The journals of gerontology. Series A, Biological sciences and medical sciences
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J. Gerontol. A Biol. Sci. Med. Sci. · Jul 2008
ReviewCholinergic deficiency hypothesis in delirium: a synthesis of current evidence.
Deficits in cholinergic function have been postulated to cause delirium and cognitive decline. This review examines current understanding of the cholinergic deficiency hypothesis in delirium by synthesizing evidence on potential pathophysiological pathways. Acetylcholine synthesis involves various precursors, enzymes, and receptors, and dysfunction in these components can lead to delirium. ⋯ Furthermore, genetic, enzymatic, and immunological overlaps exist between delirium and dementia related to the cholinergic pathway. Important areas for future research include identifying biomarkers, determining genetic contributions, and evaluating response to cholinergic drugs in delirium. Understanding how the cholinergic pathway relates to delirium may yield innovative approaches in the diagnosis, prevention, and treatment of this common, costly, and morbid condition.
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J. Gerontol. A Biol. Sci. Med. Sci. · Jun 2008
Rising incidence of low-trauma fractures of the calcaneus and foot among Finnish older adults.
Although various low-trauma fractures among older adults are said to be a major public health concern in contemporary societies with aging populations, reliable epidemiologic information on their secular trends is scarce. ⋯ In Finnish persons aged 50 years or older, the number of low-trauma fractures of the calcaneus and foot has risen considerably in 1970-2005 with a rate that cannot be explained merely by demographic changes. Further studies are needed to explore the exact reasons for the rise and possibilities for fracture prevention.
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J. Gerontol. A Biol. Sci. Med. Sci. · May 2008
Church attendance mediates the association between depressive symptoms and cognitive functioning among older Mexican Americans.
The objective of this study was to examine how the effect of depressive symptoms on cognitive function is modified by church attendance. ⋯ Church attendance appears to be beneficial for maintaining cognitive function of older persons. Church attendance moderates the impact of clinically relevant depressive symptoms on subsequent cognitive function.
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J. Gerontol. A Biol. Sci. Med. Sci. · Mar 2008
Randomized Controlled TrialEffects on health care use and associated cost of a home visiting program for older people with poor health status: a randomized clinical trial in the Netherlands.
Home visiting programs have been developed to improve the functional abilities of older people and subsequently to reduce the use of institutional care services. The results of trials have been inconsistent and their cost-effectiveness uncertain. Home visits for a high-risk population rather than the general population seems a promising approach. We therefore studied the effects of a home visiting program for older people with poor health. This article describes the effects on health care use and associated cost. ⋯ The home visiting program did not appear to have any effect on the health care use of older people with poor health and had a low chance of being cost-effective. We conclude that these visits are probably not beneficial for such persons within the health care setting in the Netherlands or comparable settings in other Western countries.
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J. Gerontol. A Biol. Sci. Med. Sci. · Mar 2008
Review Meta AnalysisMultidimensional preventive home visit programs for community-dwelling older adults: a systematic review and meta-analysis of randomized controlled trials.
Multidimensional preventive home visit programs aim at maintaining health and autonomy of older adults and preventing disability and subsequent nursing home admission, but results of randomized controlled trials (RCTs) have been inconsistent. Our objective was to systematically review RCTs examining the effect of home visit programs on mortality, nursing home admissions, and functional status decline. ⋯ Multidimensional preventive home visits have the potential to reduce disability burden among older adults when based on multidimensional assessment with clinical examination. Effects on nursing home admissions are heterogeneous and likely depend on multiple factors including population factors, program characteristics, and health care setting.