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Publisher: Oxford University Press   (Total: 370 journals)

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Showing 1 - 200 of 370 Journals sorted alphabetically
Acta Biochimica et Biophysica Sinica     Hybrid Journal   (Followers: 6, SJR: 0.881, h-index: 38)
Adaptation     Hybrid Journal   (Followers: 8, SJR: 0.111, h-index: 4)
Aesthetic Surgery J.     Hybrid Journal   (Followers: 6, SJR: 1.538, h-index: 35)
African Affairs     Hybrid Journal   (Followers: 59, SJR: 1.512, h-index: 46)
Age and Ageing     Hybrid Journal   (Followers: 85, SJR: 1.611, h-index: 107)
Alcohol and Alcoholism     Hybrid Journal   (Followers: 16, SJR: 0.935, h-index: 80)
American Entomologist     Full-text available via subscription   (Followers: 6)
American Historical Review     Hybrid Journal   (Followers: 139, SJR: 0.652, h-index: 43)
American J. of Agricultural Economics     Hybrid Journal   (Followers: 40, SJR: 1.441, h-index: 77)
American J. of Epidemiology     Hybrid Journal   (Followers: 171, SJR: 3.047, h-index: 201)
American J. of Hypertension     Hybrid Journal   (Followers: 23, SJR: 1.397, h-index: 111)
American J. of Jurisprudence     Hybrid Journal   (Followers: 17)
American J. of Legal History     Full-text available via subscription   (Followers: 6, SJR: 0.151, h-index: 7)
American Law and Economics Review     Hybrid Journal   (Followers: 25, SJR: 0.824, h-index: 23)
American Literary History     Hybrid Journal   (Followers: 12, SJR: 0.185, h-index: 22)
Analysis     Hybrid Journal   (Followers: 23)
Annals of Botany     Hybrid Journal   (Followers: 36, SJR: 1.912, h-index: 124)
Annals of Occupational Hygiene     Hybrid Journal   (Followers: 28, SJR: 0.837, h-index: 57)
Annals of Oncology     Hybrid Journal   (Followers: 49, SJR: 4.362, h-index: 173)
Annals of the Entomological Society of America     Full-text available via subscription   (Followers: 8, SJR: 0.642, h-index: 53)
Annals of Work Exposures and Health     Hybrid Journal  
AoB Plants     Open Access   (Followers: 4, SJR: 0.78, h-index: 10)
Applied Economic Perspectives and Policy     Hybrid Journal   (Followers: 19, SJR: 0.884, h-index: 31)
Applied Linguistics     Hybrid Journal   (Followers: 51, SJR: 1.749, h-index: 63)
Applied Mathematics Research eXpress     Hybrid Journal   (Followers: 1, SJR: 0.779, h-index: 11)
Arbitration Intl.     Full-text available via subscription   (Followers: 20)
Arbitration Law Reports and Review     Hybrid Journal   (Followers: 13)
Archives of Clinical Neuropsychology     Hybrid Journal   (Followers: 26, SJR: 0.96, h-index: 71)
Aristotelian Society Supplementary Volume     Hybrid Journal   (Followers: 2, SJR: 0.102, h-index: 20)
Arthropod Management Tests     Hybrid Journal   (Followers: 2)
Astronomy & Geophysics     Hybrid Journal   (Followers: 47, SJR: 0.144, h-index: 15)
Behavioral Ecology     Hybrid Journal   (Followers: 49, SJR: 1.698, h-index: 92)
Bioinformatics     Hybrid Journal   (Followers: 304, SJR: 4.643, h-index: 271)
Biology Methods and Protocols     Hybrid Journal  
Biology of Reproduction     Full-text available via subscription   (Followers: 9, SJR: 1.646, h-index: 149)
Biometrika     Hybrid Journal   (Followers: 19, SJR: 2.801, h-index: 90)
BioScience     Hybrid Journal   (Followers: 30, SJR: 2.374, h-index: 154)
Bioscience Horizons : The National Undergraduate Research J.     Open Access   (Followers: 1, SJR: 0.213, h-index: 9)
Biostatistics     Hybrid Journal   (Followers: 16, SJR: 1.955, h-index: 55)
BJA : British J. of Anaesthesia     Hybrid Journal   (Followers: 148, SJR: 2.314, h-index: 133)
BJA Education     Hybrid Journal   (Followers: 64, SJR: 0.272, h-index: 20)
Brain     Hybrid Journal   (Followers: 61, SJR: 6.097, h-index: 264)
Briefings in Bioinformatics     Hybrid Journal   (Followers: 44, SJR: 4.086, h-index: 73)
Briefings in Functional Genomics     Hybrid Journal   (Followers: 4, SJR: 1.771, h-index: 50)
British J. for the Philosophy of Science     Hybrid Journal   (Followers: 34, SJR: 1.267, h-index: 38)
British J. of Aesthetics     Hybrid Journal   (Followers: 26, SJR: 0.217, h-index: 18)
British J. of Criminology     Hybrid Journal   (Followers: 527, SJR: 1.373, h-index: 62)
British J. of Social Work     Hybrid Journal   (Followers: 83, SJR: 0.771, h-index: 53)
British Medical Bulletin     Hybrid Journal   (Followers: 7, SJR: 1.391, h-index: 84)
British Yearbook of Intl. Law     Hybrid Journal   (Followers: 27)
Bulletin of the London Mathematical Society     Hybrid Journal   (Followers: 3, SJR: 1.474, h-index: 31)
Cambridge J. of Economics     Hybrid Journal   (Followers: 58, SJR: 0.957, h-index: 59)
Cambridge J. of Regions, Economy and Society     Hybrid Journal   (Followers: 11, SJR: 1.067, h-index: 22)
Cambridge Quarterly     Hybrid Journal   (Followers: 11, SJR: 0.1, h-index: 7)
Capital Markets Law J.     Hybrid Journal   (Followers: 1)
Carcinogenesis     Hybrid Journal   (Followers: 2, SJR: 2.439, h-index: 167)
Cardiovascular Research     Hybrid Journal   (Followers: 12, SJR: 2.897, h-index: 175)
Cerebral Cortex     Hybrid Journal   (Followers: 41, SJR: 4.827, h-index: 192)
CESifo Economic Studies     Hybrid Journal   (Followers: 16, SJR: 0.501, h-index: 19)
Chemical Senses     Hybrid Journal   (Followers: 1, SJR: 1.436, h-index: 76)
Children and Schools     Hybrid Journal   (Followers: 6, SJR: 0.211, h-index: 18)
Chinese J. of Comparative Law     Hybrid Journal   (Followers: 3)
Chinese J. of Intl. Law     Hybrid Journal   (Followers: 21, SJR: 0.737, h-index: 11)
Chinese J. of Intl. Politics     Hybrid Journal   (Followers: 9, SJR: 1.238, h-index: 15)
Christian Bioethics: Non-Ecumenical Studies in Medical Morality     Hybrid Journal   (Followers: 11, SJR: 0.191, h-index: 8)
Classical Receptions J.     Hybrid Journal   (Followers: 24, SJR: 0.1, h-index: 3)
Clinical Infectious Diseases     Hybrid Journal   (Followers: 59, SJR: 4.742, h-index: 261)
Clinical Kidney J.     Open Access   (Followers: 4, SJR: 0.338, h-index: 19)
Community Development J.     Hybrid Journal   (Followers: 24, SJR: 0.47, h-index: 28)
Computer J.     Hybrid Journal   (Followers: 7, SJR: 0.371, h-index: 47)
Conservation Physiology     Open Access   (Followers: 2)
Contemporary Women's Writing     Hybrid Journal   (Followers: 11, SJR: 0.111, h-index: 3)
Contributions to Political Economy     Hybrid Journal   (Followers: 5, SJR: 0.313, h-index: 10)
Critical Values     Full-text available via subscription  
Current Legal Problems     Hybrid Journal   (Followers: 26)
Current Zoology     Full-text available via subscription   (SJR: 0.999, h-index: 20)
Database : The J. of Biological Databases and Curation     Open Access   (Followers: 11, SJR: 1.068, h-index: 24)
Digital Scholarship in the Humanities     Hybrid Journal   (Followers: 12)
Diplomatic History     Hybrid Journal   (Followers: 19, SJR: 0.296, h-index: 22)
