Epilepsy in older people

2015 ◽  
Vol 25 (1) ◽  
pp. 53-59
Author(s):  
Nicola Smith ◽  
Divya Tiwari
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Side Effects ◽  
Older People ◽  
Seizure Activity ◽  
Drug Compliance ◽  
Unprovoked Seizure ◽  
The Third ◽  
New Guidelines ◽  
Control Seizure

SummaryEpilepsy is the third most common neurological disorder of older adults, with huge functional and psychological implications. It is often difficult to diagnose in the presence of cognitive impairment and lack of a witness account. The most common identifiable causes of epilepsy in old age are cerebrovascular disease and dementia. New guidelines recommend starting treatment after first unprovoked seizure. If there is any doubt about the diagnosis, electroencephalography (EEG) should be considered, or ‘wait and watch’. The aim of treatment should be to fully control seizure activity with the most effective monotherapy and fewest possible side-effects. Drug compliance is often difficult to achieve in older adults.

scholarly journals Body mass index and mild cognitive impairment among rural older adults in China: the moderating roles of gender and age

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yemin Yuan ◽  
Jie Li ◽  
Nan Zhang ◽  
Peipei Fu ◽  
Zhengyue Jing ◽  
...  
Keyword(s):  
Older Adults ◽  
Body Mass Index ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Older People ◽  
Older Women ◽  
Older Men ◽  
Gender And Age ◽  
Low Bmi ◽  
Rural Older Adults

Abstract Background Evidence concerning the association between body mass index (BMI) and cognitive function among older people is inconsistent. This study aimed to investigate gender and age as moderators in association between BMI and mild cognitive impairment (MCI) among rural older adults. Methods Data were derived from the 2019 Health Service for Rural Elderly Families Survey in Shandong, China. In total, 3242 people aged 60 years and above were included in the analysis. Multilevel mixed-effects logistic regression was used to examine the moderating roles of gender and age, then further to explore the relationship between BMI and MCI. Results There were 601 (18.5%) participants with MCI. Compared with normal BMI group, low BMI group had a higher risk of MCI among older people [adjusted odds ratio (aOR) = 2.08, 95% confidence interval (CI): 1.26–3.44], women (aOR = 2.06, 95% CI: 1.35–3.12), or the older elderly aged ≥75 years old (aOR = 3.20, 95% CI: 1.34–7.45). This effect remained statistically significant among older women (aOR = 3.38, 95% CI: 1.69–6.73). Among older men, elevated BMI group had a higher risk of MCI (aOR = 2.32, 95% CI: 1.17–4.61) than normal BMI group. Conclusions Gender and age moderated the association between BMI and MCI among Chinese rural older adults. Older women with low BMI were more likely to have MCI, but older men with elevated BMI were more likely to have MCI. These findings suggest rural community managers strengthen the health management by grouping the weight of older people to prevent the risk of dementia.

A pilot study examining the profile of older people on clozapine

2018 ◽  
Vol 26 (6) ◽  
pp. 619-623
Author(s):  
Jen Benbow ◽  
Anne PF Wand ◽  
Brett Simpson
Keyword(s):  
Cognitive Impairment ◽  
Side Effects ◽  
Older People ◽  
Social History ◽  
Geriatric Medicine ◽  
Executive Dysfunction ◽  
Screening Tools ◽  
The Mean ◽  
Considerable Morbidity ◽  
And Function

Objective: The primary aim was to comprehensively describe the characteristics of a cohort of older people taking clozapine. Method: Participants aged ⩾ 60 had a geriatric assessment including full medical, medication and social history. Standardized screening tools for cognition, function, comorbidity and antipsychotic side effects were administered and descriptive statistics utilized. Results: Thirteen patients were eligible to participate and 10 were assessed. The mean age was 69 years. The mean clozapine dose was 309 mg/day and mean duration of use was 10 years. All participants had executive dysfunction, and half had cognitive impairment. The mean number of co-morbid conditions was five. Seven people met the criteria for polypharmacy. Eight people experienced moderate–severe antipsychotic-related side-effects. The majority demonstrated impaired physical functioning. Conclusions: This cohort of older people taking clozapine experienced considerable morbidity, functional and cognitive impairment. We suggest routine screening of cognition and function in clozapine patients aged ⩾ 60 years. Those screening positive should be considered for further assessment by Older Person’s Mental Health Services and/or a Geriatric Medicine service.

