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Impact of social and family environment on aging: A lifecourse approach in 2,350 old people
9th Congress of the EUGMS / European Geriatric Medicine 4 (2013) S81–S141
the family’s participation as a care mediator. These professionals have the acuity to capture these women’s specific demands, but face difficulties to deliver care to these clients. Nurses expect to deliver qualified care to these women. The theoretical and methodological approach of social phenomenology permitted revealing that the nurse designs qualified care to elderly women, considering the possibilities in the context. This includes the participation of different social actors and health sectors, assuming collective efforts in action strategies and professional training, in line with the particularities and care needs of elderly women nurses identify. http://dx.doi.org/10.1016/j.eurger.2013.07.403 P340
Health and wealth awareness and assessment in rural Ontario F. Chang , J. Seguin , N.S. Gupta , C. Munoz , D. Stringer Gateway Rural Health Research Institute, University of Waterloo School of Pharmacy, Waterloo, Ontario, Canada Objectives.– Recent studies show higher prevalence for chronic diseases combined with lower incomes for rural residents. This study aims to identify gaps in health and financial knowledge in a pre-retirement rural population and develop effective strategies to address identified gaps. The objectives are to 1) determine health and financial status and knowledge level in a sample of preretirement rural residents, and 2) identify strategies and resources that can be used in a future education program. Methods.– Thirty rural residents aged 45–70 years living in Southwestern Ontario completed the Canadian Financial Capability Survey, a questionnaire, and a semi-structured interview. Results.– Twenty-five (83%) participants were female. Average age was 57 years and average time living in a rural community was 39 years. Most self-reported very good health. Over half of the participants reported an annual income of $27,000 to $77,000 and about 40% had an annual income over $77,000. More than 65% were confident they can maintain a desired standard of living post retirement, although half stated they were not sure how much money that would take. Overall, participants scored at or above national average for financial knowledge but were unfamiliar with the coverage provided by the provincial health and drug benefit plans. Self-employed, rural women, and low-income individuals were identified as in need of specialized resources. Conclusions.– This pre-retirement rural population has sufficient financial capability. However, knowledge gaps exist regarding government health plans and coverage of healthcare expenses related to chronic diseases. Increased awareness would help with retirement planning. http://dx.doi.org/10.1016/j.eurger.2013.07.404
S123
project - supported by the Swiss Academy of Medical Sciences - was realized in elderly homes of the canton Ticino (Switzerland), first interviewing about 12 residents and 10 caregivers, and then sharing by the means of focus groups the results of the interviews - with a grounded-theory oriented methodological approach - and the parallel study of cinematographic narratives about the topic. The condition of the “exposed self”, of vulnerability, of the exposed intimate sphere of old persons in elderly homes is obviously the cause of a closing and the impoverishment of the sphere of the “innermost self”, and the estranging from life. By means of confrontation with autobiographical narratives (interviews) and fictional narratives (movies) it is possible to make visible for the caregivers, some ways to improve the autonomy, and fulfilling life even for elderly instutitionalized people. http://dx.doi.org/10.1016/j.eurger.2013.07.405 P342
Changing the course of health disparities in indigenous elder populations L. Kaòpua , C. Browne University of Hawaii, College of Health Science and Social Welfare, Hawaii, USA Introduction.– In 70 Countries stretching across the vast expanse from the Arctic Region to the South Pacific Basin, there live an estimated 370 million native peoples whose ancestors were the first settlers of these areas prior to colonization. Subsequent waves of migrants coming from other parts of the globe lead to numerous socio-political and economic changes. One result of colonization is found in the poor health profile of indigenous elders around the globe. The vast majority of indigenous elders are disproportionately affected by varying social and health disparities that result in early disability rates, a number of chronic diseases, and increased risk for mortality across the life course. Method.– Using the case of Native Hawaiians, the indigenous people of Hawaii (the 50th state of the US), we summarize data from a mixed-method design collected over a six year period by Ha Kupuna, National Resource Center for Native Hawaiian Elders, University of Hawaii that aimed to identify their health and long-term care service needs. Results.– We present data on their health and service use profile, and also discuss cultural traditions prevalent in this and other indigenous elder populations that if integrated into traditional health care may offer the prospect of health equity for all. In the face of such disparities, we present information on a number of culturally-tailored health and community-based programs that offer promise for the alleviation of social and health disparities in indigenous older adults. http://dx.doi.org/10.1016/j.eurger.2013.07.406
P341
Dimensions of intimacy in old age homes – A medical humanities research G. Bernegger , G. Martignoni Observatory for Medical Humanities, Supsi, Manno, Switzerland
P343
Impact of social and family environment on aging: A lifecourse approach in 2,350 old people M. Herr a , J.M. Robine b , J.J. Arvieu c , J. Ankri a Laboratoire Santé-Environnement-Vieillissement (EA2506), Université Versailles Saint Quentin, Paris, France b INSERM U988 and U710, EPHE, Paris & Montpellier, France c AG2R La Mondiale, Direction des Études, Prévoyance Individuelle et IARD, Paris, France a
Text.– Dimensions of intimacy in old age homes - a Medical Humanities research The need of intimacy is a fairly neglected component of medical care in old age homes. The need of respect of the private sphere (privacy) elderly people is usually taken into account; less so is the need of a shared dimension of the sphere of the “innermost self”, which also determines the subjective experience of the quality of care. Elderly people living in institutions are in a state of an “exposed self”. The aim of this research-project is to elucidate which problems can arise, if one doesn’t consider the need of intimacy of elderly people in retirement homes. The research-
Introduction.– Health in old age is affected by exposures throughout life. This study aimed to assess the impact of social and family life on aging.
