Diferencias en función de la edad y la autopercepción del envejecimiento en ansiedad,tristeza, soledad y sintomatología comórbida ansioso-depresiva durante el confinamiento por la COVID-19

ObjectivesTo analyze differences by age group in anxiety, depression, loneliness and comorbid anxiety and depression in young people, middle aged adults and older adults during the lock-down period at home due to the COVID-19 pandemic, and to explore the association between negative self-perceptions of aging and psychological symptoms controlling by age group.MethodParticipants are 1501 people (age range 18 to 88 years). Anxiety, sadness, loneliness and self-perceptions of aging were assessed. The sample was divided according to the age group and quartiles (lower, intermediate levels, and higher) of anxiety, sadness, loneliness and self-perceptions of aging.ResultsOlder adults reported lower levels of anxiety and sadness than middle aged adults, and middle aged adults reported lower levels than younger participants. Middle aged adults reported the lowest loneliness, followed by older adults and younger participants. For each age group, those with more negative self-perceptions of aging reported higher anxiety, sadness and loneliness. More comorbid anxiety and sadness was found in younger adults and less in older adults; more depressed participants in the middle aged group, and more older adults and less younger participants were found in the group with the lowest levels of anxiety and sadness. For all the age groups, participants with high levels of comorbid anxiety and sadness are those who report the highest scores in negative self-perceptions of aging.ConclusionsOlder adults reported lower psychological anxiety, sadness and loneliness than the other age groups. Having negative self-perceptions of aging damage psychological health irrespective of the chronological age.     

Diet quality of middle age and older women from Primorsko-Goranska County evaluated by healthy eating index and association with body mass index

Accorded dietary habits provide adequate nutrient intakes, especially important for quality aging. Adequate nutrition for older persons has vital influence on maintaining good health and social functioning. Therefore, using simple tool for evaluation of diet of older population in relation to overweight and obesity is of public health importance. Among many factor that influence quality of aging has obesity, where in Croatia the prevalence of obesity is greater in older women than men. Our aim was to evaluate diet quality of middle age and older women from Primorsko-Goranska County by Healthy Eating Index (HEI) and to see the association of HEI to overweight and obesity. Diet quality of 124 women with average age 59.91 +/- 5.31 years was graded with 10 component HEI score, ranging from 0 to 100, where HEI score less than 51 implies "poor" diet. Overweight and obesity was classified according to WHO classification. The majority of women had diet that "needs improvement" (66.1%), and only 3.2% had "good" diet. Older women had better HEI score than middle-aged women, while overweight was statistically significant positively related to better HEI score (P = 0.26, p = 0.048). Older women better scored for meat, dairy, cholesterol and dietary variety. "Poor" diet mostly had women with normal weight and middle-aged. Age did not influenced overall HEI score, neither its components. Obese women had lower achievements for almost all recommended HEI components. Women having "poor" diet quality could raise a chance for overweight and obesity for almost two times ([OR] = 1.67, 95% [CI] = 1.072-2.59, p = 0.023; [OR] = 1.51, 95% [CI] = 1.08-2.10, p = 0.015, respectively). The provided results showed that with age, women tended to have better diet. These could be because of that with aging are higher disease incidences that essentially need diet improvements; so older women tended to improve their diet to reduce disease discomforts. Being obese influenced the diet quality of our sample of women, therefore, for quality aging, the importance of public health nutrition programs are strongly needed. HEI score is a good assessment for diet quality, but further investigation of influence on other sociodemographic and health characteristics is required.     

A missing piece in the puzzle: HIV in mature adults in sub-Saharan Africa

Healthcare and social needs for mature adults aged 50 years or older differ from those of younger adults due to stigma concerning HIV in older people, beliefs that engagement in sexual activity no longer applies, age driven comorbidities and responses to antiretroviral treatment, which complicate HIV diagnosis and management. In the face of a growing HIV epidemic in mature adults, mostly due to infected people aging with HIV, but also due to new infections in this age group, HIV services, which mostly cater for HIV in young adults and children, and HIV education messages and interventions, which mainly target young adults, leave the mature adult exposed and vulnerable to HIV transmission and to a lack of care and treatment thereafter.     