Interpersonal psychotherapy

2020 ◽  
pp. 261-264
Author(s):  
Philip Wilkinson ◽  
Ken Laidlaw
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Older People ◽  
Psychological Treatment ◽  
Interpersonal Psychotherapy ◽  
Evidence Base ◽  
Theory And Practice ◽  
Role Transitions ◽  
Treatment Of Depression

This chapter on interpersonal psychotherapy (IPT) describes the theory and practice of this structured psychological treatment. It discusses the implementation of IPT with older people. Next it reviews the applications of IPT with a main focus on the treatment of depression in older adults and distinguishes between the treatment of depression with and without cognitive impairment. It summarizes the structure of IPT and the use of specific techniques, and it then addresses the main therapeutic foci encountered in treatment (grief, interpersonal role disputes, role transitions, and interpersonal deficits). Finally, it briefly reviews the evidence base for IPT with older people.

Age Differences in Coping: Does Less Mean Worse?

1989 ◽  
Vol 28 (2) ◽  
pp. 127-140 ◽  
Author(s):  
Suzanne Meeks ◽  
Laura L. Carstensen ◽  
Brenda-Fay Tamsky ◽  
Thomas L. Wright ◽  
David Pellegrini
Keyword(s):  
Older Adults ◽  
Older People ◽  
Coping Strategies ◽  
Age Differences ◽  
Adaptive Strategies ◽  
The Other ◽  
The Third ◽  
Older Subjects ◽  
Quantitative Changes

Previous research suggests that elderly people utilize fewer coping strategies than younger people. Some researchers suggest that these quantitative changes reflect decreases in the use of maladaptive strategies; others contend that they reflect decreases in the use of adaptive strategies by older adults. The present article reports the findings of three studies of coping in older people, two addressing coping with health problems, and the other addressing coping with moving. In all three studies, the number of self-reported coping strategies decreases with age. Results do not support the idea that decreases in the number of strategies imply decrements in the quality of coping, however: in two studies, age was unrelated to the effectiveness of strategies, in the third, effectiveness ratings were higher for older subjects. The need for evaluation of specific outcomes of coping strategies is discussed, along with the need for task-specific measurement of coping. It is proposed that decreases in the number of coping strategies reflect improved coping efficiency, rather than a deterioration of adaptational skills.

scholarly journals The Assessment of the Severity of COVID-19-Related Anxiety Symptoms in Participants of the University of the Third Age in Poland: A Cross-Sectional Study among Internet Survey Respondents

2021 ◽  
Vol 10 (17) ◽  
pp. 3862 ◽  
Author(s):  
Mateusz Cybulski ◽  
Urszula Cwalina ◽  
Dorota Sadowska ◽  
Elżbieta Krajewska-Kułak
Keyword(s):  
Older Adults ◽  
Older People ◽  
Trait Anxiety ◽  
Subjective Experience ◽  
Anxiety Symptoms ◽  
Internet Survey ◽  
Third Age ◽  
Financial Status ◽  
The Third ◽  
The University

