Archives of Gerontology and Geriatrics Plus最新文献

Background

The elderly population often has complex health needs due to multimorbidity, polypharmacy, and inappropriate prescriptions. Clinical pharmacists play an important role in optimizing pharmacotherapy as a part of a multidisciplinary geriatric care team. However, there is a lack of integrated models in developing countries.

Aim

To develop a standardized framework for the provision of clinical pharmacy services in geriatric care – A Comprehensive Geriatric Care Model.

Methods

A systematic service design process was used to develop an innovative geriatric care model in a tertiary hospital in southern India. The roles of stakeholders were captured through interviews and observations. Evidence-based clinical pharmacy services were developed focusing on medication reconciliation, medication review, patient counselling, and transitions of care.

Results

The Comprehensive Geriatric Care Model integrates the pharmacist into coordinated care. The responsibilities of physicians, nurses, patients, caregivers, and pharmacists throughout the inpatient stay are shown in swim-lane diagrams. Pharmacy services address inappropriate prescriptions, poor adherence, adverse drug reactions, and fragmented care.

Conclusions

The systematic development of an interprofessional geriatric care model embedded with evidence-based clinical pharmacy services was made possible using a patient-centered service design methodology. The implementation and evaluation of this collaborative approach could significantly improve the quality of care and outcomes for older adults.

Background

The COVID-19 pandemic has affected the lifestyle and mental health of community-dwelling older adults. Physical activity and social interaction are healthy lifestyle factors that can reduce psychological distress among community-dwelling older adults, although their effect may vary by sex. However, it is unclear how the anxiety and depression of older adults living in the community changed when measures were implemented to limit social interactions to control infection, as in the early stages of COVID-19, and what lifestyle factors helped ameliorate psychological distress in each sex.

Methods

This study included 550 participants aged 65 and older, who visited a drug store in Daito, Osaka Prefecture, Japan. Baseline questionnaire surveys were conducted from January to April 2021. Follow-up surveys were conducted three months after the baseline survey. We collected data on participants’ anxiety and depression symptoms using the Kessler Psychological Distress Scale-6 (K6), as well as on their lifestyle factors that may have affected anxiety and depression symptoms.

Results

A total of 520 participants completed the baseline and follow-up surveys. K6 scores did not show a significant difference, while the frequency of social interactions with neighbors, family, and friends increased significantly between the two surveys. Among women participants, more frequent moderate-intensity exercise and family interactions were associated with improved K6 scores.

Conclusions

When social interactions are restricted for infection control in community-dwelling older adults who are independent in activities of daily living including the ability to go out, social interactions recover over time, but anxiety and depressive symptoms persist. In women, lifestyle factors such as frequent moderate-intensity exercise may help reduce persisted anxiety and depression.

Background

The purpose of this review was to synthesise and determine the age-related change per annum in muscle thickness of the anterior thigh across the adult lifespan.

Methods

Electronic databases (PubMed, SPORTDiscus and MEDLINE) were searched for primary studies that were screened for eligibility.

Results

Following screening against eligibility criteria, 27 studies were included in the quantitative analysis. Linear regression revealed a 0.02 cm (95 % CI: −0.01, −0.03, p < 0.05) decline in mean muscle thickness per annum from 18 to 80 years of age, a 0.03 cm (95 % CI: −0.01 to −0.05) decline per annum between 20 and 49 years of age and a 0.05 cm (95 % CI: −0.03, −0.07) decline per annum between 50 and 80 years of age. There was a 1.5 cm (t (25) = 6.12, p < 0.05; 95 % CI= 0.98- 1.97 cm) mean difference in muscle thickness between the youngest (18–29yrs: 5.13 cm ± 0.38) and oldest adults (70–80yrs) 3.63 cm ± 0.63). There was no difference in the rate of decline of mean muscle thickness between males (−0.05 cm/annum, 95 % CI= −0.08, −0.02) and females (−0.04 cm/annum, 95 % CI= −0.07, −0.02). There was a larger difference in anterior thigh muscle thickness between the youngest and oldest in females (4.98 cm vs. 3.34 cm, 33 %, p < 0.05) compared with males (5.23 cm vs. 3.98 cm, 24 %, p < 0.05).

Conclusion

Mean anterior thigh thickness was estimated to decrease at a rate of 0.02 cm per annum and this rate of decrease was greater after 50 years of age. Females were more susceptible to age-related reductions in anterior thigh muscle thickness than males.

Purpose

The potential contributions of neuromuscular junction (NMJ) degradation to muscle loss in cancer remain poorly understood. We investigated the biomarkers of NMJ loss to muscle decline in patients with gynecological carcinomas.