S124
9th Congress of the EUGMS / European Geriatric Medicine 4 (2013) S81–S141
Methods.– This is a cross-sectional population study of people aged 70 and over in which 2,350 respondents were interviewed in 2008–2010. During a standardised interview, a nurse documented the social (education, former job, living standard) and family history (longevity of parents, children, marital life) of participants and examined their health problems, functional abilities and cognitive status. Health profiles were defined by using latent class analysis. Social and family factors associated with each profile were determined by using a polytomous regression model adjusted for age. Results.– Four profiles were identified in the study sample (mean age 83.2 ± 7.4, women 59.3%), characterized by dependency (n = 372), poor physical and/or mental health (n = 290), intermediate health (n = 648) and good health with preserved physical activity (n = 1041). Apart from the loss of a spouse, the factors that most influenced the health status of old people were more related to the living standard than to family history. There was a gradient with the socio-professional category, the lowest the category the higher the risk of dependency or poor health. Current financial difficulties were associated with poorer health. Compared to subjects who reported high standard of living in childhood, deprived subjects were more likely to be dependent (OR 1.53 [1.05–2.22]) or in poorer health (OR 1.72 [1.17–2.54]). Conclusion.– The economic environment strongly influences the health of old people, and the phenomenon has its roots in childhood. http://dx.doi.org/10.1016/j.eurger.2013.07.407 P344
Maintaince of physical capacity in elderly cross-country skiers. Longitudinal observations from the Birkebeiner Ageing Study L. Mo , M. Myrstad , I.K. Sangnes , A. Henriksen , A.H. Ranhoff University of Bergen, Department of Clinical Science and Diakonhjemmet Hospital, Bergen, Norway Background.– Physical performance decreases modestly until the age of 60–70 years in swimmers and runners, thereafter the decrease is steeper. To maintain physical capacity is important in preventing disability and studies of very active elderly people can assess how far physical capacity can be maintained in ageing. Racing time in cross-country skiing can be used as surrogate measure for physical capacity. Aim.– To study change in physical capacity from middle to old age in cross-country skiers, to find at which age decline in physical capacity could no longer be postponed. Methods.– 550 of 656 (84%) participants aged 65+ years who completed the 54 km Birkebeiner cross-country ski race in 2009 or 2010 were included in the Birkebeiner Ageing Study (BiAS). The finishing race times for skiers who had completed the race more than 15 (38 men) or 10 (22 women) times were obtained from the official result lists. Racing time was plotted against age for each of the individuals. Trends for change in racing time were calculated. Results.– Longitudinal observations were available for men from 55–82 years and women from 46–69 years. Generally the variation in racing time for each of the individuals showed small variation from year to year. The point of significant increase was 67.6 years for men, while we could not find a point of significant increase among the women. Conclusion.– Elderly men participating in a long-distance crosscountry ski competition are able to maintain their physical capacity well until the age of between 65 to 70 years. http://dx.doi.org/10.1016/j.eurger.2013.07.408
P345
Programa envejecimiento activo y saludable en atención primaria de salud I. Redondo Zambrano , C. Gonzalo Jurado , ˜ , I. Veiguela Martínez , M. Bacariza Cortinas P. Otero Ramos Centro Salud de Vite. Santiago de Compostela, Centro de Salud de Vite-Sergas, Santiago de Compostela, Spain Keywords: Aging; Dependency; Prevention; Best practices Introduction.– Basis of a comprehensive biopsychosocial approach to the population, a group of professionals Vite Health Centre (Santiago de Compostela, Spain), we conducted a pilot of three years on active and healthy aging that focuses on prevention of dependence on Primary Health Care. This proyect seeks to see the Health Center not only as a place to treat the disease but a place of prevention activities through health promotion aimed at healthy people–middle–aged–out for them and get a good quality of life (physical and emotional). The ages are between 55 and 75 years and an active state and moderate level of dependence (also included caregivers of dependents even if they are younger). Background.