Introduction: Fear of infection with SARS-CoV-2 has become widespread. All over the world, since the very beginning of the pandemic, older adults have been considered one of the groups at highest risk of SARS-CoV-2 infection and death due to COVID-19. The aim of the study was to evaluate the severity of anxiety symptoms related to COVID-19 in the older adults who are participants of the Universities of the Third Age in Poland. Material and methods: The study included participants of the University of the Third Age in Poland. A total of 296 persons were enrolled, including 258 women and 38 men. The study was a diagnostic survey, conducted with the use of the following validated psychometric scales: General Anxiety Disorder-7 (GAD-7), Short Health Anxiety Inventory (SHAI), and State-Trait Anxiety Inventory (STAI). Results: In two scales (STAI and SHAI), the mean scores demonstrated mild symptoms indicative of anxiety disorders in the older respondents. Women and men did differ significantly in terms of the scores obtained in STAI X-1 and STAI X-2. Single respondents differed significantly from divorced ones in terms of STAI X-1 scores. Moreover, widows/widowers differed significantly from divorced ones in terms of STAI X-2, and GAD-7 scores. Respondents declaring their financial status as average differed significantly from those declaring their financial status as good in terms of: STAI X-1, STAI X-2, SHAI, and GAD-7 scores. Conclusions: The subjective experience of anxiety symptoms associated with fear of contracting COVID-19 was increased due to the ongoing pandemic, but was not significantly high in the analysed population of older people. COVID-19-related anxiety was significantly more common in lonely individuals and in those of worse financial status. Women and men differed significantly in terms of perceived state anxiety and trait anxiety measured by STAI. More studies addressing COVID-19-related anxiety in older people participating in the Polish Universities of the Third Age are needed to determine a more accurate distribution of this phenomenon in Poland.

scholarly journals Social isolation and health outcomes among older people in China

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yun Zhang ◽  
Wen Hu ◽  
Zhixin Feng
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Older People ◽  
Health Outcomes ◽  
Activities Of Daily Living ◽  
Social Isolation ◽  
Daily Living ◽  
Functional Health ◽  
Social Contacts ◽  
Living Children

Abstract Background Social isolation is a serious public health issue affecting a significant number of older adults worldwide. However, associations between different dimensions of social isolation and functional health are unclear. We assessed the varied effects of social isolation on health among a nationwide sample of older adults from China. Methods We assessed social isolation among 5,419 people aged 65 and older who took part in both the 2011 and 2014 waves of the Chinese Longitudinal Healthy Longevity Survey. Social isolation includes objective social isolation (kinlessness and lack of social contacts) and subjective social isolation. Four functional health outcomes were examined: self-rated health (SRH), activities of daily living (ADLs), instrumental activities of daily living (IADLs), and cognitive function measured by the Mini-Mental State Examination (MMSE). We used multivariable regression analyses to examine the associations between social isolation and health outcomes. Results Older people who never married or who had recently lost a spouse were more likely to report poor SRH (OR=2.44) and difficulty with IADLs (ORs=1.46) than those who were married and lived with a spouse. Older people who never gave birth were less likely to report cognitive impairment (OR=0.53) than those who had living children, while older people who had recently lost a child were more likely to report poor SRH than those who had living children (OR=1.32). Older people who had no children visiting were more likely to report difficulty with IADLs than those who had children visiting (OR=1.25). In terms of subjective social isolation, older people who felt lonely were more likely to report poor SRH, cognitive impairment, and difficulty with ADLs and IADLs (ORs=1.19, 1.27, 1.28 and 1.21, respectively), and older people who had no one to talk to were more likely to report poor SRH, cognitive decline, and difficulty with ADLs and IADLs (ORs=2.08, 5.32, 2.06 and 1.98, respectively). Conclusions Kinlessness, lack of social contacts and subjective social isolation may impact various dimensions of health in older people. Due to the varied health consequences of social isolation, targeted health interventions should be developed to address relevant situations of social isolation.

scholarly journals Recruitment, Enrollment, and Retention: Creative Techniques to Overcome Obstacles

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 210-210
Author(s):  
Justine Sefcik ◽  
Darina Petrovsky
Keyword(s):  
Older Adults ◽  
Clinical Trial ◽  
Cognitive Impairment ◽  
Longitudinal Study ◽  
Research Participation ◽  
Amnestic Mild Cognitive Impairment ◽  
Lessons Learned ◽  
Survey Study ◽  
Incentive Payment ◽  
The Third

