found to influence adaptation results, increasing the use of adaptive coping strategies and decreasing the use of maladaptive strategies, as well as reducing hopelessness and depressive symptoms.
(1) To delineate whether cognitive flexibility and inhibitory ability are neurocognitive markers of passive suicidal ideation (PSI), an early stage of suicide risk in depression and (2) to determine whether PSI is associated with volumetric differences in regions of the prefrontal cortex (PFC) in middle-aged and older adults with depression.
University medical school.
Forty community-dwelling middle-aged and older adults with depression from a larger study of depression and anxiety (NIMH R01 MH091342-05 PI: O’Hara).
Psychiatric measures were assessed for the presence of a DSM-5 depressive disorder and PSI. A neurocognitive battery assessed cognitive flexibility, inhibitory ability, as well as other neurocognitive domains.
The PSI group (n = 18) performed significantly worse on cognitive flexibility and inhibitory ability, but not on other neurocognitive tasks, compared to the group without PSI (n = 22). The group with PSI had larger left mid-frontal gyri (MFG) than the no-PSI group. There was no association between cognitive flexibility/inhibitory ability and left MFG volume.
Findings implicate a neurocognitive signature of PSI: poorer cognitive flexibility and poor inhibitory ability not better accounted for by other domains of cognitive dysfunction and not associated with volumetric differences in the left MFG. This suggests that there are two specific but independent risk factors of PSI in middle- and older-aged adults.
To investigate the relationship between functional dentition (FD) and changes in dietary patterns (DP) in older adults.
This was a 12-month prospective study, with dental examinations at baseline and questionnaires at baseline and follow-up. Dentition was classified as FD (containing ≥10 occlusal contacts), non-FD with dentures and non-FD without dentures. A 154-item FFQ assessed dietary intake in the previous month. Food items (servings/d) were combined into twenty-two food groups based on their similar nutrient profile, culinary use and previous studies in Thailand. DP were identified through factor analysis of baseline intake and applied scores were used to estimate changes in DP scores. The association between baseline FD (exposure) and change in each DP score (outcome) was tested in linear regression models adjusting for baseline socio-demographic factors, behaviours, chronic conditions, medications, total energy intake and DP score.
Totally, 788 community dwellers aged ≥ 60 years.
In total, 651 participants were retained after 12 months (82·6 % retention rate), of whom 14·1 % had FD. Having an FD was positively associated with larger increases in vegetable intake. Three DP were identified. Participants with FD had larger increases in healthy (0·13; 95 % CI: −0·13, 0·39) and carbohydrate-rich diets intake (0·12; 95 % CI: −0·17, 0·40) as well as larger reductions in meat-rich diet intake (−0·12; 95 % CI: −0·45, 0·21) than those with neither FD nor dentures. However, these differences were not significant.
There was little support for an association between baseline FD and changes in DP.
To investigate if depression risk modifies the association between frailty and mortality in older adults.
Ongoing cohort study.
Albacete city, Spain
Eight hundred subjects, 58.8% women, over 70 years of age from the Frailty and Dependence in Albacete (FRADEA) study.
Frailty phenotype, Geriatric Depression Scale (GDS), comorbidity, disability, and drug use were collected at baseline. Six groups were categorized: (G1: non-frail/no depression risk; G2: non-frail/depression risk; G3: prefrail/no depression risk; G4: prefrail/depression risk; G5: frail/no depression risk; and G6: frail/depression risk). Mean follow-up was 2542 days (SD 1006). GDS was also analyzed as a continuous variable. The association between frailty and depression risk with 10-year mortality was analyzed.
Mean age was 78.5 years. Non-frail was 24.5%, prefrail 56.3%, frail 19.3%, and 33.5% at depression risk. Mean GDS score was 3.7 (SD 3.2), increasing with the number of frailty criteria (p < 0.001). Ten-year mortality rate was 44.9%. Mortality was 21.4% for the non-frail, 45.6% for the prefrail, and 72.7% for the frail participants, 56% for those with depression risk, and 39.3% for those without depression risk. Mean survival times for groups G1 to G6 were, respectively, 3390, 3437, 2897, 2554, 1887, and 1931 days. Adjusted mortality risk was higher for groups G3 (HR 2.1; 95% confidence interval (CI) 1.4–3.1), G4 (HR 2.5; 95% CI 1.7–3.8), G5 (HR 3.8; 95% CI 2.4–6.1), and G6 (HR 4.0; 95% CI 2.6–6.2), compared with G1 (p < 0.001). Interaction was found between frailty and depression risk, although they were independently associated with mortality.
Depression risk increases mortality risk in prefrail older adults but not in non-frail and frail ones. Depression should be monitored in these older adults to optimize health outcomes. Factors modulating the relationship between frailty and depression should be explored in future studies.
With China's rapid urbanisation, many residents, especially older adults, are suffering from psychological problems induced by rural-to-urban relocation. This study examines the association between older adults’ rural place attachment and their depression after relocation, as well as the protective roles of neighbourhood social cohesion and sense of community in the relocation place. Chinese older adults (N = 224) who relocated from rural villages to urban communities completed a survey for this study. The results showed that older adults with stronger rural place attachment experienced more depressive symptoms and a lesser sense of community in the relocation place. In addition, the association between rural place attachment and depression was weakened by neighbourhood social cohesion. That is, compared with older adults perceiving low neighbourhood social cohesion, the positive association between rural place attachment and depression was weaker for older adults perceiving high neighbourhood social cohesion. Furthermore, neighbourhood social cohesion's protective role depended on sense of community. In particular, neighbourhood social cohesion buffered the association between rural place attachment and depression for older adults with a strong sense of community but not for older adults with a weak sense of community. These results have implications for developing resources within neighbourhoods and communities to promote relocation adjustment for older adults.