Age‐related inequalities in health and healthcare: the life stages approach

How should healthcare systems prepare to care for growing numbers and proportions of older people? Older people generally suffer worse health than younger people do. Should societies take steps to reduce age‐related health inequalities? Some express concern that doing so would increase age‐related inequalities in healthcare. This paper addresses this debate by (1) presenting an argument in support of three principles for distributing scarce resources between age groups; (2) framing these principles of age group justice in terms of life stages; and (3) indicating policy implications that merit further attention in light of rapidly aging societies.     

Aging and insulin secretion

Glucose tolerance progressively declines with age, and there is a high prevalence of type 2 diabetes and postchallenge hyperglycemia in the older population. Age-related glucose intolerance in humans is often accompanied by insulin resistance, but circulating insulin levels are similar to those of younger people. Under some conditions of hyperglycemic challenge, insulin levels are lower in older people, suggesting beta-cell dysfunction. When insulin sensitivity is controlled for, insulin secretory defects have been consistently demonstrated in aging humans. In addition, beta-cell sensitivity to incretin hormones may be decreased with advancing age. Impaired beta-cell compensation to age-related insulin resistance may predispose older people to develop postchallenge hyperglycemia and type 2 diabetes. An improved understanding of the metabolic alterations associated with aging is essential for the development of preventive and therapeutic interventions in this population at high risk for glucose intolerance.     

Effects of diet and age on oxidative damage products in healthy subjects

Damage of molecules as a consequence of oxidative stress has been implicated in the pathogenesis of chronic diseases related to aging. Diet is a key environmental factor affecting the incidence of many chronic diseases. Antioxidant substances in diet enhance the DNA, lipid and protein protection by increasing the scavenging of free radicals. Products of oxidative damage of DNA (DNA strand breaks with oxidized purines or oxidized pyrimidines), lipids (conjugated dienes of fatty acids) and proteins (carbonyls) in relation to nutrition (vegetarian diet vs. non-vegetarian, traditional mixed diet) were measured in young women aged 20-30 years (46 vegetarians, 48 non-vegetarians) vs. older women aged 60-70 years (33 vegetarians, 34 non-vegetarians). In young subjects, no differences in values of oxidative damage as well as plasma values of antioxidative vitamins (C,beta-carotene) were observed between vegetarian and non-vegetarian groups. In older vegetarian group significantly reduced values of DNA breaks with oxidized purines, DNA breaks with oxidized pyrimidines and lipid peroxidation and on the other hand, significantly increased plasma values of vitamin C and beta-carotene were found compared to the respective non-vegetarian group. Significant age dependences of measured parameters (increase in all oxidative damage products and decrease in plasma vitamin concentrations in older women) were noted only in non-vegetarians. Vegetarian values of older women vs. young women were similar or non-significantly changed. The results suggest that increase of oxidative damage in aging may be prevented by vegetarian nutrition.     

Long‐term effects of calorie restriction on serum sex‐hormone concentrations in men

Calorie restriction (CR) slows aging and consistently reduces circulating sex hormones in laboratory animals. However, nothing is known regarding the long‐term effects of CR with adequate nutrition on serum sex‐hormone concentration in lean healthy humans. In this study, we measured body composition, and serum total testosterone, total 17‐β‐estradiol, sex hormone–binding globulin (SHBG), and dehydroepiandrosterone sulfate (DHEA‐S) concentrations in 24 men (mean age 51.5 ± 13 years), who had been practicing CR with adequate nutrition for an average of 7.4 ± 4.5 years, in 24 age‐ and body fat–matched endurance runners (EX), and 24 age‐matched sedentary controls eating Western diets (WD). We found that both the CR and EX volunteers had significantly lower body fat than the WD volunteers (total body fat, 8.7 ± 4.2%; 10.5 ± 4.4%; 23.2 ± 6.1%, respectively; P = 0.0001). Serum total testosterone and the free androgen index were significantly lower, and SHBG was higher in the CR group than in the EX and WD groups (P ≤ 0.001). Serum 17β‐estradiol and the estradiol:SHBG ratio were both significantly lower in the CR and EX groups than in the WD group (P ≤ 0.005). Serum DHEA‐S concentrations were not different between the three groups. These findings demonstrate that, as in long‐lived CR rodents, long‐term severe CR reduces serum total and free testosterone and increases SHBG concentrations in humans, independently of adiposity. More studies are needed to understand the role of this CR‐mediated reduction in sex hormones in modulating the pathogenesis of age‐associated chronic diseases such as cancer and the aging process itself.     

