The association of gait speed and self-reported difficulty walking with social isolation: A nationally-representative study.

BACKGROUND: Mobility assessments are commonly used among older adults as risk stratification for falls, preoperative function, frailty, and mortality. We determined if gait speed and self-reported difficulty walking are similarly associated with social isolation and loneliness, which are key markers of social well-being and linked to health outcomes. METHODS: We used 2015-2016 data from the National Social life Health and Aging Project (NSHAP), an in-person nationally-representative survey of 2640 community-dwelling adults ≥65 years old. We measured gait speed (timed 3-m walk: unable to walk, ≥5.7 s, and <5.7 s), and self-reported difficulty walking one block or across the room (unable, much, some, or no difficulty). Social measures included loneliness (3-item UCLA scale), social isolation (12-item scale), and individual social activities (frequency socializing, religious participation, community participation, and volunteering). We used logistic regression to determine the adjusted probability of each social measure by gait speed and difficulty walking, adjusting for sociodemographic and health characteristics, and tested for interaction terms with age. RESULTS: Participants were on average 75 years old (SD = 7.1), 54% female, 9% Black/African American, and 6% Hispanic. Difficulty walking one block was associated with (p < 0.05): social isolation (much difficulty: 26% vs no difficulty: 18%), low socializing (33% vs 19%), low volunteering (67% vs 53%), low community participation (54% vs 43%), low religious participation (51% vs 46%), and loneliness (25% vs 14%). Difficulty walking across the room was similarly strongly associated with social isolation and individual activities. The association between self-reported difficulty walking and social isolation was stronger at older ages (p-value of interaction <0.001). CONCLUSIONS: Self-reported mobility difficulty is a widely used clinical assessment that is strongly associated with loneliness and social isolation, particularly at older ages. Among persons with limited mobility, clinicians should consider a careful social history to identify social needs and interventions addressing mobility to enhance social connections

Pengaruh Kalsium-asam Lemak Sawit (Ca-als) dan Kalsium terhadap Bobot Telur, Tebal Kerabang dan Kekuatan Kerabang Ayam Petelur Lohman

Penelitian yang bertujuan untuk mengetahui pengaruh kalsium-asam lemak sawit (Ca-ALS) dan kalsium (Ca) dalam ransum terhadap bobot telur, tebal kerabang, dan kekuatan kerabang ayam petelur Lohman, telah dilaksanakan selama 20 minggu. Rancangan percobaan yang digunkanan adalah rancangan acakl lengkap (RAL) pola faktorial. Sebagai faktor pertama adalah tingkat penggunaan kalsium-asam lemak sawit (Ca-ALS) sebesar 5%, 10%, dan 15%. Faktor kedua adalah tingkat kalsium yang digunakan 2,75%, 3,00% dan 3,25% . Ayam yang digunakan sebanyak 280 ekor didistribusi kedalam 9 kombinasi perlakuan dan satu kontrol, setiap perlakuan terdiri atasb7 ulangan dan setiap ulangan terdiri atas 4 ekor ayam. Ransum yang digunakan mengandung energi metabolis 2620 kkal/kg dan protein kasar sebesar 16%. Ransum dan air minum diberikan secara adlibitum. Berdasarkan hasil penelitian ini dapat disimpulkan bahwa penggunaan kalsium-asam lemak sawit (Ca-ALS) sampai 15% dalam ransum ayam petelur Lohman dapat dimanfaatkan dengan baik sebagai sumber asam lemak dan kalsium untuk menghasilkan bobot telur, dan ketebalan kerabang telur. Penggunaan Ca-ALS 15% akan lebih baik dengan penambahan 3,25% kalsium (Ca) dibanding 2,75%, 3,0% untuk meningkatkan kekuatan kerabang telur di awal dan akhir bertelur, diukur pada posisi vertikal atau horizontal. THE EFFECT OF CALCIUM–PALM FATTY ACID (Ca-PFA) AND CALCIUM FOR EGG WEIGHT, EGG SHELL THICKNESS, AND SHELL STRENGTH OF LOHMAN LAYING HENS ABSTRACK The aims of this experiment were to study the effect of calcium-palm fatty acid (Ca-PFA) and calcium in the ration for egg weigh, egg shell thickness, and shell strength of Lohman laying hens was done fot 20 weeks. A completly randomized design (CRD) with factorial used in this experiment, the first factor was 5%, 10%, 15% Ca-PFA and second factor was 2.75%, 3.00% and 3.25% calcium . The treatment consisted 7 replicates with 4 laying hens each and control, totally used 280 laying hens. All feed is iso caloric (ME: 2620 Kcal/kg) and iso protein (CP:16%). Feed and water were offered adlibitum. Result of this experiment showed that used of palm fatty acid (Ca-PFA) until 15% in rations Lohman laying hens to utilized fatty acid and calcium resources for increased egg weigh , egg shell tickness. But can be better with addition 3.25% calcium equal 2.75%, 3.0% increased egg shell strength in vertical or horizontal position, in beginning or finished of layed

