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Population aging in Brazil increases on a large scale due to declining fertility and mortality. This phenomenon can be influenced by several factors (demographic, biological and social), making them determinants for the health conditions of the elderly populations residing in different geographic areas. The present study aims to identify the functional limitation in elderly residents of urban and rural areas of Brazil. This is a descriptive epidemiological study with a quantitative approach. It was evidenced that the functional limitation for activities of daily living   and instrumental activities of daily living are concentrated in the northeast region, mainly in the urban area. The following states presented the highest proportions of daily life activity limitation in urban areas: Alagoas (11.60%), Rio Grande do Norte (10.95%), Pernambuco (10.36%) and Paraíba (9.62%). For activities of daily living in the rural area were found in the states of Paraíba (12.19%), Maranhão (8.93%), Piauí (8.85%) and then Pernambuco (7.24%). Data from the functional limitation for instrumental activities of daily living again highlighted the Northeast region, with the states of Rio Grande do Norte (26.01%), Paraíba (25.96%), Maranhão (25.72%) and Alagoas (24.57%). Lastly, it was verified that the elderly woman exhibits greater proportions of functional limitation in relation to the elderly of the masculine sex, standing out again the northeastern region of the country.

Obesity is associated with functional limitations in muscle performance and increased likelihood of developing a functional disability such as mobility, strength, postural and dynamic balance limitations. The consensus is that obese individuals, regardless of age, have a greater absolute maximum muscle strength compared to non-obese persons, suggesting that increased adiposity acts as a chronic overload stimulus on the antigravity muscles (e.g., quadriceps and calf), thus increasing muscle size and strength. However, when maximum muscular strength is normalised to body mass, obese individuals appear weaker. This relative weakness may be caused by reduced mobility, neural adaptations and changes in muscle morphology. Discrepancies in the literature remain for maximal strength normalised to muscle mass (muscle quality) and can potentially be explained through accounting for the measurement protocol contributing to muscle strength capacity that need to be explored in more depth such as antagonist muscle co-activation, muscle architecture, a criterion valid measurement of muscle size and an accurate measurement of physical activity levels. Current evidence demonstrating the effect of obesity on muscle quality is limited. These factors not being recorded in some of the existing literature suggest a potential underestimation of muscle force either in terms of absolute force production or relative to muscle mass; thus the true effect of obesity upon skeletal muscle size, structure and function, including any interactions with ageing effects, remains to be elucidated.

We examined functional limitations and illness-related chronic absenteeism (i.e., missing >18 days of school for health reasons) in a cross-sectional nationally representative sample of 11,057 US children 5-17 years of age who ever or never had long COVID (i.e., symptoms lasting >3 months after COVID-19 illness). Among 4,587 children with prior COVID-19, we estimated whether long COVID was associated with increased illness-related chronic absenteeism by using logistic regression. Our analysis showed that ≈1.4% of school-aged children had long COVID at some point. Among children with prior COVID-19, those who had long COVID at some point more frequently reported functional limitations, such as difficulty with memory, than those who did not have long COVID (18.3% vs. 8.6%). Having long COVID was associated with higher odds of illness-related chronic absenteeism. Children who had long COVID could experience functional limitations and absenteeism. School accommodations might be an option to improve functional limitations.

Advance care planning (ACP) is a process that guarantees the respect of the patient’s values and priorities about his/her future care at the end of life. It consists of multiple conversations with the health professional that may lead to the completion of Advance Directives (AD), a set of legal documents helpful to clinicians and family members for making critical decisions on behalf of the patient, whereas he/she might become incapable. Over the past years, ACP has become particularly relevant for the growth of chronic diseases, the increase in life expectancy, and the growing attention paid to the patient’s decisional autonomy. Several nations have introduced specific regulations of ACP and AD. However, their diffusion is accompanied by unforeseen limitations and issues, burdening their complete and systematic adoption. The present article describes several controversial aspects of ACP and some of the most significant challenges in end-of-life care.

