Background: As the global population ages, the demand for family caregivers is expected to increase, underscoring the necessity to comprehend their support needs and challenges they face. However, caregiving often comes with various challenges and support needs that require attention. This study was aimed to gain an in-depth understanding of the support needs and challenges faced by family caregivers who provide care to their elderly loved ones at home. Methods: The study was conducted in Mekelle City, Ethiopia from December 2022 to October 2023 using a phenomenology study design and purposive sampling technique. A total of twenty-two in-depth interviews were conducted using an open-ended guide. The interviews were transcribed verbatim, entered into ATLAS.ti8 software, translated, and analyzed using a thematic analysis. Results: The study found that family caregivers face communication, financial, medication management, and transportation challenges in caring for elderly relatives at home. It also highlighted several key support needs of family caregivers in the care of elderly relatives at home. These includes financial assistance, training, access to information, and support from healthcare professionals. Limitations: Qualitative research, by its nature, is subjective as it relies on the perceptions and interpretations of the participants. Moreover, in qualitative studies, researchers typically work with a limited number of participants, in qualitative studies, researchers typically work with a limited number of participants, resulting in conclusions that may not reflect the experiences of all family caregivers. Conclusion: This qualitative study underscored the multitude of challenges faced by family caregivers in their role as primary caregivers for elderly relatives. The research also highlighted the pressing need for support systems that would address the physical, emotional, financial, and informational needs of these caregivers.
{"title":"Understanding the Support Needs and Challenges Faced by Family Caregivers in the Care of Their Older Adults at Home. A Qualitative Study","authors":"Gebrezabher Niguse Hailu, Muntaha Abdelkader, Hailemariam Atsbeha Meles, Tesfay Teklu","doi":"10.2147/cia.s451833","DOIUrl":"https://doi.org/10.2147/cia.s451833","url":null,"abstract":"<strong>Background:</strong> As the global population ages, the demand for family caregivers is expected to increase, underscoring the necessity to comprehend their support needs and challenges they face. However, caregiving often comes with various challenges and support needs that require attention. This study was aimed to gain an in-depth understanding of the support needs and challenges faced by family caregivers who provide care to their elderly loved ones at home.<br/><strong>Methods:</strong> The study was conducted in Mekelle City, Ethiopia from December 2022 to October 2023 using a phenomenology study design and purposive sampling technique. A total of twenty-two in-depth interviews were conducted using an open-ended guide. The interviews were transcribed verbatim, entered into ATLAS.ti8 software, translated, and analyzed using a thematic analysis.<br/><strong>Results:</strong> The study found that family caregivers face communication, financial, medication management, and transportation challenges in caring for elderly relatives at home. It also highlighted several key support needs of family caregivers in the care of elderly relatives at home. These includes financial assistance, training, access to information, and support from healthcare professionals.<br/><strong>Limitations:</strong> Qualitative research, by its nature, is subjective as it relies on the perceptions and interpretations of the participants. Moreover, in qualitative studies, researchers typically work with a limited number of participants, in qualitative studies, researchers typically work with a limited number of participants, resulting in conclusions that may not reflect the experiences of all family caregivers.<br/><strong>Conclusion:</strong> This qualitative study underscored the multitude of challenges faced by family caregivers in their role as primary caregivers for elderly relatives. The research also highlighted the pressing need for support systems that would address the physical, emotional, financial, and informational needs of these caregivers.<br/><br/>","PeriodicalId":10417,"journal":{"name":"Clinical Interventions in Aging","volume":"10 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2024-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140125227","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Bogusława Ołpińska, Rafał Wyderka, Maria Łoboz-Rudnicka, Barbara Brzezińska, Krystyna Łoboz-Grudzień, Joanna Jaroch
