Archives of Gerontology and Geriatrics Plus最新文献

This paper aims to examine the concept of functional decline in older adults from a physiotherapist's perspective. Throughout this paper, the author will shed some light on the conceptualization, identification, and assessment of functional decline among older adults. Also, a reflection on the role of physiotherapists in promoting healthy aging and how prepared they are to meet the changing demographic landscape will be discussed. A narrative literature review methodology was used to search for and analyze relevant articles that have been published in the past three decades. The reviewed materials included peer-reviewed publications that examined the assessment of physical functional decline in older adults. The assessment of functional decline in older adults is commonly done through one assessment measure at a time. Furthermore, assessments for functional decline often happen in emergency rooms when something catastrophic has taken place, such as a fall injury. The findings also suggest that multi-domain assessments are more useful than single-domain assessments in this population. One promising assessment tool for the identification of older adults who are at risk of developing functional decline that is specific to physiotherapy practice was identified and discussed. There is a need for further research to refine the assessment process, and to develop interventions to prevent or mitigate functional decline. Overall, this paper provides valuable insights into current assessment measures of functional decline in older adults relevant to physiotherapy practice and suggests potential areas for future research.

Objectives

We aimed to examine the association between population aging and the prevalence of non-communicable diseases and risk factors in the Brazilian population.

Study design

An ecological study using secondary data from 2010 to 2023 of the Surveillance System of Risk and Protective Factors for Chronic Diseases by Telephone Survey (VIGITEL).

Methods

We estimated the aging rate in 2010 and 2022 as the ratio of people aged 65 or older to those younger than 15 using the 2010 and 2022 Brazilian censuses. We calculated the absolute differences in the prevalence of non-communicable diseases (hypertension, diabetes) and their risk factors (smoking, excessive alcohol consumption, physical inactivity, obesity) and negative health perceptions in 2010 and 2023 for the 26 Brazilian states and the Federal District. Linear regression assessed the relationship between aging rate and health outcomes. We stratified the analyses to explore the differences by sex.

Results

Brazil's aging rate was higher among women than men (average of 0.20 and 0.31, respectively). The increased number of older adults was associated with a higher prevalence of excess weight and diabetes in men. In women, the aging rate was associated with a higher prevalence of smoking, excessive alcohol consumption, obesity, hypertension, and diabetes.

Conclusions

Our findings show a sex-specific association between population aging and the prevalence of health conditions in the Brazilian population. By discerning the sex-specific nuances and untangling the multifactorial influences, this research aspires to contribute valuable insights to the burgeoning field of public health in the face of evolving demographic landscapes.

Purpose

A reduction in life space (LS) is associated with a negative impact on medical and functional status during hospitalization, with potential consequences after discharge. A validated version of an evaluation tool for assessing LS in Japanese individuals in an institutionalized setting is lacking. This study developed and validated a Japanese version of the Life-Space Assessment in Institutionalized Settings (LSA-IS-J).

Material and methods

The LSA-IS-J was developed using a specified process. This study included 30 inpatients admitted to the rehabilitation ward. The Timed Up and Go Test, Berg Balance Scale scores, 10-meter walking time, Functional Independence Measure, and Falls Efficacy Scale-International were used to assess construct validity. For test-retest reliability, the same assessor evaluated the LSA-IS-J within two days. Correlation coefficients were calculated to determine the construct validity.

Results

The mean LSA-IS-J total score mean was 37.7 (standard deviation: 7.4), with skewness of -0.17 and kurtosis of -1.39. No ceiling or floor effects are observed. The test-retest reliability was excellent for the total and subtests, with intraclass correlations ranging from 0.78 to 0.99. The LSA-IS-J showed significant correlations with almost all variables related to motor status and concerns about falling, indicating high construct validity. In contrast, more generic variables were not significantly associated.

Conclusions

The LSA-IS-J demonstrated broad feasibility for assessing LS without ceiling or floor effects among patients undergoing ward-based rehabilitation. The LSA-IS-J also demonstrated excellent test-retest reliability and adequate construct validity for constructs with a high impact on LS.

Background

The ability to successfully perform various physical and cognitive tasks simultaneously is a required goal for older adults (OA). Brain areas such as the dorsolateral prefrontal cortex (DLPFC) are involved in cognitive processing during walking and balance tasks, with transcranial direct current stimulation (tDCS) used in modulating the excitability of brain cortical areas such as the DLPFC.

