Erratum: Correction to: Comprehensive 5P framework for active aging using the ecological approach: an iterative systematic review (BMC public health (2020) 20 1 (33))

It was highlighted that the original article 1 contained a spelling mistake in the name of Hamid R. Baradaran. This was incorrectly captured as Bradaran. The original article has been updated

Nature or nurture BMI and blood pressure at 90. Findings from the Belfast Elderly longitudinal free-living aging study Belfast

Hypertension is a key risk factor for stroke, cardiovascular disease and dementia. Although the link between weight, sodium and hypertension is established in younger people, little is known about their inter-relationship in people beyond 80 years of age. Associations between blood pressure, anthropometric indices and sodium were investigated in 495 apparently healthy, community-living participants (age 90, SD 4.8; range 80–106), from the cross-sectional Belfast Elderly Longitudinal Free-living Aging STudy (BELFAST) study. In age-sex-adjusted logistic regression models, blood pressure =140/90 mmHg significantly associated with body mass index (BMI) [odds ratio (OR)?=?1.28/ kg/m2], with weight (OR?=?1.22/kg) approaching significance (P?=?0.07). In further age-sex-adjusted models, blood pressure above the 120/80 mmHg normotensive reference value significantly associated with BMI (OR?=?1.44/kg/m2), weight (OR?=?1.36/kg), skin-fold-thickness (OR?=?1.33/mm) and serum sodium (OR?=?1.37 mmol/l). In BELFAST participants over 80 years old, blood pressure =140/90 mmHg is associated with BMI, in apparently similar ways to younger groups

Preoperative Kidney Function linked to mortality and readmission outcomes at Day 90 and 30 in Older Emergency Surgical Patients

Grants were received from British Geriatric Society and The Renal Association to support Louis EvansPeer reviewedPublisher PD

Resumption of elective colorectal surgery during COVID-19 and risk of death

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Does anticholinergics drug burden relate to global neuro-disability outcome measures and length of hospital stay?

Primary objective: To assess the relationship between disability, length of stay (LOS) and anticholinergic burden (ACB) with people following acquired brain or spinal cord injury. Research design: A retrospective case note review assessed total rehabilitation unit admission. Methods and procedures: Assessment of 52 consecutive patients with acquired brain/spinal injury and neuropathy in an in-patient neuro-rehabilitation unit of a UK university hospital. Data analysed included: Northwick Park Dependency Score (NPDS), Rehabilitation complexity Scale (RCS), Functional Independence Measure and Functional Assessment Measure FIM-FAM (UK version 2.2), LOS and ACB. Outcome was different in RCS, NPDS and FIM-FAM between admission and discharge. Main outcomes and results: A positive change was reported in ACB results in a positive change in NPDS, with no significant effect on FIM-FAM, either Motor or Cognitive, or on the RCS. Change in ACB correlated to the length of hospital stay (regression correlation = −6.64; SE = 3.89). There was a significant harmful impact of increase in ACB score during hospital stay, from low to high ACB on NPDS (OR = 9.65; 95% CI = 1.36–68.64) and FIM-FAM Total scores (OR = 0.03; 95% CI = 0.002–0.35). Conclusions: There was a statistically significant correlation of ACB and neuro-disability measures and LOS amongst this patient cohort

A practical risk scale for predicting morbidity and mortality in the emergency general surgical setting: a prospective multi-center study

Background Low albumin is a prognostic factor associated with poor surgical outcomes. We aimed to examine the predicative ability of easily obtainable point-of-care variables in combination, to derive a practical risk scale for predicting older adults at risk of poor outcomes on admission to the emergency general surgical setting. Methods This is an international multi-center prospective cohort study conducted as part of the Older Persons Surgical Outcomes Collaboration (www.OPSOC.eu). The effect of having hypoalbuminemia (defined as albumin ≤3.5 g/dL) on selected outcomes was examined using fully adjusted multivariable models. In a subgroup of patients with hypoalbuminemia, we observed four risk characteristics (Male, Anemia, Low albumin, Eighty-five and over [MALE]). Subsequently, the impact of incremental increase in MALE score (each characteristic scoring 1 point (maximum score 4) on measured outcomes was assessed. Results The cohort consisted of 1406 older patients with median (IQR) age of 76 (70–83) years. In fully adjusted models, hypoalbuminemia was significantly associated with undergoing emergency surgery (1.32 (95%CI 1.03–1.70); p = 0.03), 30-day mortality (4.23 (2.22–8.08); p < 0.001), 90-day mortality (3.36 (2.14–5.28); p < 0.001) (primary outcome), and increased hospital length of stay, irrespective of whether a patient received emergency surgical intervention. Every point increase in MALE score was associated with higher odds of mortality, with a MALE score of 4 being associated with 30-day mortality (adjusted OR(95% CI) = 33.38 (3.86–288.7); p = 0.001) and 90-day mortality (11.37 (3.85–33.59); p < 0.001) compared to the reference category of those with MALE score 0. Conclusions The easy to use and practical MALE risk score calculated at point of care identifies older adults at a greater risk of poor outcomes, thereby allowing clinicians to prioritize patients who may benefit from early comprehensive geriatric assessment in the emergency general surgical setting

Nosocomial COVID-19 infection : examining the risk of mortality. The COPE-Nosocomial Study (COVID in Older PEople)