Methods

We recruited women with endometrial (n = 37, 56–73 years old) or ovarian (n = 40, 55–72 years old) carcinomas along with age-matched controls (n = 47, 55–71 years old) controls, divided into two subgroups based on the presence of age-associated muscle loss, termed sarcopenia. We measured plasma c-terminal agrin-fragment-32 (CAF22; biomarker of NMJ loss), neurofilament light chain (NF-L; biomarker of neurodegeneration), handgrip strength (HGS), appendicular skeletal muscle mass index (AMMI), and short physical performance battery (SPPB; marker of physical capacity).

Results

Patients with endometrial or ovarian carcinomas exhibits low HGS, AMMI, and SPPB along with higher plasma NF-L levels than in controls (all p < 0.05). We found a modest elevation of plasma CAF22 levels in ovarian but not in endometrial carcinomas. The presence of sarcopenia was associated with further elevation of plasma NF-L but not CAF22 levels. Higher carcinoma stages were associated with higher plasma CAF22 in endometrial carcinoma and higher NF-L levels in both groups of carcinoma patients.

Conclusion

Collectively, NMJ degradation may have a modest contribution to muscle loss and sarcopenia in gynecological carcinomas. The strategies to counter muscle loss in carcinomas may target intrinsic changes within skeletal muscle independent of NMJ.

Many studies have investigated the temporal distribution of autobiographical memories, but none has focused on Self-Defining Memories (SDMs), i.e. memories that are particularly important for personal identity, in a large non-clinical sample. No study has examined the temporal distribution of Self-Defining Memories (SDMs), i.e. memories that are particularly important for personal identity, in a large non-clinical sample of older adults. Moreover, we examined for the first time the characteristics of SDMs located in RB. Two hundred and eighty elderly adults aged from 65 to 90 years old reported three SDMs. Participants were non-institutionalized retirees screened for global cognitive function. Participants were asked to recall three SDMs. They also completed the Mini-Mental State Examination. The period from 0 to 9 years corresponds to a very limited recall of SDMs. A RB appears between for the 10–24 years period. Recalled memories are enhanced after the age of 50. The temporal distribution of recalled SDMs differed according to thematic content and emotion. The percentage of positive SDMs was the highest in RB compared with other life periods. Specificity, meaning-making, tension, redemption and contamination did not differ for bump SDMs versus non-bump SDMs. In addition, differences between men and women were observed. Our results confirm the existence of the classical temporal distribution of autobiographical memories for SDMs. Recalling positive bump SDMs might improve well-being in older adults.

Background

Intrinsic capacity, the combination of physical and mental abilities, is vital for healthy aging. As the elderly population is projected to double by 2050, preserving the well-being of older adults necessitates a comprehensive understanding of and intervention in intrinsic capacity decline. This study aims to assess the pooled prevalence of intrinsic capacity impairment using WHO's ICOPE screening tool.

Methods

The systematic review used PRISMA guidelines, conducting an extensive search across multiple databases such as PUBMED, SCOPUS, CINHAL and Google Scholar. The articles that have assessed the intrinsic capacity with various domains like locomotion, cognition, psychology, vitality, vision, and hearing using WHO ICOPE tool were included in this review. We evaluated the risk of bias in cross-sectional studies using the modified Joanna Briggs Institute criteria.

Results

A total of nine studies were included for this review, involving participants from various regions all over the world. The pooled prevalence of intrinsic capacity impairment was 55.0 % in the Random Effects Model. While assessing for various domains, the pooled prevalence of locomotion, cognition, psychology, vitality, vision, and hearing was found to be 17.5 %, 18.2 %, 12.1 %, 8.5 %, 17.9 % and 14.4 % respectively.

Conclusion

This meta-analysis contributes a comprehensive overview of intrinsic capacity decline prevalence, offering valuable evidence for policymakers and healthcare stakeholders. The findings underscore the urgency of implementing targeted interventions to promote healthy aging and intrinsic capacity preservation worldwide.

Background

Aminoglycosides, maintaining antimicrobial efficacy, are considered for combating multidrug-resistant pathogens. Their contemporary use, combined with vigilant preventive strategies, may not universally lead to lasting renal complications in elderly inpatients.

Methods

This study examined data from the National Health Insurance Registry Database, focusing on elderly inpatients (aged 60 and above) hospitalized between 2000 and 2017 due to pneumonia, urinary tract infections, or bacteremia. Patients treated with aminoglycosides were compared to those receiving other antibiotics. Patient follow-up continued until the occurrence of renal disease, death, or for three months post-discharge, based on diagnoses coded in the International Classification of Diseases.