Objectives

To evaluate the available scientific evidence on the effects of tDCS on dual-task (DT) Performance (PF) in older and young adults.

Methods

Databases of PEDro, Web of Science, PubMed, Embase, and Cochrane Library were searched from inception until December 2023. RCTs were included. The risk of bias (ROB) and methodological quality of the included RCTs were assessed with the appropriate Cochrane ROB assessment tool, and PEDro scale respectively. Both narrative and quantitative synthesis were used for data analysis.

Results

The result revealed that real tDCS significantly reduced: dual-task cost (DTC) on gait speed (MD = 3.68, 95 %CI-1.04 to 6.33, P = 0.006), DTC on postural sway (PS) velocity (MD = -25.49, P < 0.00001), DTC on PS area (MD = -53.96, P < 0.00001), and significantly improved DT PS velocity (SMD = -0.61, P = 0.02), with low certainty of evidence post- experiment compared to sham tDCS in OA. However, in young adults, there was no significant difference post-experiment between real and sham tDCS on DT stride time variability (P = 0.18) and DTC on stride time variability (P = 0.34) with low certainty of evidence.

Conclusions

tDCS especially anodal tDCS to the DLPFC significantly improved DT PS velocity and area, and also significantly reduced DTC on gait speed, PS velocity, and area in OA.

Background

This study aims to investigate the levels of interleukin6(IL6), interleukin 10(IL10), the IL6:IL10 ratio, and various anthropometric measurements in different stages of sarcopenia among older individuals.

Methodology

Conducted as a one-year cross-sectional study using purposive sampling, involving individuals aged 58–85 years, screened for sarcopenia based on the AWGS-2019 criteria. Case-finding methods included the SARCCalF questionnaire, handgrip strength(HGS), and chair-stand tests(CST). Anthropometric measurementswere recorded for all participants, allowing for the calculation of body mass index(BMI), waist-to-hip ratio(WHR), and appendicular skeletal muscle mass index(ASMI). Additionally, IL6 and IL10levels were estimated using Sandwich-ELISA.

Results

Among the 130participants, 33 were free from sarcopenia, 35 exhibited pre-sarcopenia, 29 had sarcopenia, and 33 presented severe-sarcopenia. A majority (63 %) of the participants were male, and a substantial portion (77 %) had both diabetes and sarcopenia. The study's findings revealed that the SARCCalF questionnaire demonstrated a lower mean score in the non-sarcopenia group, with an increasing trend from pre-sarcopenia to severe-sarcopenia groups. HGS, CST results, and ASMI exhibited a reverse trend. Post-Hoc Tukey's tests revealed that IL6, IL10, IL6:IL10, and Calf Circumference(CC) exhibited significant differences between the study groups. Furthermore, ROC analysis demonstrated that IL6, IL10, IL6:IL10, and CC possessed an AUC ranging between 0.7 and 0.9, showcasing good sensitivity and specificity in distinguishing between non-sarcopenia and pre-sarcopenia.

Conclusion

This study highlights the utility of IL6, IL10, IL6:IL10, and CC in the early identification of pre-sarcopenia among older individuals, offering valuable insights for clinicians to intervene promptly and enhance their quality of life.

Purpose

The aim of this study is to analyse adverse health outcomes at hospital discharge adjusted to frailty degree measured by three instruments in patients admitted for medical diseases in an Acute Care for Elders (ACE).

Methods

This is a prospective observational study, including 194 frail patients aged 75 years or older. Patients were admitted to a tertiary hospital ACE for an acute medical illness or exacerbated chronic diseases from June 2022 to May 2023. Frailty was assessed by the FRAIL scale, the Clinical Frailty Scale (CFS) and the frail-VIG Index (IF-VIG). Health outcomes analysed were length of hospital stay, home destination at hospital discharge, development of delirium and functional decline.

Results

Patients were on average 85,14 years old, with 56 % women. Mean frailty punctuations were 2,83 for FRAIL scale; 4,1 for CFS and 0,3 for IF-VIG. Patients who did not return home were more fragile: FRAIL 3,1 vs 2,6; CFS 4,5 vs 4,0; IF-VIG 0,3 vs 0,2. Patients with a hospitalization longer than 10 days were more fragile: FRAIL 3,9 vs 2,6; CFS 4,5 vs 3,8; IF-VIG 0,3 vs 0,2. More frail patients had greater delirium incidence and prevalence: CFS 4,7 vs 4,1; IF-VIG 0,3 vs 0,2. These results are statistically significant.

