Ageism in healthcare has received increased attention in recent years, but literature focusing on how it affects individuals living with rare diseases remains scant. The rare disease population already faces obstacles when navigating health systems, and ageism has the potential to exacerbate existing health inequities. We conducted a systematic review of peer-reviewed and gray literature on health inequities in rare disease populations, seeking to identify publications that reported primary or secondary data on the equitable or inequitable treatment of these populations, or that discussed related regulatory, moral, or philosophical issues. Our aims were to understand how health inequities in these populations arise, how they are justified from societal points of view, how they manifest themselves in laws and regulations, and what effects they have on health care access and health outcomes. We retrieved information from 63 publications, which we inductively synthesized into five categories: ethical discussions, societal preferences, regulations, access to care, and health outcomes. Integrating insights from these categories, we developed an Ethical Spectrum and Resource Allocation Framework, which explains the emergence of equity issues and how they are manifested in health systems. By providing a better understanding of the root causes of health inequities, particularly among older adults, the framework can inform health policymaking, improving access to care and health outcomes for rare disease patients.

Ageism in healthcare has received increased attention in recent years, but there appears to be scant literature focusing on how it affects individuals living with rare diseases. The rare disease population already faces obstacles when navigating health systems, and ageism has the potential to exacerbate existing health inequities. We conducted a systematic review of peer-reviewed and gray literature on health inequities in rare disease populations, seeking to identify publications that reported primary or secondary data on the equitable or inequitable treatment of these populations, or discussed related regulatory, moral, or philosophical issues. Our aims were to understand how health inequities in these populations arise, how they are justified from societal points of view, how they manifest themselves in laws and regulations, and what effects they have on health care access and health outcomes. We retrieved information from 63 publications, which we inductively synthesized into five categories: ethical discussions, societal preferences, regulations, access to care, and health outcomes. Integrating insights from these categories, we developed an Ethical Spectrum and Resource Allocation Framework, which explains the emergence of equity issues and how they are manifested in health systems. By providing a better understanding of the root causes of health inequities, particularly among older adults, the framework can inform health policymaking, improving access to care and health outcomes for rare disease patients.

Background: At the inter of old age and illness, older adults with life-threatening illnesses (LTI) are a group who often show resilience and seek validation of life, acceptance, and integration of past and now, even under the fear of loss, suffering, and dying evoked by life adversities. Life review has been widely conducted to help older adults enhance well-being and cope with burdens. Spirituality is an important part of an older adult' overall well-being, especially for those with LTI. However, few review studies examined the effectiveness of life review interventions on psychospiritual outcomes among this population. The aim of the study was to examine the effectiveness of life review on psychospiritual well-being among older adults with LTI.Methods: A systematic review with meta-analysis following the recommendations of the Cochrane Collaboration was conducted. Database searches included PubMed, PsycINFO, the Cochrane Library, the Campbell Library, EBSCO, CNKI, and the Airiti Library up to March 2020. Gray literature and reference lists from relevant articles were also searched and reviewed.Results: In total, 34 studies were included in the systematic review and the meta-analysis for outcomes of depression (n = 24), quality-of-life (QOL) (n = 10), anxiety (n = 5), life satisfaction (n = 3), mood (n = 3), apathy (n = 2), and general well-being (n = 2). Other psychospiritual outcome measures included spirituality, self-esteem, meaning in life, hope, and some multi-dimensional instruments. The studies greatly varied in program design, content, format, length, and more. Although with high heterogeneity, meta-analysis results demonstrated standardized mean differences in favor of life review in decreasing depression, anxiety, negative mood, and increasing positive mood and QOL compared with the control group.Conclusion: This review calls for including more psycho-spiritual well-being measures among interventions for older adults with LTI, as well as studies with rigorous designs in future research.

(1) Background: To review the associated factors of sarcopenia in community-dwelling older adults. (2) Methods: PubMed, Embase, Web of Science, and four Chinese electronic databases were searched for observational studies that reported the associated factors of sarcopenia from inception to August 2021. Two researchers independently selected the literature, evaluated their quality, and extracted relevant data. The pooled odds ratio (OR) and its 95% confidence interval (CI) were calculated for each associated factors of sarcopenia using random-effects/fixed-effects models. Publication bias was assessed using funnel plot and the Eggers test. We performed statistical analysis using Stata 15.0 software. (3) Results: A total of 68 studies comprising 98,502 cases were included. Sociodemographic associated factors of sarcopenia among community-dwelling older adults included age (OR = 1.12, 95% CI: 1.10-1.13), marital status (singled, divorced, or widowed) (OR = 1.57, 95% CI: 1.08-2.28), disability for activities of daily living (ADL) (OR = 1.49, 95% CI: 1.15-1.92), and underweight (OR = 3.78, 95% CI: 2.55-5.60). Behavioral associated factors included smoking (OR = 1.20, 95% CI: 1.10-1.21), physical inactivity (OR = 1.73, 95% CI: 1.48-2.01), malnutrition/malnutrition risk (OR = 2.99, 95% CI: 2.40-3.72), long (OR = 2.30, 95% CI: 1.37-3.86) and short (OR = 3.32, 95% CI: 1.86-5.93) sleeping time, and living alone (OR = 1.55, 95% CI: 1.00-2.40). Disease-related associated factors included diabetes (OR = 1.40, 95% CI: 1.18-1.66), cognitive impairment (OR = 1.62, 95% CI: 1.05-2.51), heart diseases (OR = 1.14, 95% CI: 1.00-1.30), respiratory diseases (OR = 1.22, 95% CI: 1.09-1.36), osteopenia/osteoporosis (OR = 2.73, 95% CI: 1.63-4.57), osteoarthritis (OR = 1.33, 95% CI: 1.23-1.44), depression (OR = 1.46, 95% CI: 1.17-1.83), falls (OR = 1.28, 95% CI: 1.14-1.44), anorexia (OR = 1.50, 95% CI: 1.14-1.96), and anemia (OR = 1.39, 95% CI: 1.06-1.82). However, it remained unknown whether gender (female: OR = 1.10, 95% CI: 0.80-1.51; male: OR = 1.50, 95% CI: 0.96-2.34), overweight/obesity (OR = 0.27, 95% CI: 0.17-0.44), drinking (OR = 0.92, 95% CI: 0.84-1.01), hypertension (OR = 0.98, 95% CI: 0.84-1.14), hyperlipidemia (OR = 1.14, 95% CI: 0.89-1.47), stroke (OR = 1.70, 95% CI: 0.69-4.17), cancer (OR = 0.88, 95% CI: 0.85-0.92), pain (OR = 1.08, 95% CI: 0.98-1.20), liver disease (OR = 0.88, 95% CI: 0.85-0.91), and kidney disease (OR = 2.52, 95% CI: 0.19-33.30) were associated with sarcopenia. (4) Conclusions: There are many sociodemographic, behavioral, and disease-related associated factors of sarcopenia in community-dwelling older adults. Our view provides evidence for the early identification of high-risk individuals and the development of relevant interventions to prevent sarcopenia in community-dwelling older adults.