– The main objective is to promote, through information, and get active healthy aging with the participation of the older people between 55 and 75 years, users of the Health Center Vite. Methods.– Two programs are developed strategic and tactical reference: “Caring for the caregiver” to prevent deterioration and psychosocial caregivers, and “Health and leisure in old age” to promote healthy lifestyles (diet, exercise and leisure). Results.– The results were: - Improving information on existing health resources (50%) - to ensure the care of dependents through psychosocial support from their caregivers (75%) - teach the caregiver to project their own physical and mental (50%)- information on healthy lifestyles (30%) - to improve information on the use of leisure (40%). Conclusion.– This line of work is an experience of Community Participation in getting a health empowerment of people of 55–75 years active and healthy aging. http://dx.doi.org/10.1016/j.eurger.2013.07.409 P346
Inflammatory effect of diet and hospital outcomes after colorectal cancer surgery–Do older patients vary? A. Galas Epidemiology and Preventive Medicine, Jagiellonian University Medical College, Krakow, Poland Introduction.– Although dietary habits are the main risk factor responsible for the development of colorectal cancer (CRC), little is known about how diet may contribute to postoperative outcomes as time of hospitalization and survival, including older adults. Methods.– A prospective cohort study of 521 CRC patients admitted for surgery. Dietary habits before the development of the disease were questioned at the time of admission. Patients were followed during hospitalization and after. Information about other risk factors and clinical characteristics was collected. Mortality data was obtained from the national vital records. Dietary Inflammatory Index (DII) as developed by Cavicchia (2009) was calculated using 23 dietary items. Patients 60+ were investigated additionally. Results.– The mean DII in the group was ‘-2.58 (SD = 2.43), among 60+ patients ‘-2.45 (SD = 2.17). The risk of > 7-days hospitalization was decreased across DII textiles (adjusted for colon or rectum site, radical or palliative surgery, staging, and 4 more covariates), and for 60+ patients statistically significant (OR for 2-tertile: 0.76; 3-tertile: 0.42; P-trend 0.046). Cox regression models revealed decreased risk
the family’s participation as a care mediator. These professionals have the acuity to capture these women’s specific demands, but face difficulties to deliver care to these clients. Nurses expect to deliver qualified care to these women. The theoretical and methodological approach of social phenomenology permitted revealing that the nurse designs qualified care to elderly women, considering the possibilities in the context. This includes the participation of different social actors and health sectors, assuming collective efforts in action strategies and professional training, in line with the particularities and care needs of elderly women nurses identify. http://dx.doi.org/10.1016/j.eurger.2013.07.403 P340
Health and wealth awareness and assessment in rural Ontario F. Chang , J. Seguin , N.S. Gupta , C. Munoz , D. Stringer Gateway Rural Health Research Institute, University of Waterloo School of Pharmacy, Waterloo, Ontario, Canada Objectives.– Recent studies show higher prevalence for chronic diseases combined with lower incomes for rural residents. This study aims to identify gaps in health and financial knowledge in a pre-retirement rural population and develop effective strategies to address identified gaps. The objectives are to 1) determine health and financial status and knowledge level in a sample of preretirement rural residents, and 2) identify strategies and resources that can be used in a future education program. Methods.– Thirty rural residents aged 45–70 years living in Southwestern Ontario completed the Canadian Financial Capability Survey, a questionnaire, and a semi-structured interview. Results.– Twenty-five (83%) participants were female. Average age was 57 years and average time living in a rural community was 39 years. Most self-reported very good health. Over half of the participants reported an annual income of $27,000 to $77,000 and about 40% had an annual income over $77,000. More than 65% were confident they can maintain a desired standard of living post retirement, although half stated they were not sure how much money that would take. Overall, participants scored at or above national average for financial knowledge but were unfamiliar with the coverage provided by the provincial health and drug benefit plans. Self-employed, rural women, and low-income individuals were identified as in need of specialized resources. Conclusions.– This pre-retirement rural population has sufficient financial capability. However, knowledge gaps exist regarding government health plans and coverage of healthcare expenses related to chronic diseases. Increased awareness would help with retirement planning. http://dx.doi.org/10.1016/j.eurger.2013.07.404