Modulating human aging and age-associated diseases

Population aging is progressing rapidly in many industrialized countries. The United States population aged 65 and over is expected to double in size within the next 25 years. In sedentary people eating Western diets aging is associated with the development of serious chronic diseases, including type 2 diabetes mellitus, cancer and cardiovascular diseases. About 80% of adults over 65 years of age have at least one chronic disease, and 50% have at least two chronic diseases. These chronic diseases are the most important cause of illness and mortality burden, and they have become the leading driver of healthcare costs, constituting an important burden for our society. Data from epidemiological studies and clinical trials indicate that many age-associated chronic diseases can be prevented, and even reversed, with the implementation of healthy lifestyle interventions. Several recent studies suggest that more drastic interventions (i.e. calorie restriction without malnutrition and moderate protein restriction with adequate nutrition) may have additional beneficial effects on several metabolic and hormonal factors that are implicated in the biology of aging itself. Additional studies are needed to understand the complex interactions of factors that regulate aging and age-associated chronic disease.     

Calorie restriction and prevention of age-associated chronic disease

Life expectancy in the world has increased dramatically during the last century; the number of older adults is expected to rise while the number of youths will decline in the near future. This demographic shift has considerable public health and economic implications since aging is associated with the development of serious chronic diseases. Calorie restriction (CR) is the most effective nutritional intervention for slowing aging and preventing chronic disease in rodents. In non-human and human primates, CR with adequate nutrition protects against abdominal obesity, diabetes, hypertension and cardiovascular diseases. Cancer morbidity and mortality are also diminished in CR monkeys, and data obtained from individuals practicing long-term CR show a reduction of metabolic and hormonal factors associated with increased cancer risk.     

The fortysomething barrier: medicine and age discrimination.

Agism in the medical profession is mainly covert but it is not uncommon. It is widely believed that people become less productive as they get older. However, research has shown that older people have less absenteeism, more job stability, and greater output than younger workers. Job losses, which until recently were unheard of in the NHS, usually affect older people first, resulting in the loss of those with the most skill and experience. With an aging population it is important that the government takes steps to discourage age discrimination in the NHS and Britain as a whole.     

The effect of age and selenium on some biochemical parameters in rat liver

Two age groups, 3 and 15 mo, were used to investigate whether age-associated changes in some parameters related to lipid peroxidation occur in the liver of male Wistar rats and to observe possible effects of dietary selenium supplementation (0.25 and 0.50 ppm) for 12 mo on the same parameters. At these experimental conditions, the most important observation was that peroxidation did not change by aging, at least until 15 mo of age. In addition, the activity of Sedependent glutathione peroxidase (GSH-Px, EC 1.11.1.9) was higher in the liver of the older animals. It is suggested that the enzyme could have a role in the unchanged hepatic peroxidation observed in aged male rats. On the other hand, an effect of dietary selenium supplementation on those parameters was not observed, probably because the selenium levels were still at an adequate plateau.     

A Qualitative Study of Service Provision for Alcohol Related Health Issues in Mid to Later Life

Aims

Epidemiological surveys over the last 20 years show a steady increase in the amount of alcohol consumed by older age groups. Physiological changes and an increased likelihood of health problems and medication use make older people more likely than younger age groups to suffer negative consequences of alcohol consumption, often at lower levels. However, health services targeting excessive drinking tend to be aimed at younger age groups. The aim of this study was to gain an in-depth understanding of experiences of, and attitudes towards, support for alcohol related health issues in people aged 50 and over.