Results

Among 938,052 elderly inpatients admitted for infections, 29.19 % were prescribed aminoglycosides. Patients receiving aminoglycosides tended to be younger and had fewer associated health conditions compared to those treated with other antibiotics. The overall incidence of renal disease was 2.03 % during hospitalization and it increased to 17.45 % at the three-month follow-up. While no increased risk for renal disease was observed in the aminoglycoside group compared to other antibiotics, it correlated with higher rates of death and intensive care unit transfer. Specific comorbidities, such as diabetes mellitus, heart failure, and liver disease, exhibited a stronger association with the development of renal disease compared to aminoglycosides.

Conclusion

Current aminoglycoside use did not contribute to a higher incidence of lasting renal disease compared to other antibiotics but was linked to increased morbidity and mortality. Caution is crucial when administering aminoglycosides to elderly patients to prevent adverse outcomes.

Introduction

Falls present a significant public health concern in the United States as a primary cause of unintentional injury-related deaths among older adults. A fall risk assessment toolkit STEADI developed by the CDC has been shown to predict future falls. However, STEADI has issues with accurate evaluations due to the disagreement on cut-off scores in functional assessments and history-taking questionnaires. Wearable sensor technology offers a practical and quantifiable alternative for assessing an individual's movement performance in real-world environments. The use of Inertial Measurement Units (IMUs) offers considerable potential to enhance fall risk screening.

Purpose

The primary aim of this study is to test the agreement of STEADI functional assessment performance measured by the IMUs in comparison to human-based measurements.

Method

27 participants (Age: 74.37 ± 7.21) performed STEADI, including the Four-Stage Balance Test (4SBT), Timed Up & Go Test (TUG), 30-second Chair Stand (30sCS) with IMU placed at the fifth lumbar vertebra which is the proxy location of whole-body Center of Mass. By adopting an equivalent test, the STEADI agreement was tested between the human rater and IMU measurements, giving α = 0.05.

Result

Between the results from evaluators and IMU, the difference in TUG is -0.23 s, and the difference in 30sCS is 0.37, which is equivalent to within 4 % and 8 % for TUG and 30sCS, respectively. The difference in single-leg stance during the 4SBT is 0.59 s; however, the calculated equivalence zone is larger (22.7 %).

Conclusion

This study demonstrates the feasibility of using IMU sensors to enhance fall risk screening protocols based on the STEADI. Future refinement may still need to enable broader application and effective screening practices on a larger scale of the population.

Bedsores, commonly known as pressure ulcers, are a major healthcare issue with far-reaching effects on patient welfare and the healthcare system. This review provides an extensive summary of the existing body of knowledge on the management and prevention of bedsores. Traditional approaches for preventing bedsores include regular repositioning, nutritional assessments, the use of pressure-relief devices, and wound care protocols. Despite these approaches, the incidence of bedsores remains a challenge, and there is a need for further studies on customized pressure redistribution products and their impact on sleep quality. Technology-based prevention strategies for bedsores include the use of pressure-relieving support surfaces, such as smart mattresses and cushions, to monitor pressure, temperature, and humidity, allowing for adjustable firmness and contour redistribute pressure. Wearable sensors continuously monitor the pressure points, and pressure mapping systems assess the pressure distribution between the body and surface, providing real-time feedback. Telemedicine platforms and mobile apps for self-monitoring can also be employed to monitor patients remotely, assess skin conditions, and provide guidance for prevention and care. Clinical evidence assessing the effectiveness of various preventive tools and interventions suggests that they can improve patient outcomes and reduce the incidence of bedsores. It also outlines the complexities and limitations associated with managing pressure ulcers. The review explores several preventive techniques which highlights the economic and social burden of pressure ulcers

Objective

To investigate the mediating effect of decreased Intrinsic capacity(IC) between symptoms and ability to perform activities of daily living(ADL) in elderly patients with Heart failure(HF).

Methods

Using a convenience sampling method, 237 elderly patients with HF in the cardiology department of a Grade A Tertiary Hospital in Suzhou, China were selected from January 2022 to November 2022, and the General Information Questionnaire, Symptom Status Questionnaire-Heart Failure (SSQ-HF), Barthel Index Scale (BI), and IC Assessment Tool were applied to investigate the mediating effect of IC between HF symptoms and ADL using structural equation modeling.

Results

HF symptoms and decreased IC were associated with patients' ability to perform ADL (P=0.005, P<0.001), and decreased IC partially mediated the effect between HF symptoms and ADL, indirectly negatively predicting ADL with a mediating effect of -0.412, accounting for 59.11% of the total effect.

Conclusion

Decreased IC in elderly patients with HF is a mediating variable between HF symptoms and ADL. Healthcare professionals can use the multidimensional assessment framework of IC to identify early the risk of impaired ADL in elderly HF patients and to provide targeted rehabilitation interventions for this group of patients.