Objetivo: Evaluar la presencia de asociación entre desnutrición y riesgo de depresión en el adulto mayor de 75 años que acude al servicio de consulta externa del servicio de geriatría Método: Se realizó un estudio transversal analítico en el Centro Médico Naval del Callao - Perú.  La desnutrición fue medida con el MNA Mini Nutritional Assessment y categorizada en estado nutricional normal y desnutrición. Los pacientes fueron clasificados como con riesgo o sin riesgo de depresión de acuerdo con la puntuación obtenida en el Geriatric Scale Disease. Asimismo, se evaluó el sexo, la edad, estado marital, grado de instrucción, número de personas en el hogar, número de comorbilidades y estado funcional. Se estimaron razones de prevalencia (RP) con su respectivo IC95% mediante un modelo de regresión de Poisson a nivel crudo y ajustado. Resultados: Se incluyeron 135 adultos mayores en el análisis. El 34,1% presentaron riesgo de depresión. Por otro lado, el 34,8% tuvieron un estado nutricional alterado. La probabilidad de riesgo de depresión en pacientes adultos mayores es mayor los desnutridos que, en aquellos con un estado nutricional normal, tanto en el análisis crudo [RP: 3,51 (IC95%: 2,14 a 5,76)] como en el ajustado [RP: 2,76 (IC 95%: 1,65 a 4,63)]. Conclusión: Los hallazgos sugieren la presencia de una asociación entre la desnutrición y riesgo de depresión en los adultos mayores de 75 años que acuden a consulta externa geriátrica del Centro Médico. / Objective: To assess the presence of an association between malnutrition and the risk of depression in seniors over 75 years old who attend the outpatient clinic service in the Geriatric department. Method: It has been made an analytical cross-sectional study in the Navy Medical Centre of Callao – Peru. The malnutrition was measured with the Mini Nutritional Assessment (MNA) and categorised in normal nutritional state and malnutrition. The patients were classified as at risk or without risk of depression according to the score obtained in the Geriatric Disease Scale. Likewise, they were assessed by sex, age, marital status, level of education, number of people in the household, number of comorbidities and functional status. Prevalence ratios (RP) were estimated with their respective 95% CI using a Poisson regression model at crude and adjusted level. Results: The analysis included 135 seniors. From them, 34.1% were at risk of depression. On the other hand, 34.8% had an altered nutritional status. The likelihood of depression risk in senior patients is higher in malnourished than in those with normal nutrition status, both in the crude analysis [RP: 3,51 (IC95%: 2,14 a 5,76)], and in the adjusted [RP: 2,76 (IC 95%: 1,65 a 4,63)]. Conclusions: The findings suggest the presence of an association between malnutrition and risk of depression in seniors over 75 years old who come to the geriatric outpatient clinic of the medical centre. / Tesis

Background: Treatment decisions for elderly patients with gallbladder pathology are complex. Little is known about what factors go into treatment decisions in this population. We used Medicare data to examine gender-based differences in the use of cholecystectomy vs. cholecystostomy tube placement in elderly patients with acute cholecystitis. Methods: We queried a 5% random sample of Medicare data (2009-2011) for patients >65 admitted for acute cholecystitis (by ICD-9 code) who subsequently underwent a cholecystectomy and/or cholecystostomy tube placement. Demographic information (age, race), clinical characteristics (Elixhauser index, presence of biliary pathology), and hospital outcomes (case fatality rate, length of stay, need for ICU care) were compared by gender. A multivariable model was used to examine predictors of cholecystectomy vs. cholecystostomy tube placement. Results: Of 4063 patients admitted with cholecystitis undergoing the procedures of interest just over half (58%) were women. The majority of patients (93%) underwent cholecystectomy. Compared to women, men were younger (average age 76 vs. 78, p value < 0.01) and had few comorbidities (average Elixhauser 1.2 vs. 1.4 p value < 0.01). Case fatality rate was similar between men (2.5%) and women (2.4% p value 0.48). A higher percentage of men spent time in the ICU (36%) compared to women (31% p value < 0.01). On multivariable analysis men were 30% less likely to undergo cholecystectomy (OR 0.69, 95% CI 0.53-0.91). Conclusion: Elderly men are less likely than elderly women to undergo cholecystectomy for acute cholecystitis despite being younger with less co morbidity and are more likely to spend time in the ICU. More research is needed to determine whether a difference in treatment is contributing to the higher rate of ICU utilization in elderly men with acute cholecystitis.

