Objective: To examine the associations of suicide in the second half of life with medical and psychiatric illness, functional limitations, and reported use of inpatient, ambulatory, and home health care services. Method:A retrospective case-control design was used to compare 86 people over age 50 years who died by suicide with a comparison group of 86 living community participants that were individually matched on age, gender, race, and county of residence. Results: Suicide decedents had more Axis I diagnoses, including current mood and anxiety disorders, worse physical health status, and greater impairment in functional capacity. They were more likely to have required psychiatric treatment, medical, or surgical hospitalization in the last year, and visiting nurse or home health aide services. In a multivariate model, the presence of any active Axis I disorder and any impairment in instrumental activities of daily living (IADL) made independent contributions to suicide risk. Conclusions: Mental illness, physical illness, and associated functional impairments represent domains of risk for suicide in this age group. In addition to individuals with psychiatric illness, those with severe or comorbid physical illness and functional disability who require inpatient and home care services should be targeted for screening and preventive interventions.

Over 260,000 Americans are living with a traumatic spinal cord injury (SCI). Medical advances have increased the longevity of individuals living with SCI into middle age and beyond. The majority of these individuals are living with an incomplete SCI (NSCISC, 2012), and the proportion of incomplete injuries is rising (DeVivo, 2012). There is little research that specifically examines the changes in physical function experienced by individuals aging with a traumatic incomplete SCI. The purpose of this qualitative descriptive study was to describe the changes in physical function experienced by participants with a traumatic incomplete SCI aging through middle age. Data were collected through moderately structured individual interviews (N=17), in either a face-to-face (n=6) or an email (n=11) format. The seventeen participants ranged in age from 35 to 65 years, with a 16 to 36 year duration of injury. Participants described changes in various body systems and recalled the timing of those changes as they transitioned through their middle years. Qualitative content analysis revealed that participants described primarily gradual changes including decreased muscle strength, decreased endurance, weight gain, and wear and tear changes. When asked to identify sources of information about physical changes, participants predominantly emphasized their lack of knowledge about anticipated changes. Further content analysis revealed three themes related to this transition. Participants likened their experience to travelling through uncharted territory. They described strategies for living in uncharted territory that help them to prevent or manage changes in physical function, with sub-themes of being vigilant in their self-assessment and self-management practices, investing time in figuring out what changes they experienced and why those changes happened, and staying positive. They also described the importance of recognizing the impact of changes. These findings provide a foundation for understanding this age-related transition, and identify the need for further research to support effective self-management strategies and efficient mechanisms for disseminating this knowledge to people with SCI, their caregivers and families. In acute and chronic patient care settings, nurses are well-positioned to be a valuable support and information source for individuals living with an incomplete SCI.

The central thesis of this paper is that the social work profession needs to know much more about menopause and its concomitants in order to enhance diagnosis and treatment. Unfortunately, the woeful lack of research and consequent paucity of data on the subject require a heavy reliance upon intuitively plausible statements in support of larger propositions about many of the strategic relationships advanced in the course of the argument. When these propositions and statements are taken as a whole, the paper is also an outline of essential research topics.

Indiana University-Purdue University Indianapolis (IUPUI) / Atypical symptoms, multiple co-morbidities and a lack of public awareness make it difficult for older adults to know when to seek help for sepsis. Diagnosis delays contribute to older adults’ higher sepsis mortality rates. This research describes patients’ and caregivers’ experiences with the symptom appraisal process, self-management strategies, provider-nurse-patient interactions, and barriers when seeking sepsis care. Convenience and purposive stratified sampling were utilized on two data sources. A nurse-patient and nurse-family caregivers were interviewed. Online stories by older adult patient survivors or family members from the Faces of Sepsis ™ Sepsis Alliance website were analyzed. Emergent themes were identified using qualitative descriptive methods. Listlessness and fatigue were most bothersome symptoms for the nurse-family caregivers. Fever, pain and low blood pressure were most common complaints, followed by breathing difficulty, mental status changes and weakness. Patients expressed “excruciating pain” with abdominal and soft tissue sources of infection, and with post-operative sepsis. Concern was expressed that self-management strategies and medications create barriers by masking typical sepsis signs. Health care providers’ interpersonal interactions, lack of awareness of sepsis symptoms and guidelines, complacency towards older adults, and denial by patients were barriers. Further barriers were staff inexperience, delays, care omissions, and tension between health care providers, patients and caregivers—with emerging advocacy by patients and family. In conclusion, providers should assess previous self-management strategies when evaluating symptoms. At primary care visits or hospital discharge, older patients with risk factors need anticipatory guidance for sepsis symptoms and possible emergent infections--specifically patients with pre-existing risk factors such as urinary tract infections, pneumonia, or operative events. Public and professional education are needed to overcome a lack of urgency and understanding of symptoms for diagnosis, treatment and guideline adherence for inpatients and outpatient clinics. Further research on subjective sepsis symptoms may improve patient-clinician communications when evaluating sepsis in older adults.

