Identifying common impairments in frail and dependent older people: validation of the COPE assessment for non-specialised health workers in low resource primary health care settings.

BACKGROUND: Frail and dependent older people in resource-poor settings are poorly served by health systems that lack outreach capacity. The COPE (Caring for Older PEople) multidimensional assessment tool is designed to help community health workers (CHWs) identify clinically significant impairments and deliver evidence-based interventions METHODS: Older people (n = 150) identified by CHWs as frail or dependent, were assessed at home by the CHW using the structured COPE assessment tool, generating information on impairments in nutrition, mobility, vision, hearing, continence, cognition, mood and behaviour. The older people were reassessed by local physicians who reached a clinical judgment regarding the presence or absence of the same impairments based upon clinical examination guided by the EASY-Care assessment tool. RESULTS: The COPE tool was considered easy to administer, and gave CHWs a sense of empowerment to understand and act upon the needs of older people. Agreement between COPE assessment by CHW and clinician assessors was modest (ranged from 45.8 to 91.3 %) for most impairments. However, the prevalence of impairments was generally higher according to clinicians, particularly for visual impairment (98.7 vs 45.8 %), cognitive impairment (78.4 vs. 38.2 %) and depression (82.0 vs. 59.9 %). Most cases identified by WHO-COPE were clinician confirmed (positive predictive values - 72.2 to 98.5 %), and levels of disability and needs for care among those identified by COPE were higher than those additionally identified by the clinician alone. CONCLUSIONS: The COPE is a feasible tool for the identification of specific impairments in frail dependent older people in the community. Those identified are likely to be confirmed as having clinically relevant problems by clinicians working in the same service, and the COPE may be particularly effective at targeting attention upon those with the most substantial unmet needs

Calibrating EASY-Care independence scale to improve accuracy

Background there is currently limited support for the reliability and validity of the EASY-Care independence scale, with little work carried out in low- or middle-income countries. Therefore, we assessed the internal construct validity and hierarchical and classical scaling properties among frail dependent older people in the community. Objective we assessed the internal construct validity and hierarchical and classical scaling properties among frail dependent older people in the community. Methods three primary care physicians administered EASY-Care comprehensive geriatric assessment for 150 frail and/or dependent older people in the primary care setting. A Mokken model was applied to investigate hierarchical scaling properties of EASY-Care independence scale, and internal consistency (Cronbach's alpha) of the scale was also examined. Results we found that EASY-Care independence scale is highly internally consistent and is a strong hierarchical scale, hence providing strong evidence for unidimensionality. However, two items in the scale (unable to use telephone and manage finances) had much lower item Loevinger H coefficients than others. Exclusion of these two items improved the overall internal consistency of the scale. Conclusions the strong performance of the EASY-Care independence scale among community-dwelling frail older people is encouraging. This study confirms that EASY-Care independence scale is highly internally consistent and a strong hierarchical scale

Identifying common impairments in frail and dependent older people: Validation of the COPE assessment for non-specialised health workers in low resource primary health care settings

Background Frail and dependent older people in resource-poor settings are poorly served by health systems that lack outreach capacity. The COPE (Caring for Older PEople) multidimensional assessment tool is designed to help community health workers (CHWs) identify clinically significant impairments and deliver evidence-based interventions Methods Older people (n = 150) identified by CHWs as frail or dependent, were assessed at home by the CHW using the structured COPE assessment tool, generating information on impairments in nutrition, mobility, vision, hearing, continence, cognition, mood and behaviour. The older people were reassessed by local physicians who reached a clinical judgment regarding the presence or absence of the same impairments based upon clinical examination guided by the EASY-Care assessment tool. Results The COPE tool was considered easy to administer, and gave CHWs a sense of empowerment to understand and act upon the needs of older people. Agreement between COPE assessment by CHW and clinician assessors was modest (ranged from 45.8 to 91.3 %) for most impairments. However, the prevalence of impairments was generally higher according to clinicians, particularly for visual impairment (98.7 vs 45.8 %), cognitive impairment (78.4 vs. 38.2 %) and depression (82.0 vs. 59.9 %). Most cases identified by WHO-COPE were clinician confirmed (positive predictive values - 72.2 to 98.5 %), and levels of disability and needs for care among those identified by COPE were higher than those additionally identified by the clinician alone. Conclusions The COPE is a feasible tool for the identification of specific impairments in frail dependent older people in the community. Those identified are likely to be confirmed as having clinically relevant problems by clinicians working in the same service, and the COPE may be particularly effective at targeting attention upon those with the most substantial unmet needs