Methods

Qualitative interviews (n = 24, 12 male/12 female, ages 51–90 years) and focus groups (n = 27, 6 male/21 female, ages 50–95 years) were carried out with a purposive sample of participants who consumed alcohol or had been dependent.

Findings

Participants’ alcohol misuse was often covert, isolated and carefully regulated. Participants tended to look first to their General Practitioner for help with alcohol. Detoxification courses had been found effective for dependent participants but only in the short term; rehabilitation facilities were appreciated but seen as difficult to access. Activities, informal groups and drop-in centres were endorsed. It was seen as difficult to secure treatment for alcohol and mental health problems together. Barriers to seeking help included functioning at a high level, concern about losing positive aspects of drinking, perceived stigma, service orientation to younger people, and fatalistic attitudes to help-seeking. Facilitators included concern about risk of fatal illness or pressure from significant people.

Conclusion

Primary care professionals need training on improving the detection and treatment of alcohol problems among older people. There is also a compelling need to ensure that aftercare is in place to prevent relapse. Strong preferences were expressed for support to be provided by those who had experienced alcohol problems themselves.     

The development of culturally-sensitive measures for research on ageing

Attempts to import existing measures developed in other countries when constructing research instruments for use with older people can result in several problems including inappropriate wording, unsuitable response sets, and insufficient attention to cultural nuances. This paper addresses such problems by discussing a mixed methods approach to measurement development (i.e. both qualitative and quantitative) that incorporates input from the aging adults for whom the measure is intended. To test this approach, a step-by step process to the development of a culturally-grounded measure for older Thai people is described. Using focus groups and in-depth interviews, the process begins with an identification of the culturally meaningful domains of the construct under study. Next, input is gathered from other studies; a preliminary quantitative measure is developed; the measure is reviewed by a panel of experts; and then it is pilot-tested. Cognitive interviews are utilized when pilot-testing of the items detects problems with measurement construction or interview methods. When these problems are remedied, the measure is incorporated into a large-scale survey and tested for its psychometric qualities. In addition to providing a template for culturally-sensitive measurement development in gerontology, this paper also highlights issues that researchers should consider when attempting to develop measures and provides suggestions for how to address such issues.     

Treatment of overactive bladder and incontinence in the elderly

The prevalence of urinary incontinence (UI) and overactive bladder rises with age, and elderly people are the fastest-growing segment of the population. Many elderly people assume UI is a normal part of the aging process and do not report it to their doctors, who must therefore make the effort to elicit the information from them. Coexisting medical problems in older patients and the multiple medications many of them take make diagnosis and treatment more complex in this population. Just as the etiology of incontinence is often multifactorial, the treatment approach may need to be multipronged, with behavioral, environmental, and medical components; in any case, it must be targeted to the individual patient. New, less-invasive surgical techniques and devices make surgery more feasible if other therapy fails.     

Ageism in cardiology

This article supports the argument that ageism exists in health care, particularly on the equity of access to cardiological services. Rates of use of potentially life saving and life promoting interventions and investigations decline as the patient gets older. Higher rates of cardiological interventions occur among younger people, despite the high incidence of the condition among older individuals. Any ageism in clinical medicine and policy is simply a reflection of the presence of ageist attitudes in wider society, where the youth receives a higher priority over age. Ageism in medicine needs to be addressed to preserve or recapture this trust within an aging population. A wide ranging approach is necessary if equity in the provision of health care services is to be ensured which includes improvement of clinical guidelines and more specific monitoring of health care. Educational efforts to raise awareness that age stereotyping and ageist attitudes are unethical should be initiated. Research initiatives, which cover large numbers of older people, should be developed and older people should be empowered to influence choices and standards of treatments. Finally, legislation may be required to eradicate ageism in society.     