Background: Little is known about the effect of cardiac rehabilitation (CR) on carotid arterial stiffness (CAS) in patients with myocardial infarction (MI). Patients and Methods: Rehabilitation group (B) included 90 patients with MI subjected to CR, control group (K) consisted of 30 patients with MI not participating in CR, and healthy group comprised 38 persons without cardiovascular risk factors. CAS was determined using echo-tracking before and after CR. Results: At baseline, patients with MI (B+K) presented with significantly higher mean values of CAS parameters: beta-stiffness index (7.1 vs 6.4, p = 0.004), Peterson’s elastic modulus (96 kPa vs 77 kPa, p < 0.001) and PWV-beta (6.1 m/s vs 5.2 m/s, p < 0.001) than healthy persons. Age (beta: r = 0.242, p = 0.008; EP: r = 0.250, p = 0.006; PWV-beta: r = 0.224, p = 0.014) and blood pressure: SBP (EP: r = 0.388, PWV-beta: r = 0.360), DBP (AC: r = 0.225) and PP (PWV-beta: r = 0.221) correlated positively with the initial parameters of CAS. Beta-stiffness index (Rho=− 0.26, p = 0.04) and PWV-beta (Rho = 0.29, p = 0.03) correlated inversely with peak exercise capacity expressed in METs. After CR, mean values of beta-stiffness index (6.2 vs 7.1, p = 0.016), EP (78 kPa vs 101 kPa, p = 0.001) and PWV-beta (5.4 m/s vs 6.2 m/s, p = 0.001) in group B were significantly lower than in group K. In group B, CAS parameters decreased significantly after CR. Univariate analysis demonstrated that the likelihood of an improvement in CAS after CR was significantly higher in patients with baseline systolic blood pressure < 120 mm Hg (OR = 2.74, p = 0.009) and left ventricular ejection fraction < 43% (OR = 5.05, p = 0.005). Conclusion: In patients with MI, CR exerted a beneficial effect on CAS parameters. The improvement in CAS was predicted by lower SBP and LVEF at baseline.
背景：人们对心脏康复（CR）对心肌梗死（MI）患者颈动脉僵硬度（CAS）的影响知之甚少：康复组（B）包括90名接受心脏康复治疗的心肌梗死患者，对照组（K）包括30名未参加心脏康复治疗的心肌梗死患者，健康组包括38名无心血管危险因素的患者。CAS在CR前后通过回声跟踪进行测定：基线时，心肌梗死患者（B+K）的 CAS 参数平均值明显高于健康人：β-刚度指数（7.1 vs 6.4，p = 0.004）、彼得森弹性模量（96 kPa vs 77 kPa，p < 0.001）和脉搏波速度-β（6.1 m/s vs 5.2 m/s，p < 0.001）。年龄（β：r = 0.242，p = 0.008；EP：r = 0.250，p = 0.006；PWV-β：r = 0.224，p = 0.014）和血压：SBP（EP：r = 0.388，PWV-β：r = 0.360）、DBP（AC：r = 0.225）和 PP（PWV-β：r = 0.221）与 CAS 的初始参数呈正相关。β-僵化指数（Rho=- 0.26，P=0.04）和脉搏波速度-β（Rho=0.29，P=0.03）与以 METs 表示的峰值运动能力成反比。CR 后，B 组的β-僵硬度指数（6.2 vs 7.1，p = 0.016）、EP（78 kPa vs 101 kPa，p = 0.001）和脉搏波速度-β（5.4 m/s vs 6.2 m/s，p = 0.001）的平均值显著低于 K 组。单变量分析显示，基线收缩压为 120 mm Hg（OR = 2.74，p = 0.009）和左室射血分数为 43% （OR = 5.05，p = 0.005）的患者 CR 后 CAS 改善的可能性明显更高：结论：在心肌梗死患者中，CR对CAS参数产生了有益的影响。结论：在心肌梗死患者中，CR对CAS参数产生了有益的影响，基线时较低的SBP和LVEF预示着CAS的改善。
{"title":"Early Cardiac Rehabilitation Improves Carotid Arterial Stiffness in Patients with Myocardial Infarction","authors":"Bogusława Ołpińska, Rafał Wyderka, Maria Łoboz-Rudnicka, Barbara Brzezińska, Krystyna Łoboz-Grudzień, Joanna Jaroch","doi":"10.2147/cia.s452362","DOIUrl":"https://doi.org/10.2147/cia.s452362","url":null,"abstract":"<strong>Background:</strong> Little is known about the effect of cardiac rehabilitation (CR) on carotid arterial stiffness (CAS) in patients with myocardial infarction (MI).<br/><strong>Patients and Methods:</strong> Rehabilitation group (B) included 90 patients with MI subjected to CR, control group (K) consisted of 30 patients with MI not participating in CR, and healthy group comprised 38 persons without cardiovascular risk factors. CAS was determined using echo-tracking before and after CR.