Conclusions

A greater degree of basal frailty during a hospitalisation in an ACE is strongly related with smaller return home rates at hospital discharge, as well as with longer mean stay-length and larger amounts of delirium.

Background

Tai Chi has been recommended as a fall prevention exercise for older adults and may be particularly beneficial during the coronavirus (COVID-19) pandemic. This study aimed to investigate the benefits of regular Tai Chi practice on standing balance among older adults living in a nursing home during COVID-19 restrictions.

Methods

A cross-sectional study was conducted with 38 older adults from a nursing home during COVID-19 extended restrictions. Participants were assigned to a Tai Chi group (n = 18, with more than five years of Tai Chi experience) and a control group (n = 20, with no Tai Chi experience). Postural sway during standing balance was assessed under four conditions: eyes open (EO); eyes closed (EC); eyes open with the right leg crossed forward (ER); and eyes open with the left leg crossed forward (EL). Furthermore, participants completed questionnaires face-to-face regarding their physical activity (PA) and sleep quality during the COVID-19 period.

Results

The Tai Chi group exhibited significantly less postural sway than the control group, particularly under EO and EL conditions (p < 0.05). Both groups had similar sleep quality but different PA profiles.

Conclusion

Regular Tai Chi practice may help maintain standing balance in older adults, even with limited outdoor mobility due to COVID-19 restrictions. Tai Chi could be an effective home-based exercise for preventing balance decline and potential falls among older adults living in nursing homes during the pandemic. Future studies should investigate the long-term effects of Tai Chi on fall prevention in this population.

Background

Physical performance is a major contributor to frailty and sarcopenia. Healthier behaviour (diet and physical activity (PA)) are important, but the applicability of the evidence should be carefully discussed in the general older population and the population aged 85 years and older (85+ population). Evidence in the 85+ population is rare and there are no studies focusing on the healthier behaviours.

Methods

Data (n = 519) from the Tokyo Oldest Old survey on Total Health study were used. From each validated questionnaire in this age group, the dietary patterns (DPs) was identified, and the PA was estimated. Physical performance tests included grip strength, timed up-and-go test, and chair standing, which are important for assessing frailty or sarcopenia. Linear regression models were used to examine the relationship between the combination of DP and PA to physical performance.

Results

DPs identified `Various plant foods' (DP1), `Fish and mushrooms' (DP2), and `Cooked rice and miso soup' (DP3) were identified. The median PAI was 9.0 METs × h/week. Based on the characteristics of the combination of DP and PA with unhealthy behaviour as the reference group, all combinations were significantly associated with all physical performance tests if both achieved. However, it was observed that some combinations were not significantly associated with DP or PA alone.

Conclusions

Healthy behaviours (both diet and PA) are important for physical performance in the 85+ population. The association of PA in the 85+ population may vary depending on the dietary status of the individual.

Background

There is an association between oral health and frailty, implying that tooth loss and periodontal disease increase the risk of frailty. To examine the association between oral health status and behaviors and frailty in individuals aged ≥ 75 years.

Methods

A total of 7,927 participants underwent oral health examinations at the ages of 75, 77, and 80 years. The questionnaire for medical checkup of old-old (QMCOO) was used to assess frailty. Modified Poisson regression analysis was performed, with frailty as the dependent variable and family dentist, regular dental checkups, number of teeth, periodontal status, and swallowing function as independent variables. Modified Poisson regression analyses were conducted using the presence or absence of nine QMCOO domains (excluding smoking) as dependent variables.

Results

Participants with a family dentist, those who underwent regular dental checkups, and those with a greater number of teeth had significantly lower relative risks (RRs) for frailty, with RRs of 0.72 [95 % confidence interval (CI): 0.59–0.89], 0.70 (95 % CI: 0.63–0.79), and 0.97 (95 % CI: 0.96–0.98), respectively. By contrast, individuals with periodontal pockets ≥ 6 mm and those with reduced swallowing function had significantly higher RRs for frailty [1.17 (95 % CI: 1.01–1.36) and 1.94 (95 % CI: 1.57–2.40), respectively]. Oral health status and behavior were also associated with QMCOO domains.

Conclusion

Older individuals with good oral health had a lower likelihood of frailty. Regular oral care provided by a family dentist can reduce some of the negative effects of aging.