Measuring functional ability in healthy ageing: a nationwide cross-sectional survey in the Philippine older population

OBJECTIVES: To analyse the empirical support of the functional ability concept in the healthy ageing framework developed by the WHO in a sample of the Philippine older population. According to this framework, environmental factors may enhance or hinder functional ability, which is the person's ability to do what they value, broadly represented by subjective well-being. Moreover, this network of relationships may be moderated by personal characteristics such as gender. DESIGN: Cross-sectional observational study. SETTING: Philippines, general population. PARTICIPANTS: Respondents of the 2016 National Disability Prevalence Survey/Model Functioning Survey aged 50+ (N=2825). PRIMARY AND SECONDARY OUTCOME MEASURES: Latent (unobserved) measures of functional ability, environmental factors (physical environmental factors and social network and support) and subjective well-being (positive affect, negative affect and evaluative well-being) were obtained from different items from the survey questionnaire using a SEM framework. RESULTS: We found that the relationship between environmental factors and the three components of subjective well-being considered in this study was partially explained by differences in functional ability. The portion of those effects accounted for by functional ability was comparatively larger for the physical than for the social environmental factors. We found no evidences of gender differences in this network of relationships. CONCLUSIONS: These findings suggest the relevance of functional ability at explaining the relationship between environmental factors and subjective well-being in older adults. Future studies may replicate these findings longitudinally and including other relevant measures as the person's objective level of intrinsic capacity

Effects of physical exercise in older adults with reduced physical capacity: meta-analysis of resistance exercise and multimodal exercise

Older adults with reduced physical capacity are at greater risk of progression to care dependency. Progressive resistance strength exercise and multimodal exercise have been studied to restore reduced physical capacity. To summarize the best evidence of the two exercise regimes, this meta-analysis study appraised randomized-controlled trials from published systematic reviews. Medline, Embase, and the Cochrane Database of Systematic Review and Cochrane Central Register of Controlled Clinical Trials were searched for relevant systematic reviews. Two reviewers independently screened the relevant systematic reviews to identify eligible trials, assessed trial methodological quality, and extracted data. RevMan 5.3 software was used to analyze data on muscle strength, physical functioning, activities of daily living, and falls. Twenty-three eligible trials were identified from 22 systematic reviews. The mean age of the trial participants was 75 years or older. Almost all multimodal exercise trials included muscle strengthening exercise and balance exercise. Progressive resistance exercise is effective in improving muscle strength of the lower extremity and static standing balance. Multimodal exercise is effective in improving muscle strength of the lower extremity, dynamic standing balance, gait speed, and chair stand. In addition, multimodal exercise is effective in reducing falls. Neither type of exercise was effective in improving activities of daily living. For older adults with reduced physical capacity, multimodal exercise appears to have a broad effect on improving muscle strength, balance, and physical functioning of the lower extremity, and reducing falls relative to progressive resistance exercise alone

The methods and outcomes of cultural adaptations of psychological treatments for depressive disorders: a systematic review.

BACKGROUND: Cultural adaptations of evidence-based psychological treatments (PTs) are important to enhance their universal applicability. The aim of this study was to review systematically the literature on adaptations of PTs for depressive disorders for ethnic minorities in Western countries and for any population in non-Western countries to describe the process, extent and nature of the adaptations and the effectiveness of the adapted treatments. METHOD: Controlled trials were identified using database searches, key informants, previous reviews and reference lists. Data on the process and details of the adaptations were analyzed using qualitative methods and meta-analysis was used to assess treatment effectiveness. RESULTS: Twenty studies were included in this review, of which 16 were included in the meta-analysis. The process of adaptation was reported in two-thirds of the studies. Most adaptations were found in the dimensions of language, context and therapist delivering the treatment. The meta-analysis revealed a statistically significant benefit in favor of the adapted treatment [standardized mean difference (SMD) -0.72, 95% confidence interval (CI) -0.94 to -0.49]. CONCLUSIONS: Cultural adaptations of PTs follow a systematic procedure and lead primarily to adaptations in the implementation of the treatments rather than their content. Such PTs are effective in the treatment of depressive disorders in populations other than those for whom they were originally developed