DNA Research     Open Access   (Followers: 4, SJR: 2.42, h-index: 77)
Dynamics and Statistics of the Climate System     Open Access   (Followers: 3)
Early Music     Hybrid Journal   (Followers: 15, SJR: 0.124, h-index: 11)
Economic Policy     Hybrid Journal   (Followers: 63, SJR: 2.052, h-index: 52)
ELT J.     Hybrid Journal   (Followers: 25, SJR: 1.26, h-index: 23)
English Historical Review     Hybrid Journal   (Followers: 51, SJR: 0.311, h-index: 10)
English: J. of the English Association     Hybrid Journal   (Followers: 13, SJR: 0.144, h-index: 3)
Environmental Entomology     Full-text available via subscription   (Followers: 11, SJR: 0.791, h-index: 66)
Environmental Epigenetics     Open Access   (Followers: 1)
Environmental History     Hybrid Journal   (Followers: 26, SJR: 0.197, h-index: 25)
EP-Europace     Hybrid Journal   (Followers: 2, SJR: 2.201, h-index: 71)
Epidemiologic Reviews     Hybrid Journal   (Followers: 10, SJR: 3.917, h-index: 81)
ESHRE Monographs     Hybrid Journal  
Essays in Criticism     Hybrid Journal   (Followers: 16, SJR: 0.1, h-index: 6)
European Heart J.     Hybrid Journal   (Followers: 49, SJR: 6.997, h-index: 227)
European Heart J. - Cardiovascular Imaging     Hybrid Journal   (Followers: 8, SJR: 2.044, h-index: 58)
European Heart J. - Cardiovascular Pharmacotherapy     Full-text available via subscription   (Followers: 1)
European Heart J. - Quality of Care and Clinical Outcomes     Hybrid Journal  
European Heart J. Supplements     Hybrid Journal   (Followers: 7, SJR: 0.152, h-index: 31)
European J. of Cardio-Thoracic Surgery     Hybrid Journal   (Followers: 8, SJR: 1.568, h-index: 104)
European J. of Intl. Law     Hybrid Journal   (Followers: 160, SJR: 0.722, h-index: 38)
European J. of Orthodontics     Hybrid Journal   (Followers: 4, SJR: 1.09, h-index: 60)
European J. of Public Health     Hybrid Journal   (Followers: 22, SJR: 1.284, h-index: 64)
European Review of Agricultural Economics     Hybrid Journal   (Followers: 11, SJR: 1.549, h-index: 42)
European Review of Economic History     Hybrid Journal   (Followers: 28, SJR: 0.628, h-index: 24)
European Sociological Review     Hybrid Journal   (Followers: 41, SJR: 2.061, h-index: 53)
Evolution, Medicine, and Public Health     Open Access   (Followers: 11)
Family Practice     Hybrid Journal   (Followers: 11, SJR: 1.048, h-index: 77)
Fems Microbiology Ecology     Hybrid Journal   (Followers: 9, SJR: 1.687, h-index: 115)
Fems Microbiology Letters     Hybrid Journal   (Followers: 20, SJR: 1.126, h-index: 118)
Fems Microbiology Reviews     Hybrid Journal   (Followers: 25, SJR: 7.587, h-index: 150)
Fems Yeast Research     Hybrid Journal   (Followers: 13, SJR: 1.213, h-index: 66)
Foreign Policy Analysis     Hybrid Journal   (Followers: 22, SJR: 0.859, h-index: 10)
Forestry: An Intl. J. of Forest Research     Hybrid Journal   (Followers: 16, SJR: 0.903, h-index: 44)
Forum for Modern Language Studies     Hybrid Journal   (Followers: 6, SJR: 0.108, h-index: 6)
French History     Hybrid Journal   (Followers: 32, SJR: 0.123, h-index: 10)
French Studies     Hybrid Journal   (Followers: 20, SJR: 0.119, h-index: 7)
French Studies Bulletin     Hybrid Journal   (Followers: 10, SJR: 0.102, h-index: 3)
Gastroenterology Report     Open Access   (Followers: 2)
Genome Biology and Evolution     Open Access   (Followers: 10, SJR: 3.22, h-index: 39)
Geophysical J. Intl.     Hybrid Journal   (Followers: 34, SJR: 1.839, h-index: 119)
German History     Hybrid Journal   (Followers: 25, SJR: 0.437, h-index: 13)
GigaScience     Open Access   (Followers: 3)
Global Summitry     Hybrid Journal  
Glycobiology     Hybrid Journal   (Followers: 14, SJR: 1.692, h-index: 101)
Health and Social Work     Hybrid Journal   (Followers: 49, SJR: 0.505, h-index: 40)
Health Education Research     Hybrid Journal   (Followers: 12, SJR: 0.814, h-index: 80)
Health Policy and Planning     Hybrid Journal   (Followers: 20, SJR: 1.628, h-index: 66)
Health Promotion Intl.     Hybrid Journal   (Followers: 21, SJR: 0.664, h-index: 60)
History Workshop J.     Hybrid Journal   (Followers: 27, SJR: 0.313, h-index: 20)
Holocaust and Genocide Studies     Hybrid Journal   (Followers: 24, SJR: 0.115, h-index: 13)
Human Molecular Genetics     Hybrid Journal   (Followers: 9, SJR: 4.288, h-index: 233)
Human Reproduction     Hybrid Journal   (Followers: 78, SJR: 2.271, h-index: 179)
Human Reproduction Update     Hybrid Journal   (Followers: 17, SJR: 4.678, h-index: 128)
Human Rights Law Review     Hybrid Journal   (Followers: 60, SJR: 0.7, h-index: 21)
ICES J. of Marine Science: J. du Conseil     Hybrid Journal   (Followers: 54, SJR: 1.233, h-index: 88)
ICSID Review     Hybrid Journal   (Followers: 10)
ILAR J.     Hybrid Journal   (Followers: 1, SJR: 1.099, h-index: 51)
IMA J. of Applied Mathematics     Hybrid Journal   (SJR: 0.329, h-index: 26)
IMA J. of Management Mathematics     Hybrid Journal   (Followers: 2, SJR: 0.351, h-index: 20)
IMA J. of Mathematical Control and Information     Hybrid Journal   (Followers: 2, SJR: 0.661, h-index: 28)
IMA J. of Numerical Analysis - advance access     Hybrid Journal   (SJR: 2.032, h-index: 44)
Industrial and Corporate Change     Hybrid Journal   (Followers: 8, SJR: 1.37, h-index: 81)
Industrial Law J.     Hybrid Journal   (Followers: 30, SJR: 0.184, h-index: 15)
Information and Inference     Free  
Integrative and Comparative Biology     Hybrid Journal   (Followers: 8, SJR: 1.911, h-index: 90)
Interacting with Computers     Hybrid Journal   (Followers: 10, SJR: 0.529, h-index: 59)
Interactive CardioVascular and Thoracic Surgery     Hybrid Journal   (Followers: 5, SJR: 0.743, h-index: 35)
Intl. Affairs     Hybrid Journal   (Followers: 52, SJR: 1.264, h-index: 53)
Intl. Data Privacy Law     Hybrid Journal   (Followers: 28)
Intl. Health     Hybrid Journal   (Followers: 5, SJR: 0.835, h-index: 15)
Intl. Immunology     Hybrid Journal   (Followers: 3, SJR: 1.613, h-index: 111)
Intl. J. for Quality in Health Care     Hybrid Journal   (Followers: 33, SJR: 1.593, h-index: 69)
Intl. J. of Constitutional Law     Hybrid Journal   (Followers: 60, SJR: 0.613, h-index: 19)
Intl. J. of Epidemiology     Hybrid Journal   (Followers: 148, SJR: 4.381, h-index: 145)
Intl. J. of Law and Information Technology     Hybrid Journal   (Followers: 4, SJR: 0.247, h-index: 8)
Intl. J. of Law, Policy and the Family     Hybrid Journal   (Followers: 29, SJR: 0.307, h-index: 15)
Intl. J. of Lexicography     Hybrid Journal   (Followers: 8, SJR: 0.404, h-index: 18)
Intl. J. of Low-Carbon Technologies     Open Access   (Followers: 1, SJR: 0.457, h-index: 12)
Intl. J. of Neuropsychopharmacology     Open Access   (Followers: 3, SJR: 1.69, h-index: 79)
Intl. J. of Public Opinion Research     Hybrid Journal   (Followers: 9, SJR: 0.906, h-index: 33)