In the United Kingdom, authority to conduct the study was granted by the Health Research Authority (20/HRA/1898), and in Italy by the Ethics Committee of Policlinico Hospital Modena (Reference 369/2020/OSS/AOUMO). Cardiff University was the study sponsor.Peer reviewedPostprin

The association of antihypertensives with postural blood pressure and falls among seniors residing in the community: a case-control study

Background: A drop in postural blood pressure (BP) may contribute to falls, while antihypertensives have been considered to induce postural drop or orthostatic hypotension (OH) and falls among older people. However, this relationship between antihypertensives, postural BP and the risk of falls has never been evaluated in a single study. Objective: To examine the association of postural BP changes and BP therapy with the risk of falls among community-dwelling older people in a case-control manner. Method: Cases (n = 202) included participants aged ≥ 65 years with two falls or one injurious fall while controls (n = 156) included participants ≥ 65 years with no falls in the preceding 12 months. Antihypertensives usage and medical history were recorded. Supine BP measurements were obtained at 10 min rest and at 1, 2 and 3 min after standing. Orthostatic hypotension was defined as a reduction in BP of 20/10 mmHg within 3 min of standing. Results: Individual antihypertensive classes were not associated with falls. Minimal standing systolic BP (SBP) was significantly lower among fallers [128 (± 27·3) vs. 135·7 (± 24·7) mmHg; P = 0·01], but fallers were not more likely to fulfil the diagnostic criteria for OH. Diuretics were associated with OH and α-blockers were associated with minimal standing SBP. Univariate analysis revealed that the use of ≥ 2 antihypertensives was associated with recurrent and injurious falls [OR,1.97;CI,1.2-3.1], which was no longer significant aftermultivariateadjustment for age and number of comorbidities [OR, 1.6; CI, 0.95-2.6]. Discussion: Minimal standing SBP or a lower SBP at 2 or 3minutes standing was associated with falls rather than OH using consensus definition. Association between ≥ 2 antihypertensives and falls was attenuated by increasing age and comorbidities. Our findings challenge previous assumptions that OH or the use of antihypertensives is associated with falls. Future studies should now seek to link these findings prospectively with falls in order to guide decision-making for BP lowering therapy among older patients

Anticholinergic burden is associated with recurrent and injurious falls in older individuals

Objective While the anticholinergic activity of medications has been linked to cognitive decline, few studies have linked anticholinergic burden with falls in older people. We evaluated the relationship between anticholinergic burden and recurrent and injurious falls among community-dwelling older adults. Study design This case-control study was performed on 428 participants aged ≥65 years, 263 cases with two or more falls or one injurious fall in the preceding 12 months, and 165 controls with no falls in the preceding 12 months. Anticholinergic burden was determined using the anticholinergic cognitive burden (ACB) scale. Upper and lower limb functional abilities were assessed with timed up and go (TUG), functional reach (FR) and grip strength (GS). Logistic regression analysis was employed to calculate the mediation effect of TUG, FR and GS on ACB associated falls. Results Univariate analysis revealed a significant association between an ACB score of ≥1 with falls (OR, 1.8; 95% CI; 1.1-3.0; p = 0.01) and significantly poorer TUG and FR. The association between ACB≥1 and falls was no longer significant after adjustment for either TUG (OR for ACB associated falls, 1.4; 95% CI, 0.88-2.4; p = 0.14) or FR (OR for ACB associated falls, 1.4; 95% CI, 0.89-2.4, p = 0.12) but remained significant with GS. Conclusion The association between recurrent and injurious falls and the use of any medications listed in the ACB scale was mediated through gait and balance impairment but not by muscular weakness, providing a novel insight into the potential mechanistic link between ACB and falls. Future studies should determine whether TUG and FR measurements could help inform risk to benefit decisions where ACB medications are being considered

Systematic review on factors associated with medication non-adherence in Parkinson's disease

Background: Medication non-adherence is prevalent in Parkinson's disease (PD) and results in substantial motor dysfunction. Although various approaches have been suggested to address non-adherence in PD, good quality evidence of associated factors is limited. Objective: To systematically review the literature on clinical and demographic factors associated with medication non-adherence in PD. Methods: We searched five online databases in April 2011 (updated in January 2012): MEDLINE, EMBASE, AMED, PsycINFO and CINAHL for studies reporting data on factors associated with medication non-adherence in people with idiopathic PD. Bibliographies were hand searched to acquire records not identified electronically. Two reviewers independently assessed identified articles for potential inclusion. Data extraction was undertaken using a standardised data extraction form. Methodological quality was assessed against a specially designed quality indicator tool emphasising the detection of threats to internal validity. Results: We identified 1880 records of which six met inclusion criteria. A total of 772 PD patients were included (mean age 62 years, males 61%). We identified eleven factors (six clinical and five demographic) associated with non-adherence. We ranked each factor in order by weight of overall evidence: mood disorders, cognition, poor symptom control/QoL, younger age/longer disease duration, regimen complexity/polypharmacy, risk taking behaviours, poor knowledge of PD/education, lack of spouse/partner, low income, maintaining employment and gender. Conclusion: Clinicians should be aware of factors associated with medication non-adherence in PD. Targeted interventions should be developed and investigated to establish if addressing factors associated with non-adherence in PD leads to greater medication adherence. © 2012 Elsevier Ltd