Metabolic responses to exercise in young and older athletes and sedentary men

This study evaluated the effects of aging and endurance training on the metabolic responses of trained and sedentary young (age 20-32 yr) and older (age 60-70 yr) men to exercise at the same relative exercise stress (70% of maximal O2 consumption). Plasma growth hormone concentrations at rest were similar in all four groups, but both older groups had an attenuated response to exercise. The older trained men appeared to have avoided the age-associated changes that were evident in their sedentary peers with respect to resting plasma insulin, C-peptide, and norepinephrine concentrations. Plasma glucagon concentrations were lower in both older subject groups at rest. Both sedentary groups decreased their plasma glucose concentrations and increased their plasma glucagon concentrations during exercise, whereas the trained groups had increases in their plasma glucose concentrations but had no change in their glucagon concentrations. Thus, although the concentrations of some hormones at rest and during submaximal exercise are unaffected by aging or by training, others are markedly altered by aging, training, or the interaction of the two. However, it appears that older healthy sedentary men undergo less physiological stress than young untrained men during submaximal exercise at the same relative exercise intensity, and they have no responses that would contraindicate their participation in exercise of the duration and intensity usually prescribed in exercise-training programs.     

The Medical Care of Older Patients

Proper medical care for growing numbers of older people depends upon application of advances in medicine to the special problems of ageing. Despite gaps in understanding of the ageing process, high-quality care can be achieved through routine use of knowledge already available.Older people differ structurally, functionally and psychologically. Health influences every aspect of their lives. Their reactions to stress and disease are altered. In practice, the doctor must assess the biological changes of ageing and their possible influences on symptoms and signs. Modifications in the application of ordinary methods of medicine and surgery are determined by functional impairments and structural defects. While the medical problems of the aged are special, the approach must be general; the practitioner needs experience with disease in all age groups and should be alert to the adverse effects on old people of the universal misunderstandings of ageing and its problems.     

Experimental pathology and pharmacology in brain research and aging

The most important theories on aging are presented and the morphological and neurochemical aspects of the processes of aging in the brain are discussed. Considerably more evidence for specific changes with age can be found on the neurochemical than on the morphological side. The reduction in the capacity of the brain to adapt to metabolic stress situations is a manifestation of the progressive decrease, with advancing age, in the enzyme activity of aerobic energy metabolism.A special section is devoted to the difficulties involved in experimental studies with older laboratory animals, the limited number of species which are suitable for such work (rat, mouse, hamster) and the problems of building up colonies of these older animals.In the last part the significance of the progressive age dependent reduction in the functional tolerance range of oxygen consumption is discussed. Decreased metabolic capacity is part of the reduced adaptability to increased metabolic activity which is characteristic of the aging process. The extensive experimental pathological work carried out on the pathophysiology of ischemia and hypoxia within the framework of experimental brain research has today led to the use of such hypoxia models as screening methods being a prerequisite for the testing of geriatric pharmaceutical preparations in experimental pharmacology.     

Functional impact of high protein intake on healthy elderly people

Decline in muscle mass, protein synthesis, and mitochondrial function occurs with age, and amino acids are reported to enhance both muscle protein synthesis and mitochondrial function. It is unclear whether increasing dietary protein intake corrects postabsorptive muscle changes in aging. We determined whether a 10-day diet of high [HP; 3.0 g protein x kg fat-free mass (FFM)(-1) x day(-1)] vs. usual protein intake (UP; 1.5 g protein x kg FFM(-1) x day(-1)) favorably affects mitochondrial function, protein metabolism, and nitrogen balance or adversely affects insulin sensitivity and glomerular filtration rate (GFR) in 10 healthy younger (24+/-1 yr) and 9 older (70+/-2 yr) participants in a randomized crossover study. Net daily nitrogen balance increased equally in young and older participants, but postabsorptive catabolic state also increased, as indicated by higher whole body protein turnover and leucine oxidation with no change in protein synthesis. Maximal muscle mitochondrial ATP production rate was lower in older people, with no change occurring in diet. GFR was lower in older people, and response to HP was significantly different between the two groups, with a significant increase occurring only in younger people, thus widening the differences in GFR between the young and older participants. In conclusion, a short-term high-protein diet increased net daily nitrogen balance but increased the postabsorptive use of protein as a fuel. HP did not enhance protein synthesis or muscle mitochondrial function in either young or older participants. Additionally, widening differences in GFR between young and older patients is a potential cause of concern in using HP diet in older people.