Intl. J. of Refugee Law     Hybrid Journal   (Followers: 33, SJR: 0.231, h-index: 21)
Intl. J. of Transitional Justice     Hybrid Journal   (Followers: 13, SJR: 0.833, h-index: 12)
Intl. Mathematics Research Notices     Hybrid Journal   (Followers: 1, SJR: 2.052, h-index: 42)
Intl. Political Sociology     Hybrid Journal   (Followers: 31, SJR: 1.339, h-index: 19)
Intl. Relations of the Asia-Pacific     Hybrid Journal   (Followers: 18, SJR: 0.539, h-index: 17)
Intl. Studies Perspectives     Hybrid Journal   (Followers: 7, SJR: 0.998, h-index: 28)
Intl. Studies Quarterly     Hybrid Journal   (Followers: 39, SJR: 2.184, h-index: 68)
Intl. Studies Review     Hybrid Journal   (Followers: 18, SJR: 0.783, h-index: 38)
ISLE: Interdisciplinary Studies in Literature and Environment     Hybrid Journal   (Followers: 1, SJR: 0.155, h-index: 4)
ITNOW     Hybrid Journal   (Followers: 2, SJR: 0.102, h-index: 4)
J. of African Economies     Hybrid Journal   (Followers: 15, SJR: 0.647, h-index: 30)
J. of American History     Hybrid Journal   (Followers: 43, SJR: 0.286, h-index: 34)
J. of Analytical Toxicology     Hybrid Journal   (Followers: 13, SJR: 1.038, h-index: 60)
J. of Antimicrobial Chemotherapy     Hybrid Journal   (Followers: 13, SJR: 2.157, h-index: 149)
J. of Antitrust Enforcement     Hybrid Journal   (Followers: 1)
J. of Applied Poultry Research     Hybrid Journal   (Followers: 3, SJR: 0.563, h-index: 43)
J. of Biochemistry     Hybrid Journal   (Followers: 43, SJR: 1.341, h-index: 96)
J. of Chromatographic Science     Hybrid Journal   (Followers: 16, SJR: 0.448, h-index: 42)
J. of Church and State     Hybrid Journal   (Followers: 11, SJR: 0.167, h-index: 11)
J. of Competition Law and Economics     Hybrid Journal   (Followers: 35, SJR: 0.442, h-index: 16)
J. of Complex Networks     Hybrid Journal   (Followers: 1, SJR: 1.165, h-index: 5)
J. of Conflict and Security Law     Hybrid Journal   (Followers: 13, SJR: 0.196, h-index: 15)
J. of Consumer Research     Full-text available via subscription   (Followers: 43, SJR: 4.896, h-index: 121)
J. of Crohn's and Colitis     Hybrid Journal   (Followers: 10, SJR: 1.543, h-index: 37)
J. of Cybersecurity     Hybrid Journal   (Followers: 3)
J. of Deaf Studies and Deaf Education     Hybrid Journal   (Followers: 9, SJR: 0.69, h-index: 36)
J. of Design History     Hybrid Journal   (Followers: 16, SJR: 0.166, h-index: 14)
J. of Economic Entomology     Full-text available via subscription   (Followers: 6, SJR: 0.894, h-index: 76)
J. of Economic Geography     Hybrid Journal   (Followers: 39, SJR: 2.909, h-index: 69)
J. of Environmental Law     Hybrid Journal   (Followers: 23, SJR: 0.457, h-index: 20)
J. of European Competition Law & Practice     Hybrid Journal   (Followers: 19)
J. of Experimental Botany     Hybrid Journal   (Followers: 14, SJR: 2.798, h-index: 163)
J. of Financial Econometrics     Hybrid Journal   (Followers: 23, SJR: 1.314, h-index: 27)
J. of Global Security Studies     Hybrid Journal   (Followers: 3)
J. of Heredity     Hybrid Journal   (Followers: 4, SJR: 1.024, h-index: 76)
J. of Hindu Studies     Hybrid Journal   (Followers: 7, SJR: 0.186, h-index: 3)
J. of Hip Preservation Surgery     Open Access  
J. of Human Rights Practice     Hybrid Journal   (Followers: 20, SJR: 0.399, h-index: 10)
J. of Infectious Diseases     Hybrid Journal   (Followers: 39, SJR: 4, h-index: 209)
J. of Insect Science     Open Access   (Followers: 8, SJR: 0.388, h-index: 31)

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Journal Cover Age and Ageing
  [SJR: 1.611]   [H-I: 107]   [85 followers]  Follow
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 0002-0729 - ISSN (Online) 1468-2834
   Published by Oxford University Press Homepage  [370 journals]
  • Editor's view
    • First page: 703
      PubDate: 2017-06-29
      DOI: 10.1093/ageing/afx125
  • Giant steps forward
    • Authors: Starr JM.
      First page: 704
      PubDate: 2017-06-17
      DOI: 10.1093/ageing/afx097
  • Comorbidity and vascular cognitive impairment-no dementia (VCI-ND)
    • Authors: Le Couteur DG; Wahl D, Naismith SL.
      First page: 705
      PubDate: 2017-05-08
      DOI: 10.1093/ageing/afx080
  • Introduction of a much needed physical function-focused medication review
    • Authors: Henderson RM.
      First page: 707
      PubDate: 2017-06-14
      DOI: 10.1093/ageing/afx092
  • The growing challenge of major trauma in older people: a role for
           comprehensive geriatric assessment'
    • Authors: Fisher J; Bates C, Banerjee J.
      First page: 709
      Abstract: AbstractIn this commentary article, we describe the impact that an ageing population is having on the nature of major trauma seen in emergency departments. The proportion of major trauma victims who are older people is rapidly increasing and a fall from standing is now the most common mechanism of injury in major trauma. Potential barriers to effective care of this patient group are highlighted, including: a lack of consensus regarding triage criteria; potentially misleading physiological parameters within triage criteria; non-linear patient presentations and diagnostic nihilism. We argue that the complex ongoing care and rehabilitation needs of older patients with major trauma may be best met through Comprehensive Geriatric Assessment (CGA). Furthermore, the use of frailty screening tools may facilitate more informed early decision-making in relation to treatment interventions in older trauma victims. We call for geriatric medicine and emergency medicine departments to collaborate—equipping urgent care staff with the basic competencies necessary to initiate CGA should be a priority, and geriatricians have a key role to play in delivery of such educational interventions.
      PubDate: 2017-03-10
      DOI: 10.1093/ageing/afx035
  • New horizons in comprehensive geriatric assessment
    • Authors: Parker SG; McLeod AA, McCue PP, et al.
      First page: 713
      Abstract: In this article, we discuss the emergence of new models for delivery of comprehensive geriatric assessment (CGA) in the acute hospital setting. CGA is the core technology of Geriatric Medicine and for hospital inpatients it improves key outcomes such as survival, time spent at home and institutionalisation. Traditionally It is delivered by specialised multidisciplinary teams, often in dedicated wards, but in recent years has begun to be taken up and developed quite early in the admission process (at the ‘front door’), across traditional ward boundaries and in specialty settings such as surgical and pre-operative care, and oncology. We have scanned recent literature, including observational studies of service evaluations, and service descriptions presented as abstracts of conference presentations to provide an overview of an emerging landscape of innovation and development in CGA services for hospital inpatients.
