By 2050, the American 85 years old and over population will triple. Clinicians and the public health community need to develop a culture of sensitivity to the needs of this population and its subgroups. Sensory changes, cognitive changes, and weakness may be subtle or may be severe in the heterogeneous population of people over age 85. Falls, cardiovascular disease, and difficulty with activities of daily living are common but not universal. This paper reviews relevant changes of normal aging, diseases, and syndromes common in people over age 85, cognitive and psychological changes, social and environmental changes, and then reviews common discussions which clinicians routinely have with these patients and their families. Some hearing and vision loss are a part of normal aging as is decline in immune function. Cardiovascular disease and osteoporosis and dementia are common chronic conditions at age 85. Osteoarthritis, diabetes, and related mobility disability will increase in prevalence as the population ages and becomes more overweight. These population changes have considerable public health importance. Caregiver support, services in the home, assistive technologies, and promotion of home exercise programs as well as consideration of transportation and housing policies are recommended. For clinicians, judicious prescribing and ordering of tests includes a consideration of life expectancy, lag time to benefit, and patient goals. Furthermore, healthy behaviors starting in early childhood can optimize quality of life among the oldest-old.

BackgroundThe prevalence of pressure ulcers particularly in the frail older adult population continues to be high and very costly especially in those suffering from chronic diseases and has brought a higher awareness to comprehensive, preventive and therapeutic measures for treatment of pressure ulcers. Internal risk factors highlighted by comorbidities play a crucial role in the pathogenesis of pressure ulcers.Main bodyFocusing on the impact of common chronic diseases (comorbidities) in aging on pressure ulcers (e.g., cardiovascular diseases, diabetes, chronic pulmonary diseases, renal diseases and neurodegenerative disorders) and the significant complicating conditions e.g., anemia, infectious diseases, malnutrition, hospitalization, incontinence and polypharmacy, frailty and disability becomes important in developing a more complete, inclusive and multidisciplinary approach to prevention of PU in older patients.ObjectiveTo describe chronic and acute conditions which are risk factors in elderly patients for developing PU.MethodsWe present an overview of comorbidities seen with PU in three diverse patient locations.The inclusion criteria are sites (community, acute hospital and long term facilities), older patients, chronic diseases and pressure ulcers grade 2 and over.Using a recently developed conceptual framework accepted by European and National Pressure Ulcer Advisory Panels, we examined chronic diseases to identify the risk factors of chronic conditions and complicating conditions which potentially influence risk for PU development.ConclusionMultiple chronic diseases and complicating factors which associated with immobility, tissue ischemia, and undernutrition are caused to PU in community settings, hospitals, and nursing facilities.

BackgroundAs the population ages, older adults are seeking meaningful, and impactful, post-retirement roles. As a society, improving the health of people throughout longer lives is a major public health goal. This paper presents the design and rationale for an effectiveness trial of Experience Corps™, an intervention created to address both these needs. This trial evaluates (1) whether senior volunteer roles within Experience Corps™ beneficially impact children's academic achievement and classroom behavior in public elementary schools and (2) impact on the health of volunteers.MethodsDual evaluations of (1) an intention-to-treat trial randomizing eligible adults 60 and older to volunteer service in Experience Corps™, or to a control arm of usual volunteering opportunities, and (2) a comparison of eligible public elementary schools receiving Experience Corps™ to matched, eligible control schools in a 1:1 control:intervention school ratio.OutcomesFor older adults, the primary outcome is decreased disability in mobility and Instrumental Activities of Daily Living (IADL). Secondary outcomes are decreased frailty, falls, and memory loss; slowed loss of strength, balance, walking speed, cortical plasticity, and executive function; objective performance of IADLs; and increased social and psychological engagement. For children, primary outcomes are improved reading achievement and classroom behavior in Kindergarten through the 3rd grade; secondary outcomes are improvements in school climate, teacher morale and retention, and teacher perceptions of older adults.SummaryThis trial incorporates principles and practices of community-based participatory research and evaluates the dual benefit of a single intervention, versus usual opportunities, for two generations: older adults and children.

Objectives To determine the acceptability of a pre-consultation checklist for older patients who attend medical visits with an unpaid companion and to evaluate its effects on visit communication. Design Randomized controlled pilot study. Setting Academic geriatrics ambulatory clinic. Participants Thirty-two patients age 65+ and their unpaid companion. Intervention A self-administered checklist was compared to usual care. The checklist was designed to: (1) elicit and align patient and companion perspectives regarding health concerns to discuss with the doctor, and (2) stimulate discussion about the companion’s role in the visit. Measurement Primary outcome: ratio of patient-centered communication, coded from visit audiotapes. Secondary outcomes: checklist acceptability; visit duration; patient-companion verbal activity; patient- and physician- reported perspectives of the visit. Results All intervention patients and companions (n=17) completed the checklist, and all participants (n=32 dyads) completed the study. Patients and companions stated the checklist was easy to complete (88%), useful (91%), and they uniformly (100%) recommended it to other patients. Communication was significantly more patient-centered in intervention (versus control) group visits (ratio of 1.22 versus 0.71; p=0.03). Visit duration (35.0 and 30.6 minutes; p=0.34) and percent of total verbal activity contributed by patients and companions (58.2% and 56.3% of visit statements; p=0.50) were comparable in intervention and control groups, respectively. Physicians were more likely to indicate intervention (versus control) companions “helped them provide good care to the patient” (94% vs. 60%; p=0.02). Intervention (versus control) patients were more likely to indicate they “better understood their doctor’s advice and explanations” because their companion was present (82% vs. 47%; p=0.03). Conclusion A checklist to elicit and align perspectives of older patients and their companions resulted in enhanced patient-centered medical visit communication.