Sliding principal component and dynamic reward reinforcement learning based IIoT attack detection

The Internet of Things (IoT) involves the gathering of all those devices that connect to the Internet with the purpose of collecting and sharing data. The application of IoT in the different sectors, including health, industry has also picked up the threads to augment over the past few years. The IoT and, by integrity, the IIoT, are found to be highly susceptible to different types of threats and attacks owing to the networks nature that in turn leads to even poor outcomes (i.e., increasing error rate). Hence, it is critical to design attack detection systems that can provide the security of IIoT networks. To overcome this research work of IIoT attack detection in large amount of evolutions is failed to determine the certain attacks resulting in a minimum detection performance, reinforcement learning-based attack detection method called sliding principal component and dynamic reward reinforcement learning (SPC-DRRL) for detecting various IIoT network attacks is introduced. In the first stage of this research methodology, preprocessing of raw TON_IoT dataset is performed by employing min-max normalization scaling function to obtain normalized values with same scale. Next, with the processed sample data as output, to extract data from multi-sources (i.e., different service profiles from the dataset), a robust log likelihood sliding principal component-based feature extraction algorithm is applied with an arbitrary size sliding window to extract computationally-efficient features. Finally, dynamic reward reinforcement learning-based IIoT attack detection model is presented to control the error rate involved in the design. Here, with the design of dynamic reward function and introducing incident repository that not only generates the reward function in an arbitrary fashion but also stores the action results in the incident repository for the next training, therefore reducing the attack detection error rate. Moreover, an IIoT attack detection system based on SPC-DRRL is constructed. Finally, we verify the algorithm on the ToN_IoT dataset of University of New South Wales Australia. The experimental results show that the IIoT attack detection time and overhead along with the error rate are reduced considerably with higher accuracy than that of traditional reinforcement learning methods

Social network typologies and mortality risk among older people in China, India, and Latin America: A 10/66 Dementia Research Group population-based cohort study

BACKGROUND: Restricted social networks have been associated with higher mortality in several developed countries but there are no studies on this topic from developing countries. This gap exists despite potentially greater dependence on social networks for support and survival due to various barriers to health care and social protection schemes in this setting. Thus, this study aims to examine how social network type at baseline predicts all-cause mortality among older adults in six Latin American countries, China, and India. METHODS: Population-based surveys were conducted of all individuals aged 65+ years in eight countries (Cuba, Dominican Republic, Peru, Venezuela, Mexico, Puerto Rico, China, and India). Data on mortality were obtained at follow-up (mean 3.8 years after cohort inception). Follow-up data for 13,891 individuals were analysed. Social network types were assessed using Wenger's Practitioner Assessment of Network Type (PANT). Cox proportional hazard models were constructed to estimate the impact of social network type on mortality risk in each country, adjusting for socio-demographics, receipt of pension, disability, medical conditions, and depression. Meta-analysis was performed to obtain pooled estimates. RESULTS: The prevalence of private network type was 64.4% in urban China and 1.6% in rural China, while the prevalence of locally integrated type was 6.6% in urban China and 86.8% in rural China. The adjusted pooled estimates across (a) all countries and (b) Latin America showed that, compared to the locally integrated social network type, the locally self-contained [(b) HR = 1.24, 95%CI 1.01-1.51], family dependent [(a) HR = 1.13, 95%CI 1.01-1.26; (b) HR = 1.13, 95%CI 1.001-1.28], and private [(a) HR = 1.36, 95%CI 1.06-1.73; (b) HR = 1.45, 95%CI 1.20-1.75] social network types were significantly associated with higher mortality risk. CONCLUSION: Survival time is significantly reduced in individuals embedded in restricted social networks (i.e. locally self-contained, family dependent, and private network types). Social care interventions may be enhanced by addressing the needs of those most at risk of neglect and deteriorating health. Health policy makers in developing countries may use this information to plan efficient use of limited resources by targeting those embedded in restricted social networks. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved. KEYWORDS: Ageing; Developing countries; Interpersonal relations; Mortality; Social networks; Social support; Survival rat

Socioeconomic Factors and All Cause and Cause-Specific Mortality among Older People in Latin America, India, and China: A Population-Based Cohort Study

Cleusa Ferri and colleagues studied mortality rates in over 12,000 people aged 65 years and over in Latin America, India, and China and showed that chronic diseases are the main causes of death and that education has an important effect on mortality