      PubDate: 2017-06-27
      DOI: 10.1093/ageing/afx104
  • Systematic reviews: guidance relevant for studies of older people
    • Authors: Shenkin SD; Harrison JK, Wilkinson T, et al.
      First page: 722
      Abstract: AbstractSystematic reviews and meta-analyses are increasingly common. This article aims to provide guidance for people conducting systematic reviews relevant to the healthcare of older people. An awareness of these issues will also help people reading systematic reviews to determine whether the results will influence their clinical practice. It is essential that systematic reviews are performed by a team which includes the required technical and clinical expertise. Those performing reviews for the first time should ensure they have appropriate training and support. They must be planned and performed in a transparent and methodologically robust way: guidelines are available. The protocol should be written—and if possible published—before starting the review. Geriatricians will be interested in a table of baseline characteristics, which will help to determine if the studied samples or populations are similar to their patients. Reviews of studies of older people should consider how they will manage issues such as different age cut-offs; non-specific presentations; multiple predictors and outcomes; potential biases and confounders. Systematic reviews and meta-analyses may provide evidence to improve older people's care, or determine where new evidence is required. Newer methodologies, such as meta-analyses of individual level data, network meta-analyses and umbrella reviews, and realist synthesis, may improve the reliability and clinical utility of systematic reviews.
      PubDate: 2017-06-24
      DOI: 10.1093/ageing/afx105
  • Motor function and incident dementia: a systematic review and
    • Authors: Kueper J; Speechley M, Lingum N, et al.
      First page: 729
      Abstract: AbstractBackgroundcognitive and mobility decline are interrelated processes, whereby mobility decline coincides or precedes the onset of cognitive decline.Objectiveto assess whether there is an association between performance on motor function tests and incident dementia.Methodselectronic database, grey literature and hand searching identified studies testing for associations between baseline motor function and incident dementia in older adults.Resultsof 2,540 potentially relevant documents, 37 met the final inclusion criteria and were reviewed qualitatively. Three meta-analyses were conducted using data from 10 studies. Three main motor domains—upper limb motor function, parkinsonism and lower limb motor function—emerged as associated with increased risk of incident dementia. Studies including older adults without neurological overt disease found a higher risk of incident dementia associated with poorer performance on composite motor function scores, balance and gait velocity (meta-analysis pooled HR = 1.94, 95% CI: 1.41, 2.65). Mixed results were found across different study samples for upper limb motor function, overall parkinsonism (meta-analysis pooled OR = 3.05, 95% CI: 1.31, 7.08), bradykinesia and rigidity. Studies restricted to older adults with Parkinson's Disease found weak or no association with incident dementia even for motor domains highly associated in less restrictive samples. Tremor was not associated with an increased risk of dementia in any population (meta-analysis pooled HR = 0.80, 95% CI 0.31, 2.03).Conclusionlower limb motor function was associated with increased risk of developing dementia, while tremor and hand grip strength were not. Our results support future research investigating the inclusion of quantitative motor assessment, specifically gait velocity tests, for clinical dementia risk evaluation.
      PubDate: 2017-05-25
      DOI: 10.1093/ageing/afx084
  • Is sarcopenia associated with depression' A systematic review and
           meta-analysis of observational studies
    • Authors: Chang K; Hsu T, Wu W, et al.
      First page: 738
      Abstract: AbstractObjectivesto explore whether sarcopenia is associated with depression.Designelectronic literature databases from PubMed, Scopus, Embase and Google Scholar were searched. A systematic review and meta-analysis of observational studies was conducted.Settingcommunity and outpatient clinic.Participantspeople with and without diagnoses of sarcopenia.Measurementsoutcome measures of depression.Resultsabout 15 articles were included, 5 of which were retrieved for narrative review. The crude odds ratios (ORs) between sarcopenia and depression were extracted from the remaining 10 studies, 6 of which also included adjusted ORs. Sarcopenia was associated with depression without adjusting covariates (crude OR, 1.640; 95% confidence interval (CI), 1.247–2.155). After adjusting for potential confounders such as age, gender, cognitive performance and physical activity, sarcopenia still demonstrated a significant positive association with depression (adjusted OR, 1.821; 95% CI, 1.160–2.859). A stratified analysis showed that the studies that used bioelectrical impedance analysis for measurement of body composition tended to have an elevated association between sarcopenia and depression compared with those that used dual-energy X-ray absorptiometry or equation estimation.Conclusionsarcopenia was independently associated with depression. The causal relationship between the two clinical conditions requires future validation with cohort studies.
      PubDate: 2017-06-14
      DOI: 10.1093/ageing/afx094
  • Nurse interventions to improve medication adherence among discharged older
           adults: a systematic review
    • Authors: Verloo H; Chiolero A, Kiszio B, et al.
      First page: 747
      Abstract: AbstractBackgrounddischarged older adult inpatients are often prescribed numerous medications. However, they only take about half of their medications and many stop treatments entirely. Nurse interventions could improve medication adherence among this population.Objectiveto conduct a systematic review of trials that assessed the effects of nursing interventions to improve medication adherence among discharged, home-dwelling and older adults.Methodwe conducted a systematic review according to the methods in the Cochrane Collaboration Handbook and reported results according to the PRISMA statement. We searched for controlled clinical trials (CCTs) and randomised CCTs (RCTs), published up to 8 November 2016 (using electronic databases, grey literature and hand searching), that evaluated the effects of nurse interventions conducted alone or in collaboration with other health professionals to improve medication adherence among discharged older adults. Medication adherence was defined as the extent to which a patient takes medication as prescribed.Resultsout of 1,546 records identified, 82 full-text papers were evaluated and 14 studies were included—11 RCTs and 2 CCTs. Overall, 2,028 patients were included (995 in intervention groups; 1,033 in usual-care groups). Interventions were nurse-led in seven studies and nurse-collaborative in seven more. In nine studies, adherence was higher in the intervention group than in the usual-care group, with the difference reaching statistical significance in eight studies. There was no substantial difference in increased medication adherence whether interventions were nurse-led or nurse-collaborative. Four of the 14 studies were of relatively high quality.Conclusionnurse-led and nurse-collaborative interventions moderately improved adherence among discharged older adults. There is a need for large, well-designed studies using highly reliable tools for measuring medication adherence.
      PubDate: 2017-05-16
      DOI: 10.1093/ageing/afx076
  • Neuropsychological profiles of vascular disease and risk of dementia:
           implications for defining vascular cognitive impairment no dementia
    • Authors: Stephan B; Minett T, Muniz-Terrera G, et al.
      First page: 755
      Abstract: Backgroundvascular cognitive impairment no dementia (VCI-ND) defines a preclinical phase of cognitive decline associated with vascular disorders. The neuropsychological profile of VCI-ND may vary according to different vascular conditions.Objectiveto determine the neuropsychological profile of individuals with no dementia and vascular disorders, including hypertension, peripheral vascular disease (PVD), coronary heart disease (CHD), diabetes and stroke. Risk of 2-year incident dementia in individuals with disease and cognitive impairment was also tested.Methodsparticipants were from the Cognitive Function and Ageing Study. At baseline, 13,004 individuals aged ≥65 years were enrolled into the study. Individuals were grouped by baseline disorder status (present, absent) for each condition. Cognitive performance was assessed using the Mini Mental State Examination (MMSE) and the Cambridge Cognitive Examination (CAMCOG). Dementia was assessed at 2 years.Resultsin the cross-sectional analysis, hypertension, PVD and CHD were not associated with cognitive impairment. Stroke was associated with impaired global (MMSE) and CAMCOG sub-scale (including memory and non-memory) scores. Diabetes was associated with impairments in global cognitive function (MMSE) and abstract thinking. In the longitudinal analysis, cognitive impairments were associated with incident dementia in all groups.Conclusionthe neuropsychological profile in individuals with vascular disorders depends on the specific condition investigated. In all conditions cognitive impairment is a risk factor for dementia. A better understanding of which cognitive domains are affected in different disease groups could help improve operationalisation of the neuropsychological criteria for VCI-ND and could also aid with the development of dementia risk prediction models in persons with vascular disease.