A nurse driven care management program to engage older diabetes patients in personalized goal setting and disease management

Background and aims: Multiple diabetes care guidelines have called for the personalization of risk factor goals, medication management, and self-care plans among older patients. Study of the implementation of these recommendations is needed. This study aimed to test whether a patient survey embedded in the Electronic Healthcare Record (EHR), coupled with telephonic nurse care management, could engage patients in personalized goal setting and chronic disease management. Methods: We conducted a single-center equal-randomization delayed comparator trial at the primary care clinics of the University of Chicago Medicine from 2018.6 to 2019.12. Patients over the age of 65 years with type 2 diabetes with an active patient portal account were recruited and randomized to receive an EHR embedded goal setting and preference survey immediately in the intervention arm or after 6 months in the delayed intervention control arm. In the intervention arm, nurses reviewed American Diabetes Association recommendations for A1C goals based on health status class, established personalized goals, and provided monthly telephonic care management phone calls for a maximum of 6 months. Our primary outcome was the documentation of a personalized A1C goal in the EHR. Results: A total of 100 patients completed the trial (mean age, 72.51 [SD, 5.22] years; mean baseline A1C, 7.14% [SD, 1.06%]; 68% women). The majority were in the Healthy (59%) followed by Complex (30%) and Very Complex (11%) health status classes. Documentation of an A1C goal in the EHR increased from 42% to 90% (p Conclusions: Older patients can be engaged in personalized goal setting and disease management through an embedded EHR intervention. The clinical impact of the intervention may differ if deployed among older patients with more complex health needs and higher glucose levels. Trial registration: ClinicalTrials.gov Identifier: NCT03692208.</p

Delayed medical care and its perceived health impact among US older adults during the COVID-19 pandemic

Background: Medical care delivery has been substantially disrupted during the coronavirus disease 2019 (COVID-19) pandemic, leading to delays in medical care, particularly among older adults. Less is known about how these delays have affected different segments of this population. Understanding the negative health consequences older adults face from delayed care will provide critical insights into the longer-term population health needs following the pandemic. Methods: We used data from a COVID-19 substudy embedded in a nationally representative longitudinal study of older adults, the National Social Life, Health, and Aging Project. Data were collected between September 14, 2020, and January 27, 2021. Two thousand six hundred seventy-two individuals responded to the survey. Using logistic and multinomial logistic regressions, we determined respondent-level characteristics associated with delayed medical care, experiencing a negative impact on physical health from delayed care, and with reporting worsening physical health during the pandemic. Results: Nearly, one-third (32.8%) of older adults reported delayed medical care during the pandemic. Female sex, higher levels of education, greater concerns about the pandemic, and poorer self-rated physical health were associated with delayed medical care. Blacks and those who are 70 and older were less likely to report delayed care. Among those whose care was delayed, 76.5% reported having already recovered delayed care. Nearly one in five (17.6%) reported that delayed care negatively affected their health. Older adults with worse self-rated physical and mental health or who had not fully recovered delayed care were more likely to report perceived negative health impacts from the delay. Regardless of delayed medical care, 10.2% reported worse physical health during the pandemic. Conclusions: One-third of older adults experienced care delays during the pandemic. Despite high rates of care recovery, nearly one in five older adults who experienced delayed care reported being negatively affected. Strategies must be developed to reach these vulnerable patients to increase their healthcare utilization.</p