S123
project - supported by the Swiss Academy of Medical Sciences - was realized in elderly homes of the canton Ticino (Switzerland), first interviewing about 12 residents and 10 caregivers, and then sharing by the means of focus groups the results of the interviews - with a grounded-theory oriented methodological approach - and the parallel study of cinematographic narratives about the topic. The condition of the “exposed self”, of vulnerability, of the exposed intimate sphere of old persons in elderly homes is obviously the cause of a closing and the impoverishment of the sphere of the “innermost self”, and the estranging from life. By means of confrontation with autobiographical narratives (interviews) and fictional narratives (movies) it is possible to make visible for the caregivers, some ways to improve the autonomy, and fulfilling life even for elderly instutitionalized people. http://dx.doi.org/10.1016/j.eurger.2013.07.405 P342
Changing the course of health disparities in indigenous elder populations L. Kaòpua , C. Browne University of Hawaii, College of Health Science and Social Welfare, Hawaii, USA Introduction.– In 70 Countries stretching across the vast expanse from the Arctic Region to the South Pacific Basin, there live an estimated 370 million native peoples whose ancestors were the first settlers of these areas prior to colonization. Subsequent waves of migrants coming from other parts of the globe lead to numerous socio-political and economic changes. One result of colonization is found in the poor health profile of indigenous elders around the globe. The vast majority of indigenous elders are disproportionately affected by varying social and health disparities that result in early disability rates, a number of chronic diseases, and increased risk for mortality across the life course. Method.– Using the case of Native Hawaiians, the indigenous people of Hawaii (the 50th state of the US), we summarize data from a mixed-method design collected over a six year period by Ha Kupuna, National Resource Center for Native Hawaiian Elders, University of Hawaii that aimed to identify their health and long-term care service needs. Results.– We present data on their health and service use profile, and also discuss cultural traditions prevalent in this and other indigenous elder populations that if integrated into traditional health care may offer the prospect of health equity for all. In the face of such disparities, we present information on a number of culturally-tailored health and community-based programs that offer promise for the alleviation of social and health disparities in indigenous older adults. http://dx.doi.org/10.1016/j.eurger.2013.07.406
P341
Dimensions of intimacy in old age homes – A medical humanities research G. Bernegger , G. Martignoni Observatory for Medical Humanities, Supsi, Manno, Switzerland
P343
Impact of social and family environment on aging: A lifecourse approach in 2,350 old people M. Herr a , J.M. Robine b , J.J. Arvieu c , J. Ankri a Laboratoire Santé-Environnement-Vieillissement (EA2506), Université Versailles Saint Quentin, Paris, France b INSERM U988 and U710, EPHE, Paris & Montpellier, France c AG2R La Mondiale, Direction des Études, Prévoyance Individuelle et IARD, Paris, France a
Text.– Dimensions of intimacy in old age homes - a Medical Humanities research The need of intimacy is a fairly neglected component of medical care in old age homes. The need of respect of the private sphere (privacy) elderly people is usually taken into account; less so is the need of a shared dimension of the sphere of the “innermost self”, which also determines the subjective experience of the quality of care. Elderly people living in institutions are in a state of an “exposed self”. The aim of this research-project is to elucidate which problems can arise, if one doesn’t consider the need of intimacy of elderly people in retirement homes. The research-
Introduction.– Health in old age is affected by exposures throughout life. This study aimed to assess the impact of social and family life on aging.