      PubDate: 2017-02-14
      DOI: 10.1093/ageing/afx016
  • Development and evaluation of the medication-based index of physical
           function (MedIP)
    • Authors: Hall CD; Karpen SC, Odle B, et al.
      First page: 761
      Abstract: AbstractBackgroundthe development of an objective and comprehensive drug-based index of physical function for older adults has the potential to more accurately predict fall risk.Designthe index was developed using 862 adults (ages 57–85) from the National Social Life, Health, and Aging Project (NSHAP) Wave 1 study. The index was evaluated in 70 adults (ages 51–88) from a rehabilitation study of dizziness and balance.Methodsthe prevalence among 601 drugs for 1,694 side effects was used with fall history to determine the magnitude of each side effect's contribution towards physical function. This information was used to calculate a Medication-based Index of Physical function (MedIP) score for each individual based on his or her medication profile. The MedIP was compared to the timed up and go (TUG) test as well as drug counts using receiver operating characteristic (ROC) analysis. The associations between various indices of physical function and MedIP were calculated.Resultswithin the NSHAP data set, the MedIP was better than drug counts or TUG at predicting falls based on ROC analysis. Using scores above and below the cutpoint, the MedIP was a significant predictor of falls (OR = 2.61 [95% CI 1.83, 3.64]; P < 0.001). Using an external data set, it was shown that the MedIP was significantly correlated with fall number (P = 0.044), composite physical function (P = 0.026) and preferred gait speed (P = 0.043).Conclusionthe MedIP has the potential to become a useful tool in the healthcare and fall prevention of older individuals.
      PubDate: 2017-04-24
      DOI: 10.1093/ageing/afx056
  • Efficacy and safety of a novel acetylcholinesterase inhibitor
           octohydroaminoacridine in mild-to-moderate Alzheimer's disease: a Phase II
           multicenter randomised controlled trial
    • Authors: Xiao S; Wang T, Ma X, et al.
      First page: 767
      Abstract: AbstractBackgroundinhibition of acetylcholinesterase (AChE) has been a effective treatment for Alzheimer's disease (AD). Octohydroaminoacridine, a new AChE inhibitor, is a potential treatment for AD.Methodwe conducted a multicenter, randomised, double blind, placebo-controlled, parallel-group Phase II clinical trial to investigate the effects of octohydroaminoacridine in patients with mild-to-moderate AD. Patients were randomised to receive placebo thrice daily, octohydroaminoacridine 1 mg/thrice daily (TID) (low-dose group), 2 mg/TID (middle-dose group) or 4 mg/TID (high-dose group). Doses in the middle-dose and high-dose group were titrated over 2–4 weeks. Changes from baseline to Week 16 were assessed with the AD Assessment Scale-Cognitive Subscale (ADAS-cog), Clinician's Interview-Based Impression of Change Plus (CIBIC+), activities of daily living (ADL) and the neuropsychiatric inventory (NPI). ADAS-cog was the primary end point of the study. A two-way analysis of covariance and least squares mean t-test were used.Resultsat Week 16, the changes from baseline in ADAS-cog were 1.4, −2.1, −2.2 and −4.2 for placebo, low-, middle- and high-dose groups, respectively. Patients in the high-dose group had better performance in CIBIC+ and ADL scores at the end of the study. There was no significant difference in the change in NPI score among the groups. The effects of octohydroaminoacridine were dose dependent, and were effective within 16 weeks of treatment. No evidence was found for more adverse events that occurred in different drug groups than placebo group.Conclusionsoctohydroaminoacridine significantly improved cognitive function and behaviour in patients with mild-to-moderate AD and this effect was dose dependent.
      PubDate: 2017-04-17
      DOI: 10.1093/ageing/afx045
  • Lower risk of incident dementia among Chinese older adults having three
           servings of vegetables and two servings of fruits a day
    • Authors: Lee AC; Richards M, Chan WC, et al.
      First page: 773
      Abstract: AbstractBackgrounddietary modification can potentially reduce dementia risk, but the importance of fruits and the amount of vegetables and fruits required for cognitive maintenance are uncertain. We examined whether the minimal daily requirement of vegetables and fruits recommended by the World Health Organization (WHO) would independently lower dementia risk.Methodsin this population-based observational study, we examined the diet of 17,700 community-living dementia-free Chinese older adults who attended the Elderly Health Centres in Hong Kong at baseline and followed their cognitive status for 6 years. In line with the WHO recommendation, we defined the cutoff for minimal intake of vegetables and fruits as at least three and two servings per day, respectively. The study outcome was incident dementia in 6 years. Dementia was defined by presence of clinical dementia in accordance with the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) or Clinical Dementia Rating of 1–3.Resultsmultivariable logistic regression analysis showed that the estimated odds ratios for incident dementia were 0.88 (95% confidence interval 0.73–1.06; P = 0.17) for those consuming at least three servings of vegetables per day, 0.86 (0.74–0.99; P < 0.05) for those consuming at least two servings of fruits per day and 0.75 (0.60–0.95; P = 0.02) for those consuming at least these amounts of both at baseline, after adjusting for age, gender, education, major chronic diseases, physical exercise and smoking.Conclusionhaving at least three servings of vegetables and two servings of fruits daily might help prevent dementia in older adults.
      PubDate: 2017-02-23
      DOI: 10.1093/ageing/afx018
  • Observational cohort study examining apolipoprotein E status and
           preoperative neuropsychological performance as predictors of
           post-operative delirium in an older elective arthroplasty population
    • Authors: Cunningham E; Mawhinney T, Beverland D, et al.
      First page: 779
      Abstract: AbstractIntroductiondelirium following surgery is common and is associated with negative outcomes. Preoperative cognitive impairment has been shown to be a risk factor for post-operative delirium. Often the cognitive tests used are cumbersome. This study tests the hypothesis that the quantification of brain vulnerability, using Apolipoprotein E (ApoE) status and neuropsychological tests, both traditional and more easily administered, can quantify the risk of post-operative delirium following elective primary arthroplasty surgery.Methodsthis observational cohort study recruited participants aged 65 years or older admitted prior to elective primary hip or knee arthroplasty. Baseline data was collected and participants underwent neuropsychological testing and had blood taken for ApoE genotyping preoperatively. Post-operatively participants were assessed daily for delirium using the Confusion Assessment Method (CAM) and charts were reviewed where possible for reports of delirium. Univariate and multivariate analyses of preoperative factors were undertaken to identify independent predictors of delirium.Resultsbetween March 2012 and October 2014, 315 participants completed the study with an overall incidence of post-operative delirium of 40/315 (12.7%). Of these 18 fulfilled the CAM criteria for delirium and 22 were deemed delirious by consensus decision based on chart review. ApoE genotype was not associated with post-operative delirium in this cohort. Time taken to complete Colour Trails 2, errors in mini mental state examination and level of pain preoperatively were independent predictors of post-operative delirium.Conclusionsthis study challenges the assertion that ApoE4 genotype predicts post-operative delirium. It replicates previous work suggesting cognitive impairment predicts post-operative delirium and shows for the 1st time that simple cognitive tests can be as effective as more detailed tests.
      PubDate: 2017-04-05
      DOI: 10.1093/ageing/afx042
  • The time trends of cognitive impairment incidence among older Chinese
           people in the community: based on the CLHLS cohorts from 1998 to 2014
    • Authors: Gao M; Kuang W, Qiu P, et al.
