Archives of Gerontology and Geriatrics Plus最新文献

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.

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.