UNASSIGNED: Obesity is a global health crisis with profound implications on various body systems, contributing to a series of comorbidities. Metabolic Bariatric Surgery (MBS) has emerged as an effective treatment option for severe obesity, with significant weight reduction and potential systemic physiological alterations.
UNASSIGNED: This narrative review aims to provide a comprehensive analysis of the long-term effects of MBS on a wide array of body systems, including the heart, liver, kidneys, reproductive system, skin, lungs, digestive tract, pancreas, and blood, as well as related cancers of these organs.
UNASSIGNED: A systematic search was conducted in academic databases (PubMed, ISI Web of Science, and Scopus) for observational studies and reviews published between July 2000 and December 2023, investigating the association between MBS and the subsequent function of different organ systems. High-quality studies were prioritized to ensure reliable evidence synthesis.
UNASSIGNED: MBS has demonstrated favorable outcomes in reducing cardiovascular disease risk, improving cardiac function, and alleviating heart failure symptoms. It has also been associated with improved respiratory function, remission of obstructive sleep apnea, and reduced cancer incidence and mortality. Additionally, MBS has shown benefits in managing gastrointestinal disorders, enhancing glycemic control, and promoting pancreatic beta-cell regeneration in type 2 diabetes mellitus. However, some methods of MBS are associated with a higher risk of cholelithiasis, GERD, and pancreatic exocrine insufficiency.
UNASSIGNED: MBS has far-reaching systemic effects beyond weight loss, offering potential long-term benefits for various organ systems and comorbidities associated with obesity. For many patients with severe obesity, the potential benefits of Metabolic and Bariatric Surgery (MBS) can outweigh the associated risks. However, careful evaluation by a qualified healthcare professional is crucial to determine candidacy and ensure a successful outcome. Further research is needed to fully elucidate the long-term impacts and tailor personalized treatment approaches.

OBJECTIVE: Burnout syndrome can have a negative impact on people who work in occupations that require close interaction with others, contributing to a decline in their psychological well-being. This study aimed to examine the effectiveness of Group Interpersonal Therapy (IPT-G) in reducing burnout among care workers for older adults in a Turkish long-term care facility.
METHODS: The study employed a pretest-post-test randomised experimental design. Fifty care workers scoring 27 or above on emotional exhaustion and 10 or above on depersonalisation subscales of the Maslach Burnout Inventory (MBI) were randomly assigned to the intervention or control group for 8 weeks. The study utilised the World Health Organization (WHO) Group Interpersonal Therapy for Depression manual as a guide. The post-test was conducted immediately after the last session of the intervention.
RESULTS: In comparing pre- and post-test scores of the intervention group, a statistically significant difference was found in overall burnout scores (pretest M = 74.10, post-test M = 63.08, p < 0.001; d = 1.12). Additionally, emotional exhaustion scores (pretest M = 30.99, post-test M = 24.89, p < 0.001; d = 1.11) and depersonalisation scores (pretest M = 12.76, post-test M = 8.53, p < 0.001; d = 1.69) exhibited significant differences. However, no significant difference was observed in personal accomplishment scores (p > 0.05). The control group had no significant differences concerning the overall burnout scores and all three subscales (p > 0.05).
CONCLUSIONS: The IPT-G used in this study effectively decreased burnout among care workers in a long-term care facility in Türkiye. In addition, the participants reported high satisfaction with the IPT-G program.
CONCLUSIONS: Our results support the usefulness of the IPT-G program for care workers in long-term care facilities considering adding it to their occupational health management. This research aimed to determine whether IPT-G successfully decreased care worker burnout. Future research focusing on various types of healthcare workers in long-term care facilities and examining factors such as burnout, job satisfaction and self-efficacy could provide more information on the effects of IPT-G.

Despite the health benefits of physical activity, many older adults living in long-term care facilities lead sedentary lifestyles and do not meet minimum physical activity recommendations. Determining the behavior change techniques (BCTs) used in physical activity interventions can help us understand the underlying mechanisms by which behavioral change is achieved. The purpose of this systematic review was to identify and evaluate BCTs in physical activity interventions for the elderly residents. Six electronic databases were searched and 15 eligible studies were retained. Nine promising BCTs associated with physical activity promotion among elderly residents were identified: credible source, social support (unspecified), goal setting (outcome), goal setting (behavior), demonstration of the behavior, instruction on how to perform a behavior, self-monitoring of behavior, self-monitoring of outcome(s) of behavior, and adding objects to the environment. Future research is encouraged to select and tailor these BCTs to the specific needs and preferences of the target population.