Ethical considerations of digital health technology in older adult care

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Social capital predicts accelerometry-measured physical activity among older adults in the U.S.: a cross-sectional study in the National Social Life, Health, and Aging Project

Abstract Background Older adults receive important health benefits from more robust social capital. Yet, the mechanisms behind these associations are not fully understood. Some evidence suggests that higher levels of social capital ultimately affect health through alterations in physical activity (PA), but most of this research has relied on self-reported levels of PA. The aim of this study was to determine whether components of social capital, including social network size and composition as well as the frequency of participation in various social and community activities, were associated with accelerometry-measured PA levels in a nationally representative sample of community-dwelling older adults (≥ 62 years). Methods We conducted a cross-sectional analysis using data from the wrist accelerometry sub-study (n = 738) within Wave 2 of the National Social, Health, and Aging Project (NSHAP), a population-based longitudinal study that collects extensive survey data on the physical, cognitive, and social health of older adults. Participants’ physical activity was measured with a wrist accelerometer worn for 72 consecutive hours. We related seven, self-reported social relationship variables (network size, network proportion friends, and frequencies of socializing with friends and family, visiting with neighbors, attending organized group meetings, attending religious services, and volunteering) to accelerometer-measured PA (mean counts-per-minute) using multivariate linear regression analysis, while adjusting for potential confounders. Results Larger social networks (p = 0.042), higher network proportion friends (p = 0.013), more frequent visiting with neighbors (p = 0.009), and more frequent attendance at organized group meetings (p = 0.035) were associated with higher PA levels after controlling for demographic and health covariates. Volunteering was significant prior to adjusting for covariates. No significant associations were found between frequencies of socializing with friends and relatives or attendance at religious services and PA. Conclusions This study suggests social capital is significantly related to objectively measured PA levels among older adults, and that friendships as well as social participation in groups and with neighbors may be particularly pertinent to PA. These findings expand our understanding of and offer a potential mechanism linking social relationships and overall health among older adults. They also have implications for how we might motivate older adults to be more physically active

ضرورت بهره گیری از دانش تخصصی مدیریت در اداره امور بیمارستان ها و مراکز بهداشتی ـ درمانی

مقاله مروری حاضر به منظور تبیین ضرورت بهره گیری از دانش تخصصی مدیریت در اداره امور سازمانهای بهداشتی – درمانی به (به ویژه بیمارستان‌ها) نگاشته شده است. محورهای مورد بحث در این مطالعه عبارتند از: تحلیل وضعیت موجود مراکز بهداشتی – درمانی شکور از بعد کارایی و اثربخشی (بهره وری سازمانی) سیر تحول در مدیریت بیمارستانهای جهان، اهمیت آموزشهای مدیریت خدمات بهداشتی – درمانی، بررسی اهداف و تحلیل ویژگی‌های آموزش در نظام مدیریت خدمات بهداشتی – درمانی. با استناد به مباحث مطرح شده در این مقاله، بهره گیری از مدیران حرفه‌ای در اداره سازمانهای بهداشتی – درمانی، روزامد نمودن دانش آنان و ارائه آموزشهای تخصصی مدیریت به گردانندگان فعلی موسسات مذکور امری حیاتی و اجتناب ناپذیر می‌باشد