Special Issue:
Challenges and Opportunities in Challenges and Opportunities in Ageing
Sunil K. Panchal
School of Pharmacy and Medical Sciences, Griffith University, Gold Coast, QLD 4222, Australia
Lindsay Brown
School of Pharmacy and Medical Sciences, Griffith University, Gold Coast, QLD 4222, Australia
Abstract
Maintaining health during ageing has become a major public health initiative as the proportion of the world’s population aged over 65 years has increased markedly. Macroalgae have been incorporated in the diet for generations, especially in East Asia. Nutritional changes to include macroalgae may provide possibilities for interventions to prevent or reverse the hallmarks of ageing. Their potential to assist in healthy ageing relies on their complex composition including carbohydrates, proteins, minerals, vitamins, fibre and secondary metabolites such as phlorotannins, oxylipins and terpenoids. However, most studies are in animal models with few studies examining the responses in humans to long-term intake. Likely mechanisms of action include reversal of chronic inflammation and gut dysbiosis as part of the changes during ageing. There is now a wide range of foods that incorporate macroalgae, including bread, noodles, yogurt, gluten-free products, and meat and seafood products. Key future priorities with macroalgae include increasing the range of species available for human consumption, defining the health benefits in humans and domestic animals, improving accessibility and decreasing the risk of toxicity from pollutants. Further, health may be improved by indirect effects including wastewater remediation, production of bioenergy and biofertilisers, and decreasing methane production by ruminants. These uses also increase knowledge of macroalgal biology, especially the use ofmolecular engineering techniques to increase sustainable macroalgal biomass production.
Christian Pozzi
University of Applied Sciences and Arts of Southern Switzerland (SUPSI), Centre of Competence on Ageing; PhD Student in Public Health, University of Milano Bicocca – Italy
Andrea Staglianò
San Gerardo dei Tintori IRCCS Foundation, Monza – Italy
Claudia Ballabio
Cooperativa “La Meridiana”, Monza
Chiara De Ponti
Cooperativa “La Meridiana”, Monza
Federica Bartoli
Cooperativa “La Meridiana”, Monza
Laura Antolini
Medical Statistics University of Milano Bicocca – Italy
Maria Cristina Ferrara
PhD Student in Public Health, University of Milano Bicocca – Italy; San Gerardo dei Tintori IRCCS Foundation, Monza – Italy
Alessandro Morandi
Azienda Speciale di Cremona Solidale – Italy; Parc Sanitari Pere Virgili and Vall d’Hebrón Institute of Research, Barcelona – Spain
Stefano Cavalli
University of Applied Sciences and Arts of Southern Switzerland (SUPSI), Centre of Competence on Ageing
Laura N. Gitlin
College of Nursing and Health Professions Drexel University – Philadelphia – USA
Giuseppe Bellelli
San Gerardo dei Tintori IRCCS Foundation, Monza – Italy; School of Medicine and Surgery, University of Milano Bicocca – Italy
Abstract
Background: Nonpharmacological approaches are recommended as first-line treatment for the neuropsychiatric symptoms of persons living with dementia. Tailored Activity Program is a non-pharmacological approach which has shown to reduce neuropsychiatric symptoms and functional dependence of persons living with dementia at the community, as well as caregiver’s distress. The aim of the study is to assess the feasibility of a project in which the Tailored Activity Program is delivered partially at an acute hospital ward and partially at the patient’s home.
Material and Methods: The study is aimed at enrolling 50 dyads (patients/caregivers) from the memory clinic, acute geriatric ward, or short-stay emergency department at the IRCCS San Gerardo dei Tintori, Monza (Italy). Inclusion criteria are: the patient’s clinical diagnosis of dementia, clinically detectable neuropsychiatric symptoms (Neuro Psychiatric Inventory, NPI score >6 in at least one item), the ability to participate in activities of daily living (Katz’s index ≥ 2), the presence of a caregiver (aged ≥ 21 years; minimum 4 hours of daily care), and the willingness of the dyad patient/caregiver to participate in the project. Treatment is delivered both i) in hospital (2 sessions) and ii) at home (6 sessions), including occupational therapy, telemedicine and nursing care provided once a week. The following variables are measured: Neuro Psychiatric Inventory, Time Up and Go Test, Katz’s Index and the level of caregiver’s sense of competence with the Sense of Competence Questionnaire. Data are collected both at baseline, at the end of the treatment, with a follow-up scheduled at 4 months after enrollment. Primary outcome measure is the dyad’s retention rate at 4-month follow-up. Secondary outcomes are the reduction in the patient’s frequency and severity of NPS; the improvement in the patient’s Time Up and Go Test score; the improvement in the patient’s levels of autonomy and participation in activities of daily living and improvement in the caregiver’s Sense of Competence Questionnaire score.
