Many studies utilizing dogs, cats, birds, fish, and robotic simulations of animals have tried to ascertain the health benefits of pet ownership or animal-assisted therapy in the elderly. Several small unblinded investigations outlined improvements in behavior in demented persons given treatment in the presence of animals. Studies piloting the use of animals in the treatment of depression and schizophrenia have yielded mixed results. Animals may provide intangible benefits to the mental health of older persons, such as relief social isolation and boredom, but these have not been formally studied. Several investigations of the effect of pets on physical health suggest animals can lower blood pressure, and dog walkers partake in more physical activity. Dog walking, in epidemiological studies and few preliminary trials, is associated with lower complication risk among patients with cardiovascular disease. Pets may also have harms: they may be expensive to care for, and their owners are more likely to fall. Theoretically, zoonotic infections and bites can occur, but how often this occurs in the context of pet ownership or animal-assisted therapy is unknown. Despite the poor methodological quality of pet research after decades of study, pet ownership and animal-assisted therapy are likely to continue due to positive subjective feelings many people have toward animals.

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Objective: To review and draw conclusions about the impact of natural disasters on the elderly from the published medical literature.Design: Articles were obtained by searching the PubMed database and Google search engines using terms such as “disaster,” “elderly,” “hurricane,” “tornado,” “earthquake,” and “flood.” More articles were obtained from the reference lists of those obtained in the initial search.Results: Forty-five journal articles were reviewed.Conclusions: Many, but not all, studies have found that older individuals are more likely to suffer adverse physical consequences. This is not surprising considering the elderly are more likely to be in worse health before disasters and less able to seek assistance afterward. The lack of agreement between studies is not surprising either, considering heterogeneity in disasters, populations, and survey methods. This heterogeneity also precludes determination as to whether older individuals have a worse or more favorable psychological outcome than younger individuals. Several investigations, however, have noted that individuals may be more resilient to some of the psychological manifestations of disasters with more frequent exposure, often including the elderly. Many suggestions have been proposed to address the potential needs of older individuals such as involving existing organizations and those with existing geriatric expertise to design disaster plans, develop education, communication systems, and warnings for people with sensory impairment, create new methods for identifying, tracking, and following older individuals, and make special arrangements to provide disaster-related aid. However, there are only anecdotal reports of the success of the application of such methods.

CAM use is highly prevalent in older persons in this study, especially among females and those who are more highly educated.

VR-based applications can potentially offer more versatile, comprehensive, and safer assessments of function. However, they also might be more expensive, complex and more difficult to use by elderly patients. Side effects of head-mounted visual displays include nausea and disorientation, but, have not been reported specifically in older subjects.

Most elderly patients die with an order in place that they not be given cardiopulmonary resuscitation (DNR order). Surveys have shown that many elderly in different parts of the world want to be resuscitated, but may lack knowledge about the specifics of cardiopulmonary resuscitation (CPR). Data from countries other than the US is limited, but differences in physician and patient opinions by nationality regarding CPR do exist. Physicians' own preferences for CPR may predominate in the DNR decision making process for their patients, and many physicians may not want the participation of the elderly or believe that it is necessary. More complete and earlier discussions of a wider range of options of care for patients at the end of life have been advocated. The process ought to include education for patients about the process and efficacy of CPR, and for physicians on how to consider the values and levels of knowledge of their patients, whose preferences may differ from their own.T he use of do-not-resuscitate (DNR) orders, which preclude the use of cardiopulmonary resuscitation (CPR) has been increasing in all individuals, including the elderly, over the past several decades. 1-11 Several surveys suggest that the majority of hospitalised and institutionalised patients in the United States, and many abroad, die with a DNR order in place, 7 which was not true twenty years ago. The US Patient Self-Determination Act of 1991, which requires patients be informed of their rights to issue advance directives and be involved in medical decision making, appears to have increased the use of DNR orders. 12 While the use of the DNR order has been less systematically studied in other countries, many patients in the developed and developing world also die with a DNR order in place . [12][13][14][15][16][17][18][19][20][21] The elderly are more likely than the young to be the recipients of DNR orders. Most, 6 10 13-15 22-29 but not all 1 surveys indicate older patients, regardless of prognosis, are more frequently given a DNR order than a young patients. It remains an open question, however, whether more elderly people die with a DNR order in place because they are actually choosing to do so. Many studies show that most patients are never asked by a doctor if they wish to be resuscitated, despite a desire to express their wishes. Data from the SUPPORT (Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment) project, canvassing almost 1000 seriously ill elderly patients, noted that only approximately one quarter had ever discussed CPR with a physician. 30

Vitamin D, a multipurpose steroid hormone vital to health, has been increasingly implicated in the pathology of cognition and mental illness. Hypovitaminosis D is prevalent among older adults, and several studies suggest an association between hypovitaminosis D and basic and executive cognitive functions, depression, bipolar disorder, and schizophrenia. Vitamin D activates receptors on neurons in regions implicated in the regulation of behavior, stimulates neurotrophin release, and protects the brain by buffering antioxidant and anti-inflammatory defenses against vascular injury and improving metabolic and cardiovascular function. Although additional studies are needed to examine the impact of supplementation on cognition and mood disorders, given the known health benefits of vitamin D, we recommend greater supplementation in older adults.

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