Abstract The process of recruiting, enrolling, and retaining older adults in research studies has been challenging, even prior to the COVID-19 pandemic. This symposium presents research conducted and lessons learned on recruiting, enrolling, and retaining older adults, including those with cognitive impairment. Insights are provided on what techniques are most beneficial for improving rates of research participation, spanning time prior to and during the pandemic. The first presentation reports on qualitative perspectives of persons living with dementia and their caregivers as to what helped them decide to enroll into a clinical trial together. The second presentation speaks to how variations in incentive payment allocations played a role in consent decisions of patients with amnestic mild cognitive impairment and their study partners. The third presentation discusses the effectiveness of an adapted framework and strategies to increase the recruitment and retention of older Latinos with Alzheimer’s Disease and Related Dementias (ADRD) into a clinical trial. The fourth presentation shares techniques for recruiting older adults for a survey study during the pandemic. The fifth presentation defines challenges during a longitudinal study when the pandemic and other natural disasters occurred and strategies for success. Taken together, these presentations will inform researchers on techniques that could be used to improve recruitment, enrollment, and retention of older adults in clinical research.

scholarly journals Mental Disorders, Cognitive Impairment and the Risk of Suicide in Older Adults

2021 ◽  
Vol 12 ◽  
Author(s):  
Agnieszka Kułak-Bejda ◽  
Grzegorz Bejda ◽  
Napoleon Waszkiewicz
Keyword(s):  
Older Adults ◽  
Bipolar Disorder ◽  
Cognitive Impairment ◽  
Mental Disorders ◽  
Anxiety Disorders ◽  
Older People ◽  
Mood Disorders ◽  
The Elderly ◽  
Increased Risk ◽  
The World

More than 600 million people are aged 60 years and over are living in the world. The World Health Organization estimates that this number will double by 2025 to 2 billion older people. Suicide among people over the age of 60 is one of the most acute problems. The factors strongly associated with suicide are mentioned: physical illnesses, such as cancer, neurologic disorder, pain, liver disease, genital disorders, or rheumatoid disorders. Moreover, neurologic conditions, especially stroke, may affect decision-making processes, cognitive capacity, and language deficit. In addition to dementia, the most common mental disorders are mood and anxiety disorders. A common symptom of these disorders in the elderly is cognitive impairment. This study aimed to present the relationship between cognitive impairment due to dementia, mood disorders and anxiety, and an increased risk of suicide among older people. Dementia is a disease where the risk of suicide is significant. Many studies demonstrated that older adults with dementia had an increased risk of suicide death than those without dementia. Similar conclusions apply to prodromal dementia Depression is also a disease with a high risk of suicide. Many researchers found that a higher level of depression was associated with suicide attempts and suicide ideation. Bipolar disorder is the second entity in mood disorders with an increased risk of suicide among the elderly. Apart from suicidal thoughts, bipolar disorder is characterized by high mortality. In the group of anxiety disorders, the most significant risk of suicide occurs when depression is present. In turn, suicide thoughts are more common in social phobia than in other anxiety disorders. Suicide among the elderly is a serious public health problem. There is a positive correlation between mental disorders such as dementia, depression, bipolar disorder, or anxiety and the prevalence of suicide in the elderly. Therefore, the elderly should be comprehensively provided with psychiatric and psychological support.

scholarly journals A practical approach to the pharmacological management of hypertension in older people

2016 ◽  
Vol 8 (4) ◽  
pp. 117-132 ◽  
Author(s):  
Nikesh Parekh ◽  
Amy Page ◽  
Khalid Ali ◽  
Kevin Davies ◽  
Chakravarthi Rajkumar
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Older People ◽  
Antihypertensive Drugs ◽  
Medication Use ◽  
Older Person ◽  
Pharmacological Management ◽  
Safe Medication ◽  
The Usa ◽  
Current Guidelines

Hypertension is the leading cause of cardiovascular (CV) morbidity and mortality in adults over the age of 65. The first part of this paper is an overview, summarizing the current guidelines on the pharmacological management of hypertension in older adults in Europe and the USA, and evidence from key trials that contributed to the guidelines. In the second part of the paper, we will discuss the major challenges of managing hypertension in the context of multimorbidity, including frailty, orthostatic hypotension (OH), falls and cognitive impairment that are associated with ageing. A novel ‘BEGIN’ algorithm is proposed for use by prescribers prior to initiating antihypertensive therapy to guide safe medication use in older adults. Practical suggestions are highlighted to aid practitioners in making rational decisions to treat and monitor hypertension, and for considering withdrawal of antihypertensive drugs in the complex older person.

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