Background: Overtreatment of localized prostate cancer (PCa) is a concern as many men die of other causes prior to experiencing a treatment benefit. This dissertation characterizes the need for assessing other cause mortality (OCM) risk in older men with PCa and informs efforts to identify patients most likely to benefit from definitive PCa treatment. Methods: Using the linked Surveillance Epidemiology and End Results-Medicare Health Outcomes Survey database, 2,931 men (mean age=75) newly diagnosed with clinical stage T1a-T3a PCa from 1998-2009 were identified. Survival analysis methods were used to compare observed 10-year OCM by primary treatment type. Age and health factors predictive of primary treatment type were assessed with multinomial logistic regression. Predicted mortality estimates from Social Security life tables (recommended for life expectancy evaluation) and two OCM risk estimation tools were compared to observed rates. An improved OCM prediction model was developed fitting Fine and Gray competing risks models for 10-year OCM with age, sociodemographic, comorbidity, activities of daily living, and patient-reported health data as predictors. The tools’ ability to discriminate between patients who died and those who did not was evaluated with Harrell’s c-index (range 0.5-1), which also guided new model selection. Results: Fifty-four percent of older men with localized PCa underwent radiotherapy while 13% underwent prostatectomy. Twenty-three percent of those treated with radiotherapy and 12% of those undergoing prostatectomy experienced OCM within 10 years of treatment and thus were considered overtreated. Health factors indicative of a shorter life expectancy (increased comorbidity, worse physical health, smoking) had little to no association with radiotherapy assignment but were significantly related to reductions in the likelihood of undergoing prostatectomy. Social Security life tables overestimated mortality risk and discriminated poorly between men who died and those who did not over 10 years (c-index=0.59). Existing OCM risk estimation tools were less likely to overestimate OCM rates and had limited but improved discrimination (c-index=0.64). A risk model developed with self-reported age, Charlson comorbidity index score, overall health (excellent-good/fair/poor), smoking, and marital status predictors had improved discrimination (c-index=0.70). Conclusions: Overtreatment of older men with PCa is primarily attributable to radiotherapy and may be reduced by pretreatment assessment of mortality-related health factors. This dissertation provides a prognostic model which utilizes a set of five self-reported characteristics that better identify patients likely to die of OCM within 10 years of diagnosis than age and comorbidity-based assessments alone.

Background: Traumatic injury remains a major cause of mortality in the US. Older Americans experience lower rates of injury and higher rates of death at lower injury severity than their younger counterparts. The objectives of this study were to explore pre-injury factors and injury patterns that are associated with post-discharge mortality among injured elderly surviving index hospitalization. Methods: We queried a 5% random sample of Medicare beneficiaries (n=2,002,420) for any hospitalization with a primary ICD-9 diagnosis code for injury. Patients admitted without urgent/emergent admission were excluded, as well as patients presenting from inpatient hospitalization or rehabilitation. The primary endpoint was all-cause mortality. Patients were categorized into three mortality groups: death within 0-30 days, 31-90 days, or 91- 365 days post-discharge from the index hospitalization. These groups were compared with those who survived greater than one year post-discharge. Univariate tests of association and multivariable logistic regression models were utilized to identify factors associated with mortality during the 3 examined periods. Results: 83,439 elderly patients (4.2%) were admitted with new injuries. 63,628 met inclusion criteria. 1,936 patients (3.0%) died during their index hospitalization, 2,410 (3.8%) died within 0-30 days, 3,084 (4.8%) died within 31-90 days, and 5,718 (9.0%) died within 91- 365 days after discharge. In multivariable adjusted models, advanced age, male sex, and higher Elixhauser score were associated with post-discharge mortality. The presence of critical injury had the greatest effect on mortality early after injury (0-30 days, OR 1.81, CI 1.64-2.00). Discharge to anywhere other than home without services was associated with an increased odds of dying. Conclusions: Socio-demographic characteristics, disposition, and co-morbid factors were the strongest predictors of post-discharge mortality. Efforts to reduce injury-related mortality should focus on injury prevention and modification of co-morbidities.

Höftfrakturer hos äldre kommer att bli ett stort globalt hälsoproblem på grund av den snabbt växande åldrande befolkningen. En höftfraktur kan medföra en rad negativa konsekvenser i det dagliga livet, därmed är det viktigt att belysa hur de äldre upplever livet efter höftfrakturen. Syftet med denna studie var att belysa de äldres upplevelse av dagligt liv efter höftfraktur. Studien är en litteraturöversikt med induktiv ansats genom manifest innehållsanalys och består av tio vetenskapliga artiklar med både kvalitativa och kvantitativa ansatser. Resultatet presenteras i tre huvudkategorier: upplevda förändringar i dagligt liv, upplevelser av behov av rehabilitering, upplevelser av behov av socialt stöd. De äldre upplever förändringar i det dagliga livet efter höftfrakturen från ett fysiskt och psykiskt samt socialt perspektiv. De behöver olika former av stöd för att kunna återvända till sin fungerande vardag. Vidare forskning bör lägga fokus på könsspecifik kunskap om förändringar i det dagliga livet hos de äldre med höftfrakturer. / Hip fractures in the elderly will be a major global health problem due to the rapidly growing elderly population. A hip fracture can result in several negative consequences in daily life, thus it is important to highlight how the elderly experience life after the hip fracture. The aim of this study was to illuminate the elderly’s experience of daily life after hip fracture. The study is a literature review with inductive approach through manifest content analysis and consists of ten scientific articles with both qualitative and quantitative approaches. The result is presented in three main categories: experienced changes in daily life, experiences of need of rehabilitation, experiences of need of social support. The elderly experience changes in the daily life after the hip fracture from a physical and mental as well as social perspective. They need different forms of support to be able to return to their functional daily life. Further research should focus on gender-specific knowledge regarding changes in the daily life of the elderly with hip fractures.