S124
9th Congress of the EUGMS / European Geriatric Medicine 4 (2013) S81–S141
Methods.– This is a cross-sectional population study of people aged 70 and over in which 2,350 respondents were interviewed in 2008–2010. During a standardised interview, a nurse documented the social (education, former job, living standard) and family history (longevity of parents, children, marital life) of participants and examined their health problems, functional abilities and cognitive status. Health profiles were defined by using latent class analysis. Social and family factors associated with each profile were determined by using a polytomous regression model adjusted for age. Results.– Four profiles were identified in the study sample (mean age 83.2 ± 7.4, women 59.3%), characterized by dependency (n = 372), poor physical and/or mental health (n = 290), intermediate health (n = 648) and good health with preserved physical activity (n = 1041). Apart from the loss of a spouse, the factors that most influenced the health status of old people were more related to the living standard than to family history. There was a gradient with the socio-professional category, the lowest the category the higher the risk of dependency or poor health. Current financial difficulties were associated with poorer health. Compared to subjects who reported high standard of living in childhood, deprived subjects were more likely to be dependent (OR 1.53 [1.05–2.22]) or in poorer health (OR 1.72 [1.17–2.54]). Conclusion.– The economic environment strongly influences the health of old people, and the phenomenon has its roots in childhood. http://dx.doi.org/10.1016/j.eurger.2013.07.407 P344
Maintaince of physical capacity in elderly cross-country skiers. Longitudinal observations from the Birkebeiner Ageing Study L. Mo , M. Myrstad , I.K. Sangnes , A. Henriksen , A.H. Ranhoff University of Bergen, Department of Clinical Science and Diakonhjemmet Hospital, Bergen, Norway Background.– Physical performance decreases modestly until the age of 60–70 years in swimmers and runners, thereafter the decrease is steeper. To maintain physical capacity is important in preventing disability and studies of very active elderly people can assess how far physical capacity can be maintained in ageing. Racing time in cross-country skiing can be used as surrogate measure for physical capacity. Aim.– To study change in physical capacity from middle to old age in cross-country skiers, to find at which age decline in physical capacity could no longer be postponed. Methods.– 550 of 656 (84%) participants aged 65+ years who completed the 54 km Birkebeiner cross-country ski race in 2009 or 2010 were included in the Birkebeiner Ageing Study (BiAS). The finishing race times for skiers who had completed the race more than 15 (38 men) or 10 (22 women) times were obtained from the official result lists. Racing time was plotted against age for each of the individuals. Trends for change in racing time were calculated. Results.– Longitudinal observations were available for men from 55–82 years and women from 46–69 years. Generally the variation in racing time for each of the individuals showed small variation from year to year. The point of significant increase was 67.6 years for men, while we could not find a point of significant increase among the women. Conclusion.– Elderly men participating in a long-distance crosscountry ski competition are able to maintain their physical capacity well until the age of between 65 to 70 years. http://dx.doi.org/10.1016/j.eurger.2013.07.408
P345
Programa envejecimiento activo y saludable en atención primaria de salud I. Redondo Zambrano , C. Gonzalo Jurado , ˜ , I. Veiguela Martínez , M. Bacariza Cortinas P. Otero Ramos Centro Salud de Vite. Santiago de Compostela, Centro de Salud de Vite-Sergas, Santiago de Compostela, Spain Keywords: Aging; Dependency; Prevention; Best practices Introduction.– Basis of a comprehensive biopsychosocial approach to the population, a group of professionals Vite Health Centre (Santiago de Compostela, Spain), we conducted a pilot of three years on active and healthy aging that focuses on prevention of dependence on Primary Health Care. This proyect seeks to see the Health Center not only as a place to treat the disease but a place of prevention activities through health promotion aimed at healthy people–middle–aged–out for them and get a good quality of life (physical and emotional). The ages are between 55 and 75 years and an active state and moderate level of dependence (also included caregivers of dependents even if they are younger). Background.– The main objective is to promote, through information, and get active healthy aging with the participation of the older people between 55 and 75 years, users of the Health Center Vite. Methods.– Two programs are developed strategic and tactical reference: “Caring for the caregiver” to prevent deterioration and psychosocial caregivers, and “Health and leisure in old age” to promote healthy lifestyles (diet, exercise and leisure). Results.– The results were: - Improving information on existing health resources (50%) - to ensure the care of dependents through psychosocial support from their caregivers (75%) - teach the caregiver to project their own physical and mental (50%)- information on healthy lifestyles (30%) - to improve information on the use of leisure (40%). Conclusion.– This line of work is an experience of Community Participation in getting a health empowerment of people of 55–75 years active and healthy aging. http://dx.doi.org/10.1016/j.eurger.2013.07.409 P346
Inflammatory effect of diet and hospital outcomes after colorectal cancer surgery–Do older patients vary? A. Galas Epidemiology and Preventive Medicine, Jagiellonian University Medical College, Krakow, Poland Introduction.– Although dietary habits are the main risk factor responsible for the development of colorectal cancer (CRC), little is known about how diet may contribute to postoperative outcomes as time of hospitalization and survival, including older adults. Methods.– A prospective cohort study of 521 CRC patients admitted for surgery. Dietary habits before the development of the disease were questioned at the time of admission. Patients were followed during hospitalization and after. Information about other risk factors and clinical characteristics was collected. Mortality data was obtained from the national vital records. Dietary Inflammatory Index (DII) as developed by Cavicchia (2009) was calculated using 23 dietary items. Patients 60+ were investigated additionally. Results.– The mean DII in the group was ‘-2.58 (SD = 2.43), among 60+ patients ‘-2.45 (SD = 2.17). The risk of > 7-days hospitalization was decreased across DII textiles (adjusted for colon or rectum site, radical or palliative surgery, staging, and 4 more covariates), and for 60+ patients statistically significant (OR for 2-tertile: 0.76; 3-tertile: 0.42; P-trend 0.046). Cox regression models revealed decreased risk