To assess and compare the QoL of the older people dwelling in traditional family versus nursing home/institution. A comprehensive literature search was performed on 10 January 2018 to identify studies that investigated the QoL of older adults dwelling in family versus nursing home settings. Analyses were run using random-effects meta-analyses. A total of six cross-sectional studies with 1623 people were included. The quality of included studies was moderate. Meta-analysis showed that compared with nursing home support, the family support could significantly improve the physical health (6 studies, SMD = 0.50, 95%CI: 0.32-0.68, p < 0.05), mental status (6 studies, SMD = 0.45, 95%CI: 0.26-0.65, p < 0.05), and social relationship (5 studies, SMD = 0.51, 95%CI: 0.19-0.83, p < 0.05). Traditional family support model demonstrated a significant improvement in the physical health, psychological status and social relationships among older adults. The conclusions were driven by cross-sectional studies, Larger, adequately powered RCTs are required to confirm our finding.

Objective: The study aimed to evaluate the effectiveness of health education intervention for the control of blood pressure (BP) in older adults with hypertension. Methods: Five databases were searched in March 2018 for randomized controlled trials to manage hypertension in older adults by health education. The primary outcomes were changes in systolic and diastolic BP. RevMan5 was used for meta-analysis. Results: Seven articles with 1,105 participants were included. In them, 393 (35.56%) older adults participated in health education interventions in the form of courses, and 226 (20.45%), in health education sessions. The meta-analysis suggested an overall reduction in systolic BP after health education courses (SMD, standardized mean difference = 4.80, 95% CI: 7.01-2.59, p < .05). Similar results were observed after health education sessions (SMD = 11.73, 95% CI: 17.63-5.82, p < .05). The diastolic BP reduction showed no difference after the health education course (p = .09). The random effects meta-analysis suggested an overall reduction in diastolic BP after health education sessions (SMD = 5.39, 95% CI: 7.98-2.79, p < .05). Conclusion: Although different health education methods had different effects on hypertension control, overall, educational interventions can potentially lead to improved BP control.

Objective: To assess the effectiveness of non-pharmacological interventions for seniors with depressive symptoms. Methods: A comprehensive literature search was performed. We conducted network meta-analysis in two ways, intervention classes (psychosocial, psychotherapy, physical activity, combined, treatment as usual) and individual intervention (11 categories). Whenever included studies used different scales, the different instruments were converted to the units of the scale most frequently used (the Geriatric Depression Scale), such that the effect size was reported as a mean difference (MD) with 95% confidence interval (CI). The risk of bias of RCTs included in this review was assessed according to the Cochrane Handbook. Bayesian NMA was conducted using R-3.4.0 software. Results: A total of 35 RCTs with 3,797 enrolled patients were included. Compared to conventional treatment, physical activity and psychotherapy resulted in significant improvements in depressive symptoms (MD: 2.25, 95%CrI: 0.99-3.56; SUCRA = 86.07%; MD: 1.75, 95% CrI: 0.90-2.64; SUCRA = 66.44%, respectively). Similar results were obtained for music (MD: 2.6; 95% CrI: 0.84-4.35;SUCRA = 80.53%), life review (MD:1.92; 95% CrI:0.71-3.14; SUCRA = 65.62%), cognitive behavioral therapy (MD: 1.27; 95% CrI: 0.23-2.38; SUCRA = 45.4%), aerobic (MD: 1.84; 95% CrI: 0.39-3.36; SUCRA = 63%) and resistance training (MD: 1.72; 95% CrI: 0.06-3.42; SUCRA = 59.24%). Network meta-regression showed that there were no statistically significant subgroup effects. Conclusions: Physical activity and psychotherapy demonstrated statistically significant superiority over conventional treatment. Music and life review therapy proved the most promising individual interventions. However, conclusions are limited by the lack of sufficient sample size and consensus regarding intervention categories and so an adequately powered study is necessary to consolidate these findings.