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Understanding the Patient, Wellness, and Caregiving Work of Older Adults
Published in Rupa S. Valdez, Richard J. Holden, The Patient Factor, 2021
Abigail R. Wooldridge, Wendy A. Rogers
The myriad patient work associated with self-management involves interactions of multimorbidity, medication management, use of technology, information requirements, and needs for coordination within the care network. An individual’s ability to cope with work demands is one factor that determines success of self-management and can be characterized by their physical, sensory, cognitive, and social capabilities, or resources (Czaja et al., 2019). Forces in the environment place demands on individuals that may be physical, intellectual, or social in nature. If an individual’s level of resources does not match the work and environmental demands, then maladaptive behavior may result, such as depression, increased levels of stress, and burnout. Patient work demands, just like demands of any other work, have the potential to exceed an individual’s abilities, perhaps especially for persons with multimorbidity (Bayliss et al., 2014).
Design for health
Published in Emmanuel Tsekleves, Rachel Cooper, Design for Health, 2017
Emmanuel Tsekleves, Rachel Cooper
In addition the theme of long-term healthcare emerged in this book as one of the main challenges faced in design in healthcare today. The theme was discussed in several chapters across all four healthcare settings presented in the book. Long-term conditions fit well to the ‘wicked problem’ definition of Rittel and Webber’s (1973) as already indicated by Prendiville in Chapter 11. As the number of people with long-term (or chronic) health conditions increases through living longer and with changing lifestyles a massive challenge in maintaining present levels of high-quality patient care at an affordable cost emerges. This is further exacerbated by the rise of the number of people with two or more long-term conditions (comorbidity and multiple morbidity1) (Barnett et al., 2012; Uijen and van de Lisdonk, 2008). The challenges created by comorbidity and multimorbidity require a personalised approach to the design of interventions and to the service design of patient pathways within the existing chronic healthcare system. Other current challenges with long-term healthcare include the design of preventative interventions that enable service users to adhere to therapy and manage their condition to prevent further deterioration and development of multimorbidities.
Leisure-time physical activity is negatively associated with depression symptoms independently of the socioeconomic status
Published in European Journal of Sport Science, 2020
Adilson Marques, Miguel Peralta, Élvio R. Gouveia, João Martins, Hugo Sarmento, Diego Gomez-Baya
Multimorbidity, sedentary time and body mass index (BMI) are determinants of physical activity (Birk et al., 2019; Marques, Santos, Peralta, Sardinha, & Gonzalez Valeiro, 2018). Therefore, analysis was controlled for these potential confounders. Chronic diseases (heart or circulation problems, high blood pressure, breathing problems, allergies, diabetes, and cancer) were assessed by asking participants to indicate whether they currently have, or had been diagnosed any chronic diseases (yes/no) in the last 12 months. Multimorbidity was defined as the co-occurrence of two or more of these conditions. Participants were asked to report how much time, in total, they spend watching television on an average day. Responses were from no time to more than 3 h, using intervals of 30 min. BMI was calculated from self-reported height and weight (kg/m2).
Bone health, body composition and physical fitness dose–response effects of 16 weeks of recreational team handball for inactive middle-to-older-aged males – A randomised controlled trial
Published in European Journal of Sport Science, 2023
Ivone Carneiro, Peter Krustrup, Carlo Castagna, Rita Pereira, Niklas Rye Jørgensen, Eduardo Coelho, Susana Póvoas
Aging is associated with an increased risk of multimorbidity, which negatively impacts daily functioning and quality of life, and increases the mortality risk, that consequently increases the rates of health-care use and costs. Therefore, promoting healthy aging is important for maintaining physical and cognitive functions, quality of life and independence (Reginster & Burlet, 2006). Aging is also associated with bone loss and increased prevalence of osteoporosis, which is a musculoskeletal disorder that affects 6% of middle-to-older-aged males in the European Union (Hernlund et al., 2013), with male osteoporosis being underestimated and underdiagnosed (Vescini et al., 2021). Bone mineral density (BMD) is the gold standard for osteoporosis diagnosis (Kanis, 2002), and is thus important for determining the risk of potential fractures (Wheater et al., 2013). The rate of bone turnover is involved in determining bone quality, including bone density and qualitative determinants of bone strength (Datta et al., 2008) as a result of continuous lifelong bone remodelling (Shetty et al., 2016). Bone turnover biomarkers express the metabolic activity and can be used to determine the level of changes in bone turnover. During the remodelling process, osteocytes, osteoclasts and osteoblasts act in a coordinated manner to form or resorb bone as necessary, and their activation is controlled by a range of stimuli including mechanical forces applied to the skeleton, apoptosis of osteocytes, calciotropic and sex hormones, cytokines and local factors (Datta et al., 2008). Biomarkers of bone formation, e.g. procollagen type-1 amino-terminal propeptide (P1NP) and osteocalcin (OC), are products of active osteoblasts, while the majority of bone resorption markers, e.g. carboxy-terminal type-1 collagen crosslinks (CTX), are degradation products of type I collagen, the most abundant collagen in bone (Wheater et al., 2013). Additionally, osteocytes regulate bone turnover both through direct physical contact with other bone cells and by producing various factors which affect bone formation and can be measured in the blood, e.g. sclerostin (Weaver et al., 2016). Sclerostin is a secreted osteocyte marker that acts as inhibitor to the Wnt signalling pathway and hence, blocking the Wnt effects on osteoblasts, and thus decreasing bone formation (Zhang et al., 2004). Also, it is a biomarker that reflects the severity of bone loss and is a candidate biomarker for osteoporosis severity in chronic spinal cord injury (Morse et al., 2013). Exercise is effective in promoting short-term (∼2 months) changes in serum bone turnover markers (Banfi et al., 2010; Evans et al., 2008) and, consequently, improvements in BMD. However, bone remodelling normally takes several months to positively impact BMD, and those changes can only be detected after 6 months or longer (Weaver et al., 2016). Additionally, bone turnover markers’ positive response to exercise appears to depend on exercise modality, intensity, age and sex (Smith et al., 2021). Exercise programmes that promote high impact movements with rapid rates of loading are considered as valid tools to attenuate and counteract the rate of bone loss in middle-aged-to-older adults (Smith et al., 2021).