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The revenge of the radioactive lady
In 1953, Dr. Wilson Spriggs gave Marylou Ahearn a radioactive cocktail without her consent as part of a secret government study that had horrible consequences. For 50 years she's been plotting her revenge. At last she's found Spriggs.
Book
Ageing in urban neighbourhoods
Many western nations have experienced a rise in the number of marginalised and deprived inner-city neighbourhoods. Despite a plethora of research focused on these areas, there remain few studies that have sought to capture the 'optimality' of ageing in place in such places. In particular, little is known about why some older people desire to age in place despite multiple risks in their neighbourhood and why others reject ageing in place. Given the growth in both the ageing of the population and policy interest in the cohesion and sustainability of neighbourhoods there is an urgent need to better understand the experience of ageing in marginalised locations.
This book aims to address the shortfall in knowledge regarding older people's attachment to deprived neighbourhoods and in so doing progress what critics have referred to as the languishing state of environmental gerontology. The author examines new cross-national research with older people in deprived urban neighbourhoods and suggests a rethinking and refocusing of the older person's relationship with place. Impact on policy and future research are also discussed.
This book will be relevant to academics, students, architects, city planners and policy makers with an interest in environmental gerontology, social exclusion, urban sustainability and design of the built environment.
eBook
Elderly Sustainable Mobility: Scientific Paper Review
The number of elderly people as a proportion of the world’s population is growing significantly. Special attention to the accessibility and mobility requirements of this group is needed. The contribution of this paper is a review of travel patterns, mode preferences, infrastructure solutions, accessibility indices, mode choice models and datasets as they relate to elderly mobility. Key findings highlight the role of residential location characteristics in shaping elderly travel patterns, helping to explain why research on elderly travel has largely relied on case studies to date. The review also summarizes a range of indices that have been developed to measure public transport and walking accessibility among the elderly, including distance and time-based methods. Future research should consider the dominance of private transport in facilitating elderly mobility and its implications for cities experiencing an aging population.
Journal Article
The fixed period
Trollope's only science fiction novel, written in 1880, is set in the year 1980 on an island near New Zealand where euthanasia for citizens over the age of 67 is compulsory.
The impact of frailty on survival in elderly intensive care patients with COVID-19: the COVIP study
Background
The COVID-19 pandemic has led highly developed healthcare systems to the brink of collapse due to the large numbers of patients being admitted into hospitals. One of the potential prognostic indicators in patients with COVID-19 is frailty. The degree of frailty could be used to assist both the triage into intensive care, and decisions regarding treatment limitations. Our study sought to determine the interaction of frailty and age in elderly COVID-19 ICU patients.
Methods
A prospective multicentre study of COVID-19 patients ≥ 70 years admitted to intensive care in 138 ICUs from 28 countries was conducted. The primary endpoint was 30-day mortality. Frailty was assessed using the clinical frailty scale. Additionally, comorbidities, management strategies and treatment limitations were recorded.
Results
The study included 1346 patients (28% female) with a median age of 75 years (IQR 72–78, range 70–96), 16.3% were older than 80 years, and 21% of the patients were frail. The overall survival at 30 days was 59% (95% CI 56–62), with 66% (63–69) in fit, 53% (47–61) in vulnerable and 41% (35–47) in frail patients (
p
< 0.001). In frail patients, there was no difference in 30-day survival between different age categories. Frailty was linked to an increased use of treatment limitations and less use of mechanical ventilation. In a model controlling for age, disease severity, sex, treatment limitations and comorbidities, frailty was independently associated with lower survival.
Conclusion
Frailty provides relevant prognostic information in elderly COVID-19 patients in addition to age and comorbidities.
Trial registration
Clinicaltrials.gov:
NCT04321265
, registered 19 March 2020.
Journal Article
Individualized home-based exercise and nutrition interventions improve frailty in older adults: a randomized controlled trial
Background
Frail older adults are predisposed to multiple comorbidities and adverse events. Recent interventional studies have shown that frailty can be improved and managed. In this study, effective individualized home-based exercise and nutrition interventions were developed for reducing frailty in older adults.
Methods
This study was a four-arm, single-blind, randomized controlled trial conducted between October 2015 and June 2017 at Miaoli General Hospital in Taiwan. Overall, 319 pre-frail or frail older adults were randomly assigned into one of the four study groups (control, exercise, nutrition, and exercise plus nutrition [combination]) and followed up during a 3-month intervention period and 3-month self-maintenance period. Improvement in frailty scores was the primary outcome. Secondary outcomes included improvements in physical performance and mental health. The measurements were performed at baseline, 1 month, 3 months, and 6 months.
Results
At the 6-month measurement, the exercise (difference in frailty score change from baseline: − 0.23; 95% confidence interval [CI]: − 0.41, − 0.05;
p
= 0.012), nutrition (− 0.28; 95% CI: − 0.46, − 0.11;
p
= 0.002), and combination (− 0.34; 95% CI: − 0.52, − 0.16;
p
< 0.001) groups exhibited significantly greater improvements in the frailty scores than the control group. Significant improvements were also observed in several physical performance parameters in the exercise, nutrition, and combination groups, as well as in the 12-Item Short Form Health Survey mental component summary score for the nutrition group.
Conclusions
The designated home-based exercise and nutrition interventions can help pre-frail or frail older adults to improve their frailty score and physical performance.
Trial registration
Retrospectively registered at
ClinicalTrials.gov
(identifier: NCT03477097); registration date: March 26, 2018.
Journal Article
Vitamin D Supplementation Associated to Better Survival in Hospitalized Frail Elderly COVID-19 Patients: The GERIA-COVID Quasi-Experimental Study
Background. The objective of this quasi-experimental study was to determine whether bolus vitamin D supplementation taken either regularly over the preceding year or after the diagnosis of COVID-19 was effective in improving survival among hospitalized frail elderly COVID-19 patients. Methods. Seventy-seven patients consecutively hospitalized for COVID-19 in a geriatric unit were included. Intervention groups were participants regularly supplemented with vitamin D over the preceding year (Group 1), and those supplemented with vitamin D after COVID-19 diagnosis (Group 2). The comparator group involved participants having received no vitamin D supplements (Group 3). Outcomes were 14-day mortality and highest (worst) score on the ordinal scale for clinical improvement (OSCI) measured during COVID-19 acute phase. Potential confounders were age, gender, functional abilities, undernutrition, cancer, hypertension, cardiomyopathy, glycated hemoglobin, number of acute health issues at admission, hospital use of antibiotics, corticosteroids, and pharmacological treatments of respiratory disorders. Results. The three groups (n = 77; mean ± SD, 88 ± 5 years; 49% women) were similar at baseline (except for woman proportion, p = 0.02), as were the treatments used for COVID-19. In Group 1 (n = 29), 93.1% of COVID-19 participants survived at day 14, compared to 81.2% survivors in Group 2 (n = 16) (p = 0.33) and 68.7% survivors in Group 3 (n = 32) (p = 0.02). While considering Group 3 as reference (hazard ratio (HR) = 1), the fully-adjusted HR for 14-day mortality was HR = 0.07 (p = 0.017) for Group 1 and HR = 0.37 (p = 0.28) for Group 2. Group 1 had longer survival time than Group 3 (log-rank p = 0.015), although there was no difference between Groups 2 and 3 (log-rank p = 0.32). Group 1, but not Group 2 (p = 0.40), was associated with lower risk of OSCI score ≥5 compared to Group 3 (odds ratio = 0.08, p = 0.03). Conclusions. Regular bolus vitamin D supplementation was associated with less severe COVID-19 and better survival in frail elderly.
Journal Article