Background The COVID-19 pandemic had a lasting global health impact, with many survivors facing Long Covid. Older adults, already vulnerable to disability and cognitive decline, may also experience long-term challenges after COVID-19 infection. This study explores whether a history of COVID-19 infection interacts with pre-existing impairments in older adults, focusing on its effects on health services and work-related outcomes. Methods This longitudinal cohort study used data from the Health and Retirement Study (HRS), spanning 2018 to 2022. Participants ≥ 50 years old in 2018 with documented functional and cognitive status scores and self-reported presence or absence of COVID-19 infection were included. Functional status was assessed using the Functional Limitation score, and cognitive status using the Crimmins cognitive scale or Langa scale if the HRS respondents were represented by a proxy. Health services use and work outcomes were evaluated using the 2022 HRS survey. Multivariable logistic regression models examined the association between baseline functional and cognitive status and outcomes, controlling for COVID-19 history, 2018 functional or cognitive status, age, gender, marital status, number of chronic conditions, household size, graduation from high school, and self-report of COVID-19 vaccination. Results The study included 8,621 respondents. Those with severe functional limitations in 2018 were more likely to report health services use in 2022, irrespective of COVID-19 history. COVID-19 history did not significantly interact with baseline functional or cognitive impairments when evaluating health services use, ability to work, or disability benefit access. While older adults with moderate or severe functional limitations were more likely to report hospitalizations and nursing home stays, these outcomes were not significantly different based on COVID-19 history. Conclusions In this cohort of older adults, the relationship between baseline functional and cognitive impairment with health services use, ability to work, or disability benefit access did not significantly vary by self-reported COVID-19 infection history. While COVID-19 may have long-term impacts on older populations, our data suggest that infection history alone did not amplify the effects of pre-existing impairments in those who survived the pandemic. Further research using validated measures of persistent symptoms is needed to understand how Long Covid may manifest in older adults.

BACKGROUNDThe strategic framework on multiple chronic conditions released by the US Department of Health and Human Services calls for identifying homogeneous subgroups of older adults to effectively target interventions aimed at improving their health.OBJECTIVEWe aimed to identify combinations of chronic conditions, functional limitations, and geriatric syndromes that predict poor health outcomes.DESIGN, SETTING AND PARTICIPANTSData from the 2010–2012 Health and Retirement Study provided a representative sample of U.S. adults 50 years of age or older (n = 16,640).MAIN MEASURESOutcomes were: Self-reported fair/poor health, self-rated worse health at 2 years, and 2-year mortality. The main independent variables included self-reported chronic conditions, functional limitations, and geriatric syndromes. We conducted tree-based classification and regression analysis to identify the most salient combinations of variables to predict outcomes.KEY RESULTSTwenty-nine percent and 23 % of respondents reported fair/poor health and self-rated worse health at 2 years, respectively, and 5 % died in 2 years. The top combinations of conditions identified through our tree analysis for the three different outcome measures (and percent respondents with the outcome) were: a) for fair/poor health status: difficulty walking several blocks, depressive symptoms, and severe pain (> 80 %); b) for self-rated worse health at 2 years: 68.5 years of age or older, difficulty walking several blocks and being in fair/poor health (60 %); and c) for 2-year mortality: 80.5 years of age or older, and presenting with limitations in both ADLs and IADLs (> 40 %).CONCLUSIONSRather than chronic conditions, functional limitations and/or geriatric syndromes were the most prominent conditions in predicting health outcomes. These findings imply that accounting for chronic conditions alone may be less informative than also accounting for the co-occurrence of functional limitations and geriatric syndromes, as the latter conditions appear to drive health outcomes in older individuals.

Background Subjective cognitive decline (SCD), characterized by self-experience of deterioration in cognitive performance may be a precursor to Alzheimer’s disease (AD). Given the association of AD with dependence and disability for a long duration, earlier the detection, the sooner people and their families can receive information regarding better management. It is critical to explore disparities amongst racial and ethnic populations with SCD in order to facilitate targeted interventions. The primary objective was to identify disparities in prevalence of SCD amongst Whites, Blacks and Hispanics by select sociodemographic characteristics and functional limitations in a U.S. population-based sample of non-institutionalized adults aged 45 and older. The secondary objective was to assess the association between SCD and select chronic conditions (angina, heart attack, stroke, diabetes, high blood pressure and high cholesterol) by race/ethnicity. Methods Combined data (2015–2018) were obtained from the Behavioral Risk Factor Surveillance System (BRFSS) to conduct a population -based study. Analyses included 179,852 respondents aged 45 years or older who answered the SCD screening question as “yes” ( n  = 19,276) or “no” ( n  = 160,576). Descriptive statistics examined sociodemographic characteristics including functional limitations amongst racial/ethnic groups with SCD. Association of SCD with chronic conditions by race/ethnicity was also calculated. Results Overall, 10.8% (CI: 10.6–11.1) of adults aged 45 years or older reported SCD.10.7% Whites, 12.3% Blacks and 9.9% Hispanics experienced SCD. Blacks and Hispanics with SCD were more likely to be in the younger age group (45–54 years), less educated, low income, without access to health care, living alone and with functional limitations. Only half had discussed cognitive decline with a health care professional. Prevalence of selected chronic conditions was significantly higher in all racial/ethnic groups with SCD. Conclusions Demographic trends predict a larger proportion of Hispanics and Blacks with SCD in the coming years. This information can lead to identification of opportunities for addressing negative SCD outcomes in minorities affected by inequitable conditions.