BACKGROUND: From March 7 to April 7, 2020, the Community of Madrid (CoM), Spain, issued interventions in response to the COVID-19 epidemic, including hospital referral triage protocols for long-term care facility (LTCF) residents (March 18-25). Those with moderate to severe physical disability and cognitive impairment were excluded from hospital referral. This research assesses changes in the association between daily hospital referrals and the deaths of LTCF residents attributable to the triage protocols.
METHODS: Daily hospital referrals and all-cause mortality from January to June 2020 among LTCF residents and the CoM population aged 65 + were obtained. Significant changes in LTCF resident daily hospital referrals time series, and in-LTCF and in-hospital daily deaths, were examined with tests for breaks and regimes in time series. Multivariate time series analyses were conducted to test changes in the associations between LTCF resident hospital referrals with daily deaths in-hospital and in-LTCF, and in the CoM population aged 65 + when the triage protocols were implemented.
RESULTS: Among LTCF residents, hospital referrals declined sharply from March 6 to March 23, 2020. Increases in LTCF residents\' daily deaths occurred from March 7 to April 1, followed by a decrease reaching pre-epidemic levels after April 28. The daily ratio of in-hospital deaths to in-LTCF deaths reached its lowest values from March 9 to April 19, 2020. The four versions of the triage protocol, published from March 18 to March 25 had no impact on further changes in the association of hospital referrals with daily deaths of LTCF residents in-hospital or in-LTCF.
CONCLUSIONS: While LTCF residents\' deaths increased, hospital referrals of LTCF residents decreased with the introduction of the CoM governmental interventions on March 7. They were implemented before the enactment of the triage protocols, protecting hospitals from collapse while overlooking the need for standards of care within LTCFs. The CoM triage protocols sanctioned the existing restrictions on hospital referrals of LTCF residents.

BACKGROUND: People with dementia and severe challenging behavior in the Netherlands can be temporarily admitted to highly specialized units when their behavior is not manageable in regular dementia special care units (DSCUs). With scarce evidence available for the treatment of these patients, treatment in these units is in a pioneering phase. To gain more insight into these units, this study investigated organizational characteristics, i.e. admission and discharge characteristics, staffing, the physical environment, and the management of severe challenging behavior.
METHODS: Three data collection methods were used: 1) a digital questionnaire to be completed by the unit manager, 2) an interview with the physician responsible for medical care and often another practitioner, and 3) an observation of the physical environment for which the OAZIS-dementia questionnaire was used. Descriptive analysis was used for quantitative data and thematic analysis for qualitative data, after which data was interpreted together. Thirteen units participated, with their sizes ranging from 10 to 28 places.
RESULTS: Patients were mainly admitted from regular DSCUs, home or mental health care, and discharged to regular DSCUs. A multidisciplinary team comprising at least an elderly care physician or geriatrician, psychologist, and nursing staff member and other therapists as needed provided the treatment. Nursing staff hours per patient considerably differed among units. Nursing staff played a central role in the treatment. Competences such as reflectiveness on one\'s own behavior, and being able to cope with stressful situations were described as relevant for nursing staff. Investing in a stable nursing staff team was described as important. The units varied in whether their work-up was more intuitive or methodological. In the diagnostic phase, observation together with an extensive analysis of the patient\'s biography was essential. The units used a broad variety of interventions, and all paid attention to sensory stimuli. In the observation of the physical environment, the safety scored well and domesticity relatively low.
CONCLUSIONS: Highly specialized units show strong heterogeneity in organizational characteristics and management, which can be understood in the light of the pioneering phase. Despite this, similarities were found in nursing staff roles, frequent multidisciplinary evaluation, and attention to sensory stimuli.

Navigating the evaluation and management of pain in long-term care homes is a complex task. Despite an extensive body of literature advocating for a paradigm shift in pain assessment and management within long-term care homes, much more remains to be done. The assessment of pain in long-term care is particularly challenging, given that a substantial proportion of residents live with some degree of cognitive impairment. Individuals living with dementia may encounter difficulties articulating the frequency and intensity of their pain, potentially resulting in an underestimation of their pain. In Canada and in the United States, the interRAI Minimum Data Set 2.0, Minimum Data Set 3.0, and the interRAI Long-Term Care Facilities assessments are administered to capture the presence and intensity of pain. These assessment instruments are used both on admission and quarterly, offering a reliable and validated method for comprehensive assessment. Nonetheless, the daily assessment and documentation of pain across long-term care homes, which is used to inform the interRAI Pain Scale, is not always consistent. The reality is that assessing pain can be inaccurate for several reasons, including the fact that it is rated by long-term care staff with diverse levels of expertise, resources, and education. This call for action explores the current approaches used in pain assessment and management within long-term care homes. The authors not only bring attention to the existing challenges but also emphasize the necessity of considering a more comprehensive assessment approach.