Results and Conclusion: We seek to evaluate whether the Tailored Activity Program is well-received by the patient/caregiver dyad and, consequently, whether our project is feasible. If this objective is achieved, and if we also report some improvement in the secondary outcomes, we can then plan a larger multicenter study aimed at evaluating the effectiveness of this approach, partly delivered at the hospital and partly at patient’s home.
Maria Evandrou
ESRC Centre for Population Change, University of Southampton, Southampton, UK; Centre for Research on Ageing, University of Southampton, Southampton, UK
Jane Falkingham
ESRC Centre for Population Change, University of Southampton, Southampton, UK
Min Qin
ESRC Centre for Population Change, University of Southampton, Southampton, UK
Athina Vlachantoni
ESRC Centre for Population Change, University of Southampton, Southampton, UK; Centre for Research on Ageing, University of Southampton, Southampton, UK
Abstract
Objectives: The COVID-19 crisis significantly reshaped individuals’ daily lives and work, potentially also affecting their mental health. This study examines changes in psychological stress, anxiety, and depression during the first lockdown amongst five British cohorts at different stages of the life course: older adolescence, early adulthood, mid-career, and later life. It investigates the correlation between self-reported stress and life changes across a range of domains including health; education and the move to home schooling; working patterns and furlough; and living arrangements and family life.
Methods: The study analyses data from 14,130 cohort members participating in the special COVID-19 surveys conducted in May 2020. These surveys are part of the ongoing 1946, 1958, 1970, and 2000-01 British birth cohorts, as well as the Next Steps cohort (born in 1989-90). Probit regression models assess the likelihood of increased stress among individuals reporting pandemic-related life changes compared to those who did not, across a range of different life domains. The study also examines the association between heightened stress and subsequent anxiety and depression.
Results: The research highlights the diverse challenges faced by individuals at different life stages during the early phase of the pandemic. Young people faced disrupted education, with many returning to the parental home; parents had to cope with the closure of schools and childcare services, dealing with young children at home; mid-career professionals also found themselves balancing work and family responsibilities; retirees faced cancelled medical appointments and disrupted home care services. All these challenges were associated with significantly increased reported stress among affected individuals; particularly in adolescence and young adulthood, where mental health outcomes were poorer than in older cohorts. Moreover, heightened stress substantially raised the risk of developing anxiety and depression.
Conclusions: The study affirms that individuals in various life stages faced exceptional challenges during the initial lockdown, adversely affecting mental well-being. Adolescents and young adults, experiencing more life changes but lacking coping resources, felt the disruption especially heavily. Going forward, given the potential health consequences of prolonged stress, anxiety, and depression, policymakers must consider these temporary challenges through a life course lens when designing appropriate interventions and support services.
Yurong Zhang
School of Sociology, Beijing Normal University
Yanli Liu
School of Law, Politics and Public Administration, Hebei Normal University
Xiulan Zhang
Emeritus Professor, Beijing Normal University
Abstract
Background: China is facing the challenge of an increasingly ageing population. The proportion of people aged 60 and above increased from 10% to 21.1% between 1999 and 2023 and is projected to reach 28% by 2040. In response to this demographic shift, the Chinese central government has implemented a series of policies that have evolved over time. The rapid advancement of information technology and science has accelerated these changes. However, there is still a research gap in understanding the digital service policies for elderly care.
Methodology: Based on research literature and policy texts, this study specifically focuses on policy development between January 2019 and January 2024. Seventy traceable national policy texts were categorized and analyzed, gathered from the State Council’s policy document database and the official websites of national ministries.
Result: The 70 policies were interpreted and categorized into three major aspects. Firstly, the policies on the improvement of traditional elderly care aimed to meet diverse needs by focusing on health and medical care, the management and standards of serving institutions, service improvements and standardization, and the development of the service workforce. Secondly, the policies on system integration between elderly care and other industries included the integration of finance and elderly care, the construction of the insurance system, long-term care institutions and insurance, hospice care, and the silver economy. Thirdly, the policies on digital services comprised the smart healthcare industry, information accessibility, elderly-friendly digital technology and empowerment, and the creation of elderly-friendly communities and societies.