Indiana University-Purdue University Indianapolis (IUPUI) / Literature pertaining to geriatric care contains rich information regarding the best practices related to geriatric health care issues. The publication domain of geriatric care is small as compared to other health related areas, however, there are over a million articles pertaining to different cases and case interventions capturing best practice outcomes. If the data found in these articles could be harvested and processed effectively, such knowledge could then be translated from research to practice in a quicker and more efficient manner. Geriatric literature contains multiple domains or practice areas and within these domains is a wealth of information such as interventions, information on care for elderly, case studies, and real life scenarios. These articles are comprised of a variety of causal relationships such as the relationship between interventions and disorders. The goal of this study is to identify these causal relations from published abstracts. Natural language processing and statistical methods were adopted to identify and extract these causal relations. Using the developed methods, causal relations were extracted with precision of 79.54%, recall of 81% while only having a false positive rate 8%.

<p dir="ltr">Individuals with typical audiometric sensitivity exhibit varying speech perception abilities in noisy environments, which may decline with age. Temporal processing plays a pivotal role in speech perception, especially in challenging listening conditions. Auditory decline due to aging involves both peripheral pathology and central auditory system changes, impacting temporal processing. To delineate the contributions of these changes, measurements of within- and across-channel temporal processing were conducted in a wide age range of normal-hearing individuals. Robust perception of within-channel temporal cues requires precise coding at both peripheral and central auditory pathway levels, while cross-channel processing relies on central mechanisms. Comprehensive data collection involved behavioral and electrophysiological measures, revealing age-related increases in behavioral thresholds, less robust cortical responses to gaps and temporal-coherence changes, and declining SPIN performance. Cross-channel measures proved to be more predictive of speech perception outcomes, emphasizing the significance of central auditory changes in age-related perceptual deficits.</p><p dir="ltr">A mini-EEG cap to record cortical EEG auditory responses to gaps in chinchillas using a new sedation protocol was validated. This advancement enhances translational potential and paves the way for exploring cortical auditory processing using complex stimuli in animal models. By facilitating simultaneous exploration of both subcortical and cortical consequences of auditory system pathologies, this development contributes to a more comprehensive understanding of auditory processes across species.</p>

