Gerontology
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Cognitive neuroscience of the healthy aging human brain has thus far addressed age-related changes of local functional and structural properties of gray and white matter and their association with declining or preserved cognitive functions. In addition to these localized changes, recent neuroimaging research has attributed an important role to neural networks with a stronger focus on interacting rather than isolated brain regions. The analysis of functional connectivity encompasses task-dependent and -independent synchronous activity in the brain, and thus reflects the organization of the brain in distinct performance-relevant networks. ⋯ Finally, studies using noninvasive brain stimulation techniques like transcranial direct current stimulation (tDCS) to simultaneously modulate behavior and functional connectivity support the importance of 'selective connectivity' of aging brain networks for preserved cognitive functions. These studies demonstrate that enhancing task performance by tDCS is paralleled by increased connectivity within functional networks. In this review, we outline the network perspective on healthy brain aging and discuss recent developments in this field.
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Frailty and body mass index (BMI) are known to be predictive of late life mortality, but little is known about the combined effects of frailty and BMI on mortality. ⋯ Among older people who were of normal weight or underweight, greater frailty was associated with poorer survival. Whereas being overweight tended to be neutral of the influence of frailty on mortality, the obese frail exhibited a significantly elevated rate of death.
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It was found that age and female gender are predisposing factors for hyponatremia in patients taking thiazides. ⋯ Sodium levels were lower with increasing age, independent of diuretic intake, while potassium levels were higher. We found dramatically increasing prevalences of hyponatremia and hyperkalemia with increasing age, while no such effect could be found for hypernatremia and hypokalemia.
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Comparative Study
Swiss quality and outcomes framework: quality indicators for diabetes management in Swiss primary care based on electronic medical records.
Most industrialized countries are faced with a growing population of patients with chronic diseases and multimorbidity. Evidence performance gaps have been recognized in the treatment of this vulnerable patient group. In England, the Quality and Outcomes Framework (QOF) - based on incentivized quality indicators - has been established to narrow the gap. ⋯ Our results show that it is technically feasible to establish a diabetes QOF in Swiss primary care based on EMRs. However, a high amount of missing data made it impossible to evaluate the actual quality of care. For a nationwide introduction, standards for electronic medical documentation and EMR use need to be set. It should also be acknowledged that important dimensions of suffering from one or more chronic diseases such as health-related quality of life are not reflected within a system focusing only on somatic aspects of a disease.
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For people with dementia dying from pneumonia, hospitalization at the end of life may be of little benefit and result in unfavourable outcomes such as hospital death. ⋯ Almost half of all those with dementia dying from pneumonia and a quarter of those living in long-term care settings died in a hospital. These results suggest shortcomings in the Belgian healthcare system in preventing potentially avoidable terminal hospitalizations in a vulnerable population.