Conclusion: The development concepts and contents of China’s elderly care policy have evolved. The acceleration of transformation and promotion of the silver economy has become a new comprehensive and universal measure. Despite recent policy developments indicating a growing trend towards integration, there remains considerable room for improvement in actual implementation. This should focus on the uneven development of the “three pillars” of the pension system, insufficient innovation in financial products, and inadequate industry financing channels. It is important to be alert to the persistent problems and obstacles, which widen the gap in elderly welfare, create new forms of social inequality and exclusion, and hinder the development of a friendly information society.
Abstract
The organisation of society into social systems led, from the nineteenth century onwards, to the differentiation of medicine. Its object has been diseases, with the sub-systems of healthcare, responsible for diagnosis and treatment, and public health, responsible for communicating the truths of medical science to the population with the aim of preventing and treating diseases. This organisation, which remains effective, is currently facing two problems:
- Its possible extension of its scope to include health as understood by international organisations, in order to meet the challenges posed by the rapid transformation of the planet: global warming, overpopulation, ageing, poverty, etc.
- The ability to make this advice effective at a time when there is no longer an entity that can generate the confidence needed to apply its recommendations.
To overcome the silos that have prevented the changes we are undergoing today, it will be necessary to organise collaborations that the revolution brought about by Artificial Intelligence (AI) may be able to facilitate.
Abstract
Introduction: Chronic Obstructive Pulmonary Disease (COPD) in exacerbation is globally a frequent cause of admission. In Denmark, annual national epidemiological data on COPD patients have been reported since 2008, and there has been registered a reduction in admissions due to COPD in exacerbation of approximately 25% compared to 2014. There has also been revealed regional differences in use of non-invasive ventilation (NIV) and mortality, and especially, the 30-day mortality rate was significantly higher at Odense University Hospital compared to the other regions in 2022, where the number of admissions was even lower due to the effect of the COVID- 19 pandemic. We therefore decided to repeat an internal audit of all admissions with COPD exacerbation with focus on in-house initiation of NIV as an add-on treatment to standard treatment and mortality.
Methods: Patient data was collected from medical records from the COPD cohort, and the cohort was defined by discharge between 1 st of January to 31 st of December 2023, admission at Odense University Hospital, and confirmed COPD exacerbation.
Results: The COPD cohort comprised in all 396 patients. NIV criteria were fulfilled in 112 patients and initiation of NIV in 92.9%. The 30-day mortality rate was in this cohort 16.2%. Patients who died within 30 days, were significantly older than patients still alive, although there was no difference in comorbidities. The patients, who received NIV and died, had significantly fewer comorbidites compared to patients who died and did not receive NIV.
Conclusions: Acute treatment was given according to guidelines, and the need of NIV was found in 28% of the patients in the cohort. The patients that died were significantly older compared to survivors. The increased mortality can therefore be a consequence of admissions with an ageing population, and, hence, more fragile COPD patients. The COPD population in Denmark is getting older, although there are still some patients with severe COPD dying at younger age.
Lisa Brandon
St James Hospital, Dublin, Ireland
Niall Connolly
St James Hospital, Dublin, Ireland
Mark Hensey
St James Hospital, Dublin, Ireland
Stephen O’Connor
St James Hospital, Dublin, Ireland
I Cruz-Gonzalez
University of Salamanca, Spain
Rose Anne Kenny
St James Hospital, Dublin, Ireland; Trinity College, Dublin, Ireland
Andrew O Maree
St James Hospital, Dublin, Ireland; Trinity College, Dublin, Ireland
Abstract
Aortic stenosis remains the most common valvular abnormality that requires intervention and is becoming more prevalent with an ageing population. Untreated symptomatic severe aortic stenosis is associated with a mortality of 50-60% within two years. Valve replacement either surgical or transcatheter remains the only effective treatment.
The autonomic nervous system involuntarily controls many basic cardiac, respiratory, gastrointestinal and genitourinary functions and plays a central role in the regulation of heart rate and blood pressure. Cardiovascular autonomic dysfunction has shown to be a marker of increased mortality. We discuss current methods to assess autonomic function, alongside abnormalities noted in common cardiac conditions and their correlation to mortality, and review current literature available that confirms severe aortic stenosis is associated with dysregulation of cardiovascular autonomic system.