This thesis discusses current insights into the applications of deep transcranial magnetic stimulation (dTMS) in older adults with treatment-resistant depression (TRD). / Objectives: To examine current evidence of clinical efficacy and applications of deep transcranial magnetic stimulation (dTMS) among older adults with treatment-resistant depression (TRD). Methods: In Study 1, we conducted a systematic review of existing literature on the clinical efficacy of dTMS across psychiatric and cognitive disorders. Studies eligible for inclusion were clinical trials which were required to have a sham/control condition to mitigate confounding variables and to strengthen our assessment of efficacy. This dissertation specifically aimed to discuss these findings in the context of older adults with depression, as a means to investigate whether available evidence supporting the clinical efficacy of dTMS for depression is generalizable to older populations. In Study 2, we analyzed recruitment data from a pilot study investigating the effects of dTMS in older adults with TRD. Specifically, we aimed to evaluate the effectiveness of various recruitment strategies by using an enrollment-cost analysis, as well as comparing enrollment rates (i.e., enrolled participants/referrals received) for each recruitment method. Moreover, we identified potential facilitators and barriers to recruitment following a verbal thematic analysis of qualitative interview data. Results: In Study 1, most substantial evidence (n = 6 studies) within the literature supports the clinical efficacy of the dTMS H1-coil for the treatment of depressive episodes in patients with bipolar disorder (BD) or major depressive disorder (MDD). Only one randomized controlled trial was conducted in older adults with TRD. This trial reported higher remission rates in the active dTMS arm compared to the sham dTMS arm following treatment with the H1-coil. In study 2, we found (1) health provider outreach within the affiliated inpatient and outpatient mental health clinics and (2) Facebook, to be the most effective recruitment strategies. Lastly, social support from research staff (n = 15; 88.24%) and the time-intensiveness aspect of dTMS treatments (n = 6; 35.29%) were the most frequently identified facilitators and barriers to recruitment, respectively. Conclusions: While there is notable evidence supporting the clinical efficacy of the dTMS H1-coil for the treatment of depressive episodes, the majority of such evidence is based on findings from younger-to-middle aged groups. Thus, the generalizability of dTMS treatment efficacy to older adults remains less understood. Further sham-controlled studies are needed to determine the clinical efficacy of dTMS in older adults and to improve evidence-based care in the field of geriatric psychiatry. Importantly, we aimed to address this underrepresentation of older adults in clinical research by analyzing recruitment strategies and examining facilitators and barriers to recruitment. Future research is warranted to examine facilitators and barriers to recruitment in older adults with depression, particularly the importance of social support, which may offer valuable insights on how to overcome the issue of underrepresentation. / Thesis / Master of Science (MSc) / Brain stimulation therapies, such as deep transcranial magnetic stimulation (dTMS), show promising results for treatment-resistant depression (TRD). However, the applications of dTMS remain overlooked in geriatric populations with TRD, limiting the generalizability of such treatments to older adults. This dissertation aimed to examine current evidence supporting the use of dTMS in older adults with depression. In Study 1, we conducted a systematic review of available evidence on the clinical efficacy of dTMS across psychiatric and cognitive disorders. We found most evidence supporting the clinical efficacy of dTMS for the treatment of depressive episodes. However, the underrepresentation of older adults in such research was highly prevalent, with only one study being focused on older adults. In Study 2, we explored the effectiveness of diverse recruitment methods used in an ongoing dTMS trial for older adults with depression. Additionally, we identified potential facilitators and barriers to recruitment. Overall, the most effective recruitment strategies were (1) health provider outreach within the affiliated inpatient and outpatient mental health clinics and (2) Facebook advertising. Furthermore, social support from research staff and high time commitment of dTMS treatments were identified as facilitators and barriers to recruitment, respectively. These findings highlight the importance of conducting dTMS research in older adults to address the issue of underrepresentation and to improve evidence-based care in this special population.

On March 23, 2010, President Barack Obama signed the Patient Protection and Affordable Care Act (PPACA) into law. This reform, it is argued, is projected to increase insurance coverage of pre-existing conditions, to expand access to insurance for more than 30 million Americans, and to increase estimated National medical spending while lowering projected Medicare spending. This thesis sought to investigate and analyze the perceptions of senior citizens in Central Florida about PPACA and their perceived effects on the healthcare quality provided to them under this law. Four sections of PPACA bill, thought to specifically pertain to the elderly, were selected for this study; respondents were asked their opinions regarding PPACA's aspects of: (1) the reform on preventive healthcare services; (2) Medicare Part D (prescription drugs); (3) Medicare; and (4) Medicaid. This thesis employed both qualitative and quantitative methodologies; data were collected and analyzed with findings presented and discussed.

This research on healthcare strategies of home-based, low-wage, immigrant careworkers contributes to the ways medical anthropology, migration studies and social science understand human-economy-family care relationships and health and carework as commodities in today's global economy. It reveals the consequences for workers as they defray the costs of care for the Italian government and contribute to their home economies. This research was conducted in Genoa, Italy, which has the largest percentage of people over the age of 70 in any city of its size in the world and a tradition of sending and receiving immigrant workers. The main question was: Under the circumstances of providing labor-intensive, in-home supportive services, how do immigrant workers respond to their own health needs? The researcher collected data from interviews with 50 careworkers, 25 professionals who provide services to the careworkers, and 23 administrators in the health system, government agencies, labor unions, and the Catholic Church. The careworkers interviewed were women from South America, as they do most of the carework jobs in this city. Long-term participant observation and interview data were analyzed to: 1) produce empirical data on health concerns of and healthcare resource use by migrant careworkers; and 2) investigate the relationships between health concerns, living/working conditions, and healthcare resource use of transnational immigrants in the informal economy. The data showed that the Catholic Church promoted immigrants as able workers, aided their elderly parishioners, and provided necessary mental health support to careworkers who experienced stress. The data also revealed that the health care system of Italy functioned well to address the physical health concerns of immigrant careworkers. The relationship between the client and the worker was important for the general well-being of the worker and her ability to maintain her general health, have time for medical appointments, socialize outside of the workplace, and attend community events. This study examined: strategies for using health resources; responses of the Italian medical system personnel to anti-immigrant legislation; use of non-State resources to meet health needs; the health consequences of caring for an elderly person in the private home; and ways to address these health consequences.