      First page: 787
      Abstract: AbstractObjectiveto examine a 16-year trend in cognitive impairment (CI) incidence and associated factors among older Chinese people.Subjectsaged 60 and above whose cognitive function were normal at their first test.Methodsa secondary analysis that identified subjects from the database of Chinese Longitudinal Healthy Longevity Survey (CLHLS). The database contained mixed longitudinal cohorts of older Chinese people surveyed in 1998, 2000, 2002, 2005, 2008–09, 2011–12 and 2014. The cognitive function of subjects was tested using the Chinese Mini-Mental State Examination (CMMSE) in each wave. The unique individual code identified a mixed cohort of 17,896 subjects who had multiple CMMSE measures over a 16-year period and available covariates for the analysis. CI was defined as the CMMSE score below 18 points. Crude and age-standardised incidence of CI by gender were calculated by year of survey. Risk factor adjusted time trends in the incidence were examined using multilevel regression models.Resultsage-standardised CI incidence decreased from 58.77‰ to 10.09‰ (P < 0.001) from 1998 to 2014, and this decrease remained after adjusting for covariates. About 15.8% in the observed decline was explained by higher education, and 7.9% was due to health practice (regular exercise, physical activity and cognitive activity), beyond age and gender effects.Conclusionthe CI incidence among older Chinese people decreased from 1998 to 2014. Lower education level and less frequent health practices mentioned above were important risk factors in CI prevention.
      PubDate: 2017-03-21
      DOI: 10.1093/ageing/afx038
  • The relationship between cognitive impairment, mortality and discharge
           characteristics in a large cohort of older adults with unscheduled
           admissions to an acute hospital: a retrospective observational study
    • Authors: Fogg C; Meredith P, Bridges J, et al.
      First page: 794
      Abstract: AbstractBackgroundolder people with dementia admitted to hospital for acute illness have higher mortality and longer hospital stays compared to those without dementia. Cognitive impairment (CI) is common in older people, and they may also be at increased risk of poor outcomes.Methodsretrospective observational study of unscheduled admissions aged ≥75 years. Admission characteristics, mortality rates and discharge outcomes were compared between three groups: (i) known dementia diagnosis (DD), (ii) CI but no diagnosis of dementia and (iii) no CI.Resultsof 19,269 admissions (13,652 patients), 19.8% had a DD, 11.6% had CI and 68.6% had neither. Admissions with CI or DD were older and had more females than those with no CI, and were more likely to be admitted through the Emergency Department (88.4% and 90.7%, versus 82.0%) and to medical wards (89.4% and 84.4%, versus 76.8%). Acuity levels at admission were similar between the groups. Patients with CI or DD had more admissions at ‘high risk’ from malnutrition than patients with no CI (28.0% and 33.7% versus 17.5%), and a higher risk of dying in hospital (11.8% [10.5–13.3] and 10.8% [9.8–11.9] versus (6.6% [6.2–7.0])).Conclusionsthe admission characteristics, mortality and length of stay of patients with CI resemble those of patients with diagnosed dementia. Whilst attention has been focussed on the need for additional support for people with dementia, patients with CI, which may include those with undiagnosed dementia or delirium, appear to have equally bad outcomes from hospitalisation.
      PubDate: 2017-02-25
      DOI: 10.1093/ageing/afx022
  • Frailty status at admission to hospital predicts multiple adverse outcomes
    • Authors: Hubbard RE; Peel NM, Samanta M, et al.
      First page: 801
      Abstract: AbstractAimsfrailty is proposed as a summative measure of health status and marker of individual vulnerability. We aimed to investigate the discriminative capacity of a frailty index (FI) derived from interRAI Comprehensive Geriatric Assessment for Acute Care (AC) in relation to multiple adverse inpatient outcomes.Methodsin this prospective cohort study, an FI was derived for 1,418 patients ≥70 years across 11 hospitals in Australia. The interRAI-AC was administered at admission and discharge by trained nurses, who also screened patients daily for geriatric syndromes.Resultsin adjusted logistic regression models an increase of 0.1 in FI was significantly associated with increased likelihood of length of stay >28 days (odds ratio [OR]: 1.29 [1.10–1.52]), new discharge to residential aged care (OR: 1.31 [1.10–1.57]), in-hospital falls (OR: 1.29 [1.10–1.50]), delirium (OR: 2.34 [2.08–2.63]), pressure ulcer incidence (OR: 1.51 [1.23–1.87]) and inpatient mortality (OR: 2.01 [1.66–2.42]). For each of these adverse outcomes, the cut-point at which optimal sensitivity and specificity occurred was for an FI > 0.40. Specificity was higher than sensitivity with positive predictive values of 7–52% and negative predictive values of 88–98%. FI-AC was not significantly associated with readmissions to hospital.Conclusionsthe interRAI-AC can be used to derive a single score that predicts multiple adverse outcomes in older inpatients. A score of ≤0.40 can well discriminate patients who are unlikely to die or experience a geriatric syndrome. Whether the FI-AC can result in management decisions that improve outcomes requires further study.
      PubDate: 2017-05-22
      DOI: 10.1093/ageing/afx081
  • Metabolic syndrome and insulin resistance are associated with frailty in
           older adults: a prospective cohort study
    • Authors: Pérez-Tasigchana RF; León-Muñoz LM, Lopez-Garcia E, et al.
      First page: 807
      Abstract: AbstractBackgrounddiabetes increases the risk of frailty that is a leading cause of disability and premature mortality in older people. Metabolic syndrome (MS) and insulin resistance (IR) are strong risk factors for diabetes and could, thus, lead to frailty. However, the association between MS or IR and frailty has barely been investigated.Methodsdata were obtained from a cohort of 1,499 community-dwelling individuals aged ≥60, who were free of diabetes at 2008–10 and were followed up for 3.5 years. At baseline, MS was ascertained according to the harmonised definition, and IR with the Homoeostatic Model Assessment for IR index (HOMA-IR). Frailty was defined as having three or more of the Fried's criteria: exhaustion, low physical activity, slow walking, unintentional weight loss and low grip strength. Statistical analyses were performed with logistic regression, and adjusted for the main confounders.Resultsin 2012, 84 cases of incident frailty were identified. Compared with subjects without MS, those with MS showed increased risk of frailty (multivariate odds ratio [OR]: 1.85; 95% confidence interval [CI] 1.12–3.05). The association persisted after further adjustment for fibrinogen and C-reactive protein. When the frailty criteria were considered individually, low grip strength was the criterion that showed a stronger association with MS (OR: 1.67; 95% CI: 1.25–2.21). Higher HOMA-IR values were also associated with higher risk of frailty.ConclusionMS and IR were associated with increased risk of frailty. This work extends the spectrum of harmful consequences of MS, and suggests that preventing or controlling MS may serve to delay frailty.
      PubDate: 2017-03-01
      DOI: 10.1093/ageing/afx023
  • How does social support affect functional impairment in late life'
           Findings of a multicenter prospective cohort study in Germany
    • Authors: Hajek A; Brettschneider C, Mallon T, et al.
      First page: 813
      Abstract: AbstractObjectiveto investigate how social support affects functional impairment (FI) in late life in a longitudinal approach.Methodsin a multicenter prospective cohort study, subjects in old age (≥75 years at baseline) were interviewed every 1.5 years. Social support was quantified in the follow-up (FU) Waves 2 and 4 (FU Wave 2: n = 2,349; FU Wave 4: n = 1,484). FI was assessed by using the Lawton and Brody Instrumental Activities of Daily Living scale.Resultsfixed effects regressions showed that a decrease in social support is associated with FI in the total sample and in both sexes. The effect on FI was most pronounced with the dimension social integration, whereas changes in practical support only affected FI in the total sample and changes in emotional support only affected FI in men.Conclusionsour findings emphasise the importance of social support for functional status in late life. Thus, strengthening social support in old age might be effective in maintaining functional abilities.