Driving and stopping driving present challenging issues for older people living with memory problems and the family members supporting them. Changes to driving status impact the individual stopping driving and their family members. CarFreeMe is an existing, effective driving cessation program for older people that may be applicable to older people living with dementia. The purpose of this study was to adapt the program and explore feasibility and key stakeholder perspectives.
The Medical Research Council guidelines for conducting research into complex interventions guided the development, acceptability and feasibility piloting. A multidisciplinary approach was taken, and key stakeholders were involved throughout the process. This included an adaptation process, followed by expert reference group feedback and case series pilot study.
The background research indicated that some key changes were required to meet the needs of people living with dementia. Aspects of the content, language, format and activities were adapted and an additional module was created for family members – whose involvement was identified as important. A more personalized, flexible approach was recommended. The expert reference group [psychologists (n = 2), occupational therapists (n = 3) and dementia behavior consultants (n = 2)] indicated the program was appropriate and needed, and made recommendations for feasibility. Pilot testing with three families indicated acceptability.
A driving cessation program adapted for use with people living with dementia and their families required some changes to meet the needs and situations based on feedback from key stakeholders. Future studies will evaluate implementation outcomes across a range of settings.
Alzheimer's disease (AD) is a major health concern as the world population ages. Yet, few studies have examined what the public over the age of 50 knows about AD. This qualitative study, based on 40 in-depth interviews, examines the knowledge of AD by Flemish people between 50 and 80 years old and their cross-source engagement with information sources. Building on AD media representations and theories on media complementarity and health information behaviour, we find that respondents mostly encounter AD information non-purposively via traditional mass media and interpersonal communication, while the internet is occasionally used to purposefully seek information. Novels, personal experiences/social proximity, public figures and particularly film stand out as channels and sources of AD information, suggesting that fictional narratives, personal experiences and being able to identify with others leave lasting impressions and help to communicate and disperse AD information. However, common misconceptions and gaps in knowledge persist, including AD being considered part of the normal ageing process and old age as well as confusing AD with Parkinson's disease. The biomedical perspective and the tragedy discourse prevail among the majority of respondents, who describe AD in terms of decline, loss and death and as ‘the beginning of the end’. Only a few, typically female respondents, appear aware of the role of individual health behaviour and lifestyle choices to prevent dementia or delay its onset. The misconceptions of AD and gaps in knowledge, as well as the fact that a third of all cases of dementia might be delayed or prevented by managing lifestyle and other risk factors, stress the importance of public educational programmes and the need to emphasise and raise awareness of preventative behaviour. Overall, the findings from this study can be of help to public health communicators and dementia-awareness campaigns, as well as AD training programmes for health-care professionals and family care-givers.
Personality and emotions have not been studied as thoroughly as cognition in old age. Recent research suggests personality changes across the entire life span, through middle age and even into old age. Thus, the previous assumption of stability in personality traits from early adulthood has been challenged and novel approaches to the study of personality development have emerged.
The aim of this presentation is to describe the effects of the ageing process in personality and emotions.
A non-systematic review of the literature was performed on PubMed, PsycINFO and Web of science using selected keywords.
When older adults compare their current and past selves, they usually perceive a subjective growth in personality. Descriptive research suggests that the big five personality characteristics (neuroticism, extraversion, openness, agreeableness and conscientiousness) remain generally stable over the lifespan, despite variations in life experiences. Some studies revealed age-related linear decrease in extraversion. One of the studies found that hearing impairment, already identified as a significant risk factor for social isolation, was related to this decline in extraversion. Although levels of neuroticism tends to go down over the course of adulthood, the increased vulnerabilities that accompany old age may amplify neurotic traits, increasing worries about physical health and memory, common features of depression in the elderly. Emotions, relative to more neutral knowledge and skills, increase in later years. Elderly have better control over emotions than do younger adults, they reason more flexibly about emotion-laden dilemmas and remember emotionally charged information better than neutral facts. Older people also rely more often on emotion-focused forms of coping, as opposed to active, problem-solving approaches.
Core features of personality seem to remain relatively stable throughout adulthood and any marked change in mood or social behavior may indicate a disorder. However, more subtle reordering of personal priorities and shifts in coping styles are common with normal ageing. The richness of emotional processing in older persons runs counter to the generally declining patterns seen in many cognitive and physical skills.
Given the rising numbers of older adults in Canada experiencing falls, evidence-based identification of fall risks and plans for prevention across the continuum of care is a significant priority for health care providers. A scoping review was conducted to synthesize published international clinical practice guidelines (CPGs) and recommendations for fall risk screening and assessment in older adults (defined as 65 years of age and older). Of the 22 CPGs, 6 pertained to multiple settings, 9 pertained to community-dwelling older adults only, 2 each pertained to acute care and long-term care settings only, and 3 did not specify setting. Two criteria, prior fall history and gait and balance abnormalities, were applied either independently or sequentially in 19 CPG fall risk screening algorithms. Fall risk assessment components were more varied across CPGs but commonly included: detailed fall history; detailed evaluation of gait, balance, and/or mobility; medication review; vision; and environmental hazards assessment. Despite these similarities, more work is needed to streamline assessment approaches for heterogeneous and complex older adult populations across the care continuum. Support is also needed for sustainable implementation of CPGs in order to improve health outcomes.