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  • ISSN: 2378-9409
    Volume 4, Issue 1
    Research Article
    Kieke G.H. Okma1* and Michael K. Gusmano2
    Average life expectancy expanded by about 30 years across the industrialized world since the late 19th century due to improved living conditions and medical care. Changing demographics obviously requires adjustments in public pension schemes, healthcare services, labor markets and fiscal and social policy. The good news is that demographic change occurs over a very long period of time, allowing for gradual policy adjustments. Other industrialized nations, with much older populations, have already adjusted their public pensions or healthcare without dramatic cuts, and there is no reason to believe that such adjustments will become unaffordable. Moreover, most people in the Western world will live their additional decades in relative wealth, prosperity and good health--of course that do not apply to all; many elderly persons do need financial and other support for daily living. Following shifts in images of the elderly, the policy debate in the U.S. about policies for elderly citizens has changed color and focus. Reignited during the 2016 presidential election, it prompted policy proposals and measures that, we argue, are misguided, inconsistent and disproportionate. The policy debate about aging provides interesting examples of reframing of policy issues, expressive of divergent ideological perspectives. It resulted in both overt and somewhat covert and gradual changes in policy directions, the latter sometimes framed as policy drift, layering or conversion. In older political science literature, such policy change was simply labeled as marginal adjustment or ‘muddling through.' While the 2016 U.S. Presidential elections resulted in a-for most political commentators-unexpected victory for Republican candidate Donald Trump. His repeated claim that he would "repeal and replace" the Patient Protection and Affordable Care Act the first day in office, flies in the face of Pierson's finding that the "institutions, once in place, tend to create their own constituencies of beneficiaries, administrators and political supporters who will fiercely oppose the erosion or demise of such programs. Early February 2017, however, less than one month later, Trump said that replacement of the ACA was not likely until the end of this year or in 2018. Indeed, "change is difficult", former President Obama concluded, especially in times of hyper-partisanship.
    Anders Karlsen*, Mads Rohde Loeb, Ida Fanny Turtumoeygard, Frederik Ulrik Scheel, Kristine Bramsen Andersen, Katrine Jeong Joergensen, Alberto Luis Rodriguez Perez, Michael Kjaer, and Nina Beyer
    The aim of the current study was to evaluate changes in lower limb extension power (LLEP) during hospitalization in older medical patients.
    LLEP was measured in a PowerRig at admission (day 2 to 4; mean ± SD: day 2.5 ± 0.8) and before discharge (day 5-11; mean ± SD: day 8.4 ± 2.2) in 33 older medical patients (age = 65 years, mean age 86.7 years). "High" asymmetry was defined as >10% difference in LLEP between the lower limbs. Functional performance was measured with the De Morton Mobility Index (DEMMI-test) and 30 second chair stand test (30-s CST).
    The patients were characterized by very low LLEP (0.95 ± 0.37 watt/kg for men, 0.68 ± 0.27 watt/kg for women; mean ± SD) and a high prevalence of asymmetry. LLEP did not change during hospital stay while the prevalence of "high" asymmetry seemed to increase. Significant improvements in the DEMMI-test and 30-s CST was observed, but did not correlate with changes in LLEP. The patient's activity level (measured with ActivPal) was not related to LLEP at admission, and could not explain the individual changes in LLEP during the hospital stay.
    Conclusion: Although LLEP is related to function, the current results suggest that the functional improvements in older geriatric patients occur in the absence of improvements in LLEP. Individual changes in LLEP were not related to the changes in function or to the daily activity level in the patients.
    Jean F. Wyman*, Donna Z. Bliss, Olga V. Gurvich, Kay Savik, Lynn E. Eberly, Christine A. Mueller, Susan Harms, and Beth A. Virnig
    Introduction: Older adults admitted to nursing homes (NHs) are at risk for dual incontinence (urinary and fecal incontinence; DI). Minority residents may be disadvantaged for DI and its treatment because of their racial or ethnic group identity.
    Materials and Methods: This study assessed if there were racial/ethnic disparities in time to DI and in its treatment in a cohort of NH residents age = 65 years (N = 39,181) who were free of DI at the time of NH admission. Individual, NH, and community level predictors of time to DI and its treatment (any and behavioral treatment) from three national surveys were modeled. Disparities were analyzed in four racial/ethnic groups using the Peters-Belson method.
    Results and discussion: A significant disparity in time to DI and in receiving its treatment was found for Black residents. Significant predictors associated with disparity in time to DI were older age, male sex, greater functional and cognitive deficits, higher comorbidity, fecal incontinence at admission, and Census division. Significant predictors associated with disparity in receiving any treatment for DI were greater functional deficits, fewer cognitive deficits, and living in a NH with fewer care deficiencies. Significant predictors associated with disparity in receiving behavioral treatment for DI were fewer functional deficits, greater cognitive deficits, living in a NH with fewer qualities of care deficiencies, and a lower percentage of residents receiving Medicaid.
    Conclusions: Efforts to eliminate disparities in the development and treatment of DI for Black NH residents are recommended.
    Carolyn Botros*, Joshua Eng, and Peter Sand
    Objective: The objective of this study is to determine the prevalence and correlation of urinary incontinence symptoms to diagnoses made on urodynamic testing among women older than 65 when compared to women less than age 65.
    Methods: This is a cross-sectional study of patients with complaints of urinary incontinence between January, 2014 and August, 2016, who underwent urodynamic testing. The cohort was split by age over 65 versus those less than or equal to 65. Baseline demographics, and the prevalences of both urinary symptoms and diag-noses on urodynamic testing were compared. The proportion of patients with high pressure detrusor overactivity or a maximum detrusor pressure over 40 cm H2O and low pressure urethra, defined as a urethral closure pressure less than 28 cm H2O were also compared between groups.
    Results: Baseline demographics other than age did not differ between groups. Patients over 65 more often com-plained of urgency urinary incontinence while those less than 65 more commonly complained of stress urinary incontinence, post-micturition dribbling, and coital incontinence. There was no difference in the proportion of patients with insensible urine loss or nocturnal enuresis. When diagnoses were compared be-tween groups, there was no difference in the proportion of patients diagnosed with either detrusor overac-tivity or urodynamic stress incontinence. A significantly greater proportion of patients over 65, however, had both diagnoses. Nocturnal enuresis was associated with detrusor overactivity. There were no other sig-nificant correlations between individual symptoms and urodynamic diagnoses in either group.
    Conclusion: Patients over 65 complain more about urgency urinary incontinence, while patients under 65 complain about stress urinary incontinence, post-micturition dribbling, and coital incontinence. Patients over 65 also tend to have both detrusor overactivity and urodynamic stress incontinence on urodynamic testing when compared with patients less than 65.
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