      PubDate: 2017-02-14
      DOI: 10.1093/ageing/afx012
  • Caregiving, volunteering or both' Comparing effects on health and
           mortality using census-based records from almost 250,000 people aged 65
           and over
    • Authors: O'Reilly D; Rosato M, Ferry F, et al.
      First page: 821
      Abstract: AbstractBackgroundthe health impacts of caregiving and volunteering are rarely studied concurrently, despite the potential for both synergies and conflicts. This population-based study examines the association of these activities on health and subsequent mortality.Methoda census-based record-linkage study of 244,429 people aged 65 and over, with cohort characteristics, caregiving and volunteering status, and presence of chronic health conditions derived from the Census returns. Mortality risk was assessed over the following 45 months with adjustment for baseline characteristics.Resultscaregivers and volunteers were individually more mobile than those undertaking neither activity; caregivers who also volunteered were more mobile than those who did not volunteer, but no less likely to suffer from poor mental health. Both caregiving and volunteering were separately associated with reduced mortality risk (HR = 0.74: 95% confidence intervals (CIs) = 0.71, 0.77 and HR = 0.76: 0.73, 0.81, respectively); the lowest mortality was found amongst light caregivers who also volunteered (HR = 0.53: 95% CIs = 0.45, 0.62), compared to those engaged in neither. There was no evidence of a multiplicative effect of caregiving and volunteering at more intense levels of caregiving.Conclusionthere is a large overlap in caregiving and volunteering activities with complex associations with health status. There is some evidence that combining caregiving and volunteering activities, for those involved in less intense levels of caregiving, maybe associated with lower mortality risk than associated with either activity alone. Further research is needed to understand which aspects of caregiving and volunteering are best and for whom and in which circumstances.
      PubDate: 2017-02-22
      DOI: 10.1093/ageing/afx017
  • Continuity and changes in three types of caregiving and the risk of
           depression in later life: a 2-year prospective study
    • Authors: Liu H; Lou W.
      First page: 827
      Abstract: AbstractObjectiveprevious studies have well documented the psychological consequences of family caregiving but less is known about the heterogeneity of older carers being affected during different temporal phases of caregiving over time. This study aimed to prospectively examine the impact of continuity and changes in grandchild care, parent care and spouse care on older carers’ depressive symptoms 2 years later.Methodsthe analytic sample contained 2,398 urban seniors who completed interviews for both the 2011 and 2013 waves of the China Health and Retirement Longitudinal Study. The generalized estimating equations approach estimated the longitudinal associations of caring transitions with depressive symptoms.Resultsin comparison with non-carers, elders who continuously provided grandchild care, and those who stopped providing parent care reported significantly fewer depressive symptoms; those who entered into or exited from providing spousal care reported significantly more depressive symptoms.Conclusionsby separating the impact of caring transitions on subsequent depressive symptoms, our findings added evidence of the great diversity of caring experiences among older adults who provided care to grandchildren, parents or spouses. Our findings have implications for carer support programmes in targeting those older carers at higher risk of depression.
      PubDate: 2017-03-10
      DOI: 10.1093/ageing/afx032
  • Sources of unsafe primary care for older adults: a mixed-methods analysis
           of patient safety incident reports
    • Authors: Cooper A; Edwards A, Williams H, et al.
      First page: 833
      Abstract: AbstractBackgroundolder adults are frequent users of primary healthcare services, but are at increased risk of healthcare-related harm in this setting.Objectivesto describe the factors associated with actual or potential harm to patients aged 65 years and older, treated in primary care, to identify action to produce safer care.Design and Settinga cross-sectional mixed-methods analysis of a national (England and Wales) database of patient safety incident reports from 2005 to 2013.Subjects1,591 primary care patient safety incident reports regarding patients aged 65 years and older.Methodswe developed a classification system for the analysis of patient safety incident reports to describe: the incident and preceding chain of incidents; other contributory factors; and patient harm outcome. We combined findings from exploratory descriptive and thematic analyses to identify key sources of unsafe care.Resultsthe main sources of unsafe care in our weighted sample were due to: medication-related incidents e.g. prescribing, dispensing and administering (n = 486, 31%; 15% serious patient harm); communication-related incidents e.g. incomplete or non-transfer of information across care boundaries (n = 390, 25%; 12% serious patient harm); and clinical decision-making incidents which led to the most serious patient harm outcomes (n = 203, 13%; 41% serious patient harm).Conclusionpriority areas for further research to determine the burden and preventability of unsafe primary care for older adults, include: the timely electronic tools for prescribing, dispensing and administering medication in the community; electronic transfer of information between healthcare settings; and, better clinical decision-making support and guidance.
      PubDate: 2017-04-11
      DOI: 10.1093/ageing/afx044
  • Identifying frailty in the Emergency Department—feasibility study
    • Authors: Elliott A; Phelps K, Regen E, et al.
      First page: 840
      Abstract: AbstractIntroductionidentifying the most at risk older people in Emergency Departments (EDs) may help guide clinical practice, and service improvement in emergency care, but little is known about how to implement such tools in practice.Methodsconsensus building was used to determine the desirable characteristics of a risk stratification process, including focus groups and literature reviewing. Candidate tools were tested using clinical vignettes in semi-structured interviews with a range of clinicians working in one large ED, assessing speed of use, ease of use and agreement with clinical judgement. The primary outcome was the likelihood of future use of a given frailty tool.Resultsthe ideal tool characteristics included brevity (<1 min), simplicity and multidimensionality; tools selected for testing included the Identification of Seniors At Risk, Clinical Frailty Scale, PRISMA-7 and Silver Code. One hundred and twenty-one staff members (43% of the total ED workforce) were recruited from one large ED in the East Midlands. Two hundred and thirty-six individual frailty tool assessments were undertaken using 1 of 10 clinical vignettes; 75% of staff stated that they would use at least one of the tools again, with no significant differences between the individual tools. The median time to complete the tool was around 1 min per patient for all four tools. There were no significant differences in timing, ease of use or agreement with clinical judgement between tools.Discussionvalidated risk stratification tools are quick, simple, easy to use and 75% of staff would use the tools again in the future.
      PubDate: 2017-05-25
      DOI: 10.1093/ageing/afx089
  • Preventive oral health intervention among old home care clients
    • Authors: Nihtilä A; Tuuliainen E, Komulainen K, et al.
      First page: 846
      Abstract: AbstractBackgroundpoor oral health is common among older people dependent on supportive care and it affects their quality of life. Cognitive impairment and functional dependency may increase the risk of compromised daily oral hygiene.Aimto investigate the effectiveness of a tailored preventive oral health intervention among home care clients aged 75 years or over.Patients and methodsthe intervention group comprised 151 patients (84.4 ± 5.6 years) and the control group 118 patients (84.7 ± 5.2 years). An interview and a clinical examination were carried out before a tailored intervention of oral and denture hygiene. The participants in both groups were re-interviewed and re-examined after 6 months.Resultsthe intervention significantly reduced the number of plaque covered teeth and improved denture hygiene. In addition, functional ability and cognitive function were significantly associated with better oral hygiene.Conclusionsthe intervention had a positive effect on oral hygiene, however the number of teeth with plaque remained high, even after the intervention. Multiple approaches based on individual needs are required to improve the oral health of vulnerable older adults, including integrating dental preventive care into daily care plan carried out by home care nurses.
      PubDate: 2017-02-14
      DOI: 10.1093/ageing/afx020
  • The oral health status of older patients in acute care on admission and
           Day 7 in two Australian hospitals
    • Authors: Gibney J; Wright C, Sharma A, et al.