Objetive: To evaluate the quality of life of older adults who belong to the Seniors Centers (CAM) of the Social Security during the COVID-19 pandemic. Material and methods: Data were collected through telephone calls to older adults aged 60 years and over in the CAM. Quality of life was assessed with the EQ-5D-3L questionnaire, which considers the dimensions of mobility, self-care, activities of daily living, pain/discomfort and anxiety/depression and an analog scale from 0 to 100. The presence of depression, anxiety, comorbidities and functional status were also measured. A bivariate analysis with nonparametric tests was performed to assess the association between covariates and the quality of life analog scale. In addition, a simple regression analysis was performed using generalized linear models of the Poisson family to evaluate variables associated with the presence of problems in the quality of life dimensions. Results: A total of 99 older adults participated, mostly women (84.9%) and with an average age of 73.1 years, 83.3% had a higher education level and 86.7% lived with their spouse. Older adults with obesity, lung disease, inability to manage their own money, feeling fatigued, and hearing problems reported a lower than average score (<78.9) on the analogous quality of life scale. Osteoarticular diseases and feeling fatigued increase the likelihood of having problems with mobility, performing daily activities, and pain/discomfort. Conclusions: Older adults quality of life is influenced by multiple factors that must be addressed to improve their physical and mental well-being. / Revisión por pares

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Background: This article aims to carry out a review on social prescription and trust regarding the deployment of social benefits in the Elderly Centers (CAM) of the Social Health Security (EsSalud) during the health emergency due to COVID-19. EsSalud in its 126 CAM provides social benefits to older adults, that is, activities for the use of free time that are linked to social prescription; that when the sanitary emergency was decreed they turned to the virtual modality. Experience in the face of the pandemic indicates that trust in institutions varies around the decisions made; helping to maintain it, measures such as transparency, collaboration between stakeholders, among others; Aspects of interest if you want the population to follow the health guidelines provided. In this sense, we propose that social prescription activities can contribute to the improvement of trust, and must carry out binding research for decision-making. / Revisión por pares

Background: Nurses are essential for good palliative care and their responsibility lies in relieving patients from suffering and being supportive to them and their relatives. It is required that the nurse has substantial knowledge in medical and caring treatments. Most of the palliative care is performed in a hospital or elderly care facility. Therefore, it is important to compare the differences and similarities between what the nurses experience. Aim: This study aims to describe the nurses’ own experiences of caring for elderly patients while in palliative care. Method: A literature-based study of 11 reports was performed. Friberg’s five-step model was used for the analysis. Three themes emerged from the analysis; to promote person-centered care, the feeling of not being enough and difficulties regarding the communication. Results: The results show that nurses experience that they must take on too much responsibility. They also feel that the division of labor many times is unclear to them. These factors could hinder the quality of person-centered care. The lack of time and education were two vital parts that clearly affected the nurses' experiences in a negative manner. Lastly, the results showed that communication between nurses and physicians, and between nurses and relatives did not always function adequately. Conclusion: The conclusion from this study is that nurses feel that they do not have the time or resources to perform the optimal care. Palliative care is emotionally distressing for nurses,and they need support from their employers and more experienced colleagues.

The primary purpose of this study was to measure geriatric patients’ levels of intellectual functioning in order to determine the reliability of several specific test instruments. From the battery of measurements used in the study, it was an additional objective to recommend which of these test instruments, or combination thereof, would be most applicable for geriatric patients, based on the empirical findings of this study. Level of intellectual functioning may certainly be influenced by many factors. Therefore, it was part of this study to measure and control for the effects of the following variable: sex, age, education, and medication.

Dyslexia is a clinical diagnosis often associated with phonological processing deficits. There are, however, other areas of concern, such as the presence of auditory temporal processing (ATP) disorders. One method of investigating ATP is the gap detection (GD) paradigm. This study investigated GD performance using the Gaps-in-Noise © (GIN) test in three groups of 30 children, aged 8 to 9 years. GD thresholds and gap identification scores (%) were determined for each participant. The three groups of participants included (Group I) children with dyslexia and phonological deficits, (Group II) children with dyslexia and no significant phonological deficits, and (Group III) normal reading peers. Repeated-measures ANOVA showed that GD thresholds for the three groups were significantly different. Group I showed longer GD thresholds (RE, 8.5 msec; LE, 8 msec), than did Group II (4.9 msec for both ears) or Group III (RE, 4.2 msec; LE, 4.3 msec). Close inspection of the threshold values for the three groups revealed that the thresholds for Group II overlapped substantially with those of Group III, but not with those of Group I. Similar trends were also noted for the gap identification analysis. From a clinical perspective, the majority of participants in Group II and all participants in Group III performed within normal limits on both measures (i.e., thresholds and identifications), while performance of participants in Group I fell below established norms on these measures. Finally, additional analyses revealed that ATP was highly correlated with phonological processing measures indicating a relationship between the presence of phonological deficits and ATP deficits. This study confirmed that ATP deficit is a factor to be considered in dyslexia and suggested that the GIN © test is a promising clinical tool that should be incorporated in the evaluation procedures for children with reading difficulties.