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BACKGROUND: Most older adults wish to remain in their homes and communities as they age. Despite this widespread preference, disparities in health outcomes and access to healthcare and social support may create inequities in the ability to age in place. Our objectives were to synthesise evidence of social inequity in ageing in place among older adults using an intersectional lens and to evaluate the methods used to define and measure inequities.
METHODS: We conducted a mixed studies systematic review. We searched MEDLINE, EMBASE, PsycINFO, CINAHL and AgeLine for quantitative or qualitative literature that examined social inequities in ageing in place among adults aged 65 and older in Organisation for Economic Co-operation and Development (OECD) member countries. Results of included studies were synthesised using qualitative content analysis guided by the PROGRESS-Plus framework.
RESULTS: Of 4874 identified records, 55 studies were included. Rural residents, racial/ethnic minorities, immigrants and those with higher socioeconomic position and greater social resources are more likely to age in place. Women and those with higher educational attainment appear less likely to age in place. The influence of socioeconomic position, education and social resources differs by gender and race/ethnicity, indicating intersectional effects across social dimensions.
CONCLUSIONS: Social dimensions influence the ability to age in place in OECD settings, likely due to health inequalities across the lifespan, disparities in access to healthcare and support services, and different preferences regarding ageing in place. Our results can inform the development of policies and programmes to equitably support ageing in place in diverse populations.

OBJECTIVE: Advance directives (AD) are based on state-specific statutes that vary in structure, terminology, and options. This variability leads to inconsistent end-of-life (EOL) care for patients who have executed an AD in one state but fall ill in another state. This study revisits a 2002 article that identified considerable differences in ADs to determine whether ADs have become more uniform.
METHODS: ADs from all 50 states and the District of Columbia were examined to determine the frequency of document types and seven key issues. The results were = compared to the 2002 study using non-parametric approaches. Mean numbers of key issues were compared using t-tests and one-way ANOVA.
RESULTS: Consistent with 2002, three states in 2023 provide statutes for Health Care Power of Attorney (HCPOA). However, states offering a combined HCPOA, and living will (LW), deemed an advance directive for health care (ADHC), increased from 13 to 30. Between both studies, Long Term Care increased significantly in LW and ADHC, while Artificial Sustenance significantly increased in LW. Despite the rising prevalence of Alzheimer\'s in the United States, only 10% of states included this issue in 2023.
CONCLUSIONS: Despite evolving healthcare trends, minimal revisions have been made to ADs since 2002. This lack of uniformity can cause confusion regarding proper understanding of EOL wishes. The authors recommend that the Uniform Act for Advance Directives be revisited to promote greater uniformity in ADs and ensure that individuals\' preferences are understood and respected across different states.

OBJECTIVE: For the first time in human history, older adults will outnumber children and a substantial and growing proportion will live alone and lack one or more nuclear family tie. Such unprecedented shifts require a reevaluation of existing models of \"successful aging\", particularly in terms of long-term care policies.
METHODS: This paper draws on country-level data from multiple publicly available sources (e.g., World Bank, Organization for Economic Cooperation and Development, Our World in Data, and the World Values Survey) to examine cross-national patterns of development, health, demography, resources and policies, and cultural values in low-, middle-, and high-income countries.
RESULTS: Although there exists substantial heterogeneity across countries, country-level patterns illustrate the economic privilege of living alone and the dominance of \"successful aging\" opportunities in high income countries. Cultural values about family reflect standard patterns of economic development, yet friendship emerges as a particularly consistent global value. At the country-level, living alone and health are associated in higher income countries with lower within-country inequality.
CONCLUSIONS: Aging \"alone\" is a risk factor in some contexts, yet a marker of privilege in others. Models of \"successful aging\" are largely unobtainable in lower income countries or high inequality countries, and therefore require a thorough incorporation of global realities, or final abandonment in favor of more nuanced structural perspectives. Long-term care policies that assume the presence of family will yield increasing risk over time across all global contexts and represent a key vulnerability in the future of healthy aging policy.