      First page: 852
      Abstract: AbstractObjectiveto determine the oral health status of older patients in acute care wards at admission and after 7 days.Methodsa prospective descriptive study was conducted in two acute tertiary referral hospitals in New South Wales, Australia. Oral health was assessed on admission (within 24 h) and Day 7 using the Oral Health Assessment Tool.Resultsa total of 575 patients were admitted under the Geriatric teams at the two hospitals. Four hundred and thirty-five (76%) patients had oral cleanliness (debris) scores in the ‘not healthy’ range with food particles, tartar or plaque evident in at least one area in most areas of the mouth, teeth or dentures. At Day 7 206 were reassessed. One hundred and forty-nine patients (73%) were in the ‘not healthy’ range and of these 127 (62%) had the same score as on admission.Conclusionpoor oral health is common in older people admitted to hospital acute care wards and does not improve over a 7-day period. Given the link between oral health and general health the next steps are to determine how oral health can be improved in this setting and see whether this leads to better patient outcomes.
      PubDate: 2017-05-25
      DOI: 10.1093/ageing/afx085
  • Changes in time spent walking and the risk of incident dementia in older
           Japanese people: the Ohsaki Cohort 2006 Study
    • Authors: Tomata Y; Zhang S, Sugiyama K, et al.
      First page: 857
      Abstract: AbstractBackgroundthe impact of long-term changes in physical activity during adulthood in the context of primary prevention of dementia has not been addressed previously.Objectiveto study the relationship between changes in time spent walking after middle age and incident dementia in older Japanese individuals.Methodologywe conducted a cohort study of 6,909 disability-free Japanese individuals aged ≥65 years who lived in Ohsaki City, Japan. In both 1994 and 2006, the individual amount of time spent walking per day was assessed using a self-reported questionnaire (<0.5 h, 0.5–1 h or ≥1 h). Based on these three categories of exposure at the two points, participants were categorised into nine groups according to changes in time spent walking. Data on incident dementia were retrieved from the public Long-term Care Insurance (LTCI) Database, in which participants were followed up for 5.7 years (between April 2007 and November 2012). The Cox model was used for estimating the multivariate-adjusted hazard ratios (HRs) of incident dementia.Resultsthe 5.7-year incidence of dementia was 9.2%. Compared with persons who remained in the lowest category of time spent walking (<0.5 h/day in both 1994 and 2006), persons who remained in the highest category (≥1 h/day in both 1994 and 2006) had a significantly lower risk of incident dementia: the multivariate-adjusted HR (95% confidence intervals) was 0.72 (0.53 and 0.97).Conclusionsthese results suggest that maintaining a higher level of physical activity after middle age may be a key strategy for prevention of dementia in older age.
      PubDate: 2017-05-05
      DOI: 10.1093/ageing/afx078
  • Circulating microRNAs as potential biomarkers for the identification of
           vascular dementia due to cerebral small vessel disease
    • Authors: Prabhakar P; Chandra S, Christopher R.
      First page: 861
      Abstract: AbstractBackgroundthe diagnosis of cerebral small vessel disease, a leading cause of vascular dementia (VaD), relies solely on neuroimaging studies. Circulating microRNAs (miRNAs) have been proposed as diagnostic biomarkers in various disorders. Our aim was to identify differentially expressed, circulating miRNAs in small vessel VaD which could serve as diagnostic biomarkers for this disease.Methodwe performed plasma miRNA profiling by quantitative polymerase chain reaction (qPCR) array in small vessel VaD patients and age- and gender-matched, cognitively normal and healthy controls. Selected, differentially expressed miRNAs were validated by qPCR. Sensitivity, specificity and area under the curve (AUC) were calculated for each individual miRNA.Resultsprofiling results showed that 44 miRNAs were differentially expressed in small vessel VaD cases (P < 0.05 with a fold change of <2 or >2). A set of seven, highly differentially expressed miRNAs (fold change of <3.6 or >3.6), were estimated in a cohort of 204 small vessel VaD patients and 200 healthy, age and gender-matched controls. Validation study revealed that four miRNAs (miR-409-3p, miR-502-3p, miR-486-5p and miR-451a) could be used as valuable biomarkers for identifying the disease. Sensitivity, specificity and AUC for these miRNAs were 76, 75, 75  and 70%; 89, 89, 83 and 75% and 0.94, 0.92, 0.90 and 0.86, respectively. However, combined receiver operating characteristic curve analysis of seven miRNAs revealed an AUC of 0.64 with sensitivity of 55.5% and specificity of 65.7%.Conclusionplasma miR-409-3p, miR-502-3p, miR-486-5p and miR-451a could be used to differentiate small vessel VaD patients from healthy controls. Large-scale studies of their biomarker potential are warranted.
      PubDate: 2017-06-13
      DOI: 10.1093/ageing/afx090
  • Public knowledge and understanding of dementia—evidence from a
           national survey in Ireland
    • Authors: Glynn RW; Shelley E, Lawlor BA.
      First page: 865
      Abstract: AbstractBackgroundthere is growing consensus around the importance of population level approaches which seek to improve public knowledge and awareness of dementia.Aimto assess knowledge of the relationship between dementia and ageing, and of the risk and protective factors associated with it, among the general public in Ireland.Designcross-sectional survey. Participants selected using quota sampling based on Census data.Methodsthe final sample of 1,217 respondents provided estimates of dementia knowledge in the Irish population. Logistic regression was used to assess the impact of potential predictor variables on knowledge of dementia.Resultsa majority (52%) reported that they knew someone living with dementia. Just 39% were confident that they could tell the difference between the early signs of dementia and normal ageing. Less than half (46%) believed that there were things they could do to reduce their risk of developing dementia, and knowledge of risk and protective factors for dementia was very poor. Although significant differences were seen according to area of residence, social class and experience of dementia, even those groups with ‘better’ understanding demonstrated substantial knowledge deficits regarding risk and protective factors.Conclusionsthe general public in Ireland are confused about the relationship between dementia and ageing, and knowledge of risk and protective factors for dementia is very poor. While not dissimilar to those reported internationally, the findings present a challenge to those tasked with promoting behaviour change and interventions to delay or prevent the onset of dementia.
      PubDate: 2017-05-22
      DOI: 10.1093/ageing/afx082
  • Rivaroxaban withdrawal and rebound hypercoagulability leading to upper
           extremity deep vein thrombosis: a case report
    • Authors: Nagasayi S; Varman S, Ting Y, et al.
      First page: 870
      Abstract: AbstractAs the newer oral anticoagulants (NOACs) are increasingly used in older patients, clinical scenarios when they may need to be discontinued temporarily or indefinitely, may be encountered. Similarly with increasing use of permanent pacemakers and other intra-cardiac devices, there is an increased risk of upper limb venous thrombosis even few years after their insertion. We report a case of a patient with a permanent pacemaker, on rivaroxaban (NOAC) for atrial fibrillation, who developed an upper extremity deep vein thrombosis after its temporary withdrawal following a traumatic acute subdural haematoma. Physicians should be aware of the possibility of rebound hypercoagulability and venous thrombosis soon after the withdrawal of NOACs.
      PubDate: 2017-05-03
      DOI: 10.1093/ageing/afx073
  • Herpes zoster encephalitis: a rare complication in a nonagenarian
    • Authors: Tapia HA; Tello T, Galvez M, et al.
      First page: 872
      PubDate: 2017-06-14
      DOI: 10.1093/ageing/afx093
  • Brocklehurst's Textbook of Geriatric Medicine and Gerontology
    • Authors: Stott DJ.
      First page: 873
      Abstract: Brocklehurst's Textbook of Geriatric Medicine and Gerontology, 8th EditionHoward M.Fillit,KennethRockwoodandJohn B.YoungElsevier, 2016, 1168 pp, ISBN: 978-0-7020-6185-1, £164.
      PubDate: 2017-08-09
      DOI: 10.1093/ageing/afx140
  • STOPPFrail: a misleading name for a potentially useful tool
    • Authors: Caballero-Mora MA; Rodriguez-Mañas LL.
      First page: 874
      PubDate: 2017-08-09
      DOI: 10.1093/ageing/afx139
  • Response to Dr Caballero-Mora's comments
    • Authors: Lavan A; O'Mahony D, Gallagher P.
      First page: 875
      PubDate: 2017-08-10
      DOI: 10.1093/ageing/afx138
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