Background The associations between trajectories of different health conditions and cognitive impairment among older adults were unknown. Our cohort study aimed to investigate the impact of various trajectories, including sleep disturbances, depressive symptoms, functional limitations, and multimorbidity, on the subsequent risk of cognitive impairment. Methods We conducted a prospective cohort study by using eight waves of national data from the Health and Retirement Study (HRS 2002–2018), involving 4319 adults aged 60 years or older in the USA. Sleep disturbances and depressive symptoms were measured using the Jenkins Sleep Scale and the Centers for Epidemiologic Research Depression (CES-D) scale, respectively. Functional limitations were assessed using activities of daily living (ADLs) and instrumental activities of daily living (IADLs), respectively. Multimorbidity status was assessed by self-reporting physician-diagnosed diseases. We identified 8-year trajectories at four examinations from 2002 to 2010 using latent class trajectory modeling. We screened participants for cognitive impairment using the 27-point HRS cognitive scale from 2010 to 2018 across four subsequent waves. We calculated hazard ratios (HR) using Cox proportional hazard models. Results During 25,914 person-years, 1230 participants developed cognitive impairment. In the fully adjusted model 3, the trajectories of sleep disturbances and ADLs limitations were not associated with the risk of cognitive impairment. Compared to the low trajectory, we found that the increasing trajectory of depressive symptoms (HR = 1.39; 95% CI = 1.17–1.65), the increasing trajectory of IADLs limitations (HR = 1.88; 95% CI = 1.43–2.46), and the high trajectory of multimorbidity status (HR = 1.48; 95% CI = 1.16–1.88) all posed an elevated risk of cognitive impairment. The increasing trajectory of IADLs limitations was associated with a higher risk of cognitive impairment among older adults living in urban areas (HR = 2.30; 95% CI = 1.65–3.21) and those who smoked (HR = 2.77; 95% CI = 1.91–4.02) (all P for interaction < 0.05). Conclusions The results suggest that tracking trajectories of depressive symptoms, instrumental functioning limitations, and multimorbidity status may be a potential and feasible screening method for identifying older adults at risk of cognitive impairment.

Introduction Hospital staff’s perception of oral health directly impacts their overall oral health-related well-being (OHRQoL) and their job performance. This study seeks to analyze the relationship between these two dimensions, providing information for designing strategies that promote a healthier work environment. Aim To determine the relationship between oral health-related quality of life (OHRQoL) and oral health perceptions in the staff of a level II-1 hospital located in northern Peru. Methods The study had a quantitative approach, with a cross-sectional, applied, and correlational design. Seventy-two participants participated. The validated OHIP-14 and HU-DBI questionnaires were used, with reliability coefficients of 0.847 and 0.804, respectively. Spearman’s correlation coefficient, appropriate for ordinal variables, was used for data analysis. Results A statistically significant association was found between health-related quality of life and subjective perception of oral status (Rho = 0.391, p < 0.05), with an explained variance of 19.8% according to Nagelkerke’s pseudo R-squared. The most frequently associated quality of life dimensions were physical disability (Rho = 0.319; p < 0.05) and social disability (Rho = 0.242; p < 0.05). Excellent quality of life was the most prevalent (38.9%), while poor oral health was the most common (52.8%). Conclusion The findings show a significant relationship between self-perceived oral health and oral health-related quality of life in this group of professionals. Promoting oral health strategies tailored to the hospital setting is recommended to improve workplace well-being.

By understanding health conditions, impairments, and impact on quality of life for pediatric feeding disorders, assessment and treatment approaches can target multiple levels of health-related domains that improve child health and well-being. The purpose of this study was to characterize medical diagnoses and feeding impairments for children with feeding disorders; examine child quality of life and caregiver impact; and compare quality of life differences between children with feeding disorders and children with other conditions. A cross-sectional study was conducted in the Greater Boston Area, between October 2017 and June 2018. Fifty children with a feeding disorder diagnosis, ages 2–5 years, were enrolled. Demographic and clinical data were abstracted from the electronic health record to characterize medical diagnoses and impairments. Parents completed the Pediatric Quality of Life Generic Core Scales 4.0 (PedsQL) and the Feeding/Swallowing Impact Survey (FS-IS) to understand child quality of life and caregiver impact. We calculated descriptive statistics across the medical diagnosis and impairment groups, and for the surveys. Children presented with heterogeneous medical diagnoses and feeding impairments. We found a mean (SD) total score of 72.82(19.21) on the PedsQL and 2.33(0.89) on the FS-IS demonstrating that children with feeding disorders presented with poor quality of life and their caregivers were negatively impacted by their feeding difficulties. By understanding medical diagnoses, impairments, and quality of life, assessment and treatment methods can be tailored to children’s specific needs, as well as address the overall wellbeing of children and their families.