<br/><strong>Results:</strong> At baseline, patients with MI (B+K) presented with significantly higher mean values of CAS parameters: beta-stiffness index (7.1 vs 6.4, p = 0.004), Peterson’s elastic modulus (96 kPa vs 77 kPa, p < 0.001) and PWV-beta (6.1 m/s vs 5.2 m/s, p < 0.001) than healthy persons. Age (beta: r = 0.242, p = 0.008; EP: r = 0.250, p = 0.006; PWV-beta: r = 0.224, p = 0.014) and blood pressure: SBP (EP: r = 0.388, PWV-beta: r = 0.360), DBP (AC: r = 0.225) and PP (PWV-beta: r = 0.221) correlated positively with the initial parameters of CAS. Beta-stiffness index (Rho=− 0.26, p = 0.04) and PWV-beta (Rho = 0.29, p = 0.03) correlated inversely with peak exercise capacity expressed in METs. After CR, mean values of beta-stiffness index (6.2 vs 7.1, p = 0.016), EP (78 kPa vs 101 kPa, p = 0.001) and PWV-beta (5.4 m/s vs 6.2 m/s, p = 0.001) in group B were significantly lower than in group K. In group B, CAS parameters decreased significantly after CR. Univariate analysis demonstrated that the likelihood of an improvement in CAS after CR was significantly higher in patients with baseline systolic blood pressure < 120 mm Hg (OR = 2.74, p = 0.009) and left ventricular ejection fraction < 43% (OR = 5.05, p = 0.005).<br/><strong>Conclusion:</strong> In patients with MI, CR exerted a beneficial effect on CAS parameters. The improvement in CAS was predicted by lower SBP and LVEF at baseline.<br/><br/>","PeriodicalId":10417,"journal":{"name":"Clinical Interventions in Aging","volume":"20 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2024-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140125247","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Daoda Qi, Yang Chen, Chengyi Peng, Yuan Wang, Zihao Liang, Jingjing Guo, Yan Gu
Background and Objective: Timely recognition of risk factors for early progression in older adult patients with COVID-19 is of great significance to the following clinical management. This study aims to analyze the risk factors and create a nomogram for early progression in older adult patients with COVID-19 in the Omicron era. Methods: A total of 272 older adults infected with COVID-19 admitted from December 2022 to February 2023 were retrospectively recruited. Risk factor selection was determined using the logistic and the least absolute shrinkage and selection operator (LASSO) regression. A nomogram was then created to predict early progression, followed by the internal validation and assessment of its performance through plotting the receiver operating characteristic (ROC), calibration, and decision curves. Results: A total of 83 (30.5%) older adult patients presented an early progression on chest CT after 3– 5 days of admission under standard initiate therapy. Six independent predictive factors were incorporated into the nomogram to predict the early progression, including CRP > 10 mg/L, IL-6 > 6.6 pg/mL, LDH > 245 U/L, CD4+ T-lymphocyte count < 400/μL, the Activities of Daily Living (ADL) score ≤ 40 points, and the Mini Nutritional Assessment Scale-Short Form (MNA-SF) score ≤ 7 points. The area under the curve (AUC) of the nomogram in discriminating older adult patients who had risk factors in the training and validation cohort was 0.857 (95% CI 0.798, 0.916) and 0.774 (95% CI 0.667, 0.881), respectively. The calibration and decision curves demonstrated a high agreement in the predicted and observed risks, and the acceptable net benefit in predicting the early progression, respectively. Conclusion: We created a nomogram incorporating highly available laboratory data and the Comprehensive Geriatric Assessment (CGA) findings that effectively predict early-stage progression in older adult patients with COVID-19 in the Omicron era.
Keywords: early progression, CGA, nomogram, COVID-19, omicron era
{"title":"Risk Factor Analysis and Nomogram for Early Progression of COVID-19 Pneumonia in Older Adult Patients in the Omicron Era","authors":"Daoda Qi, Yang Chen, Chengyi Peng, Yuan Wang, Zihao Liang, Jingjing Guo, Yan Gu","doi":"10.2147/cia.s453057","DOIUrl":"https://doi.org/10.2147/cia.s453057","url":null,"abstract":"<strong>Background and Objective:</strong> Timely recognition of risk factors for early progression in older adult patients with COVID-19 is of great significance to the following clinical management. This study aims to analyze the risk factors and create a nomogram for early progression in older adult patients with COVID-19 in the Omicron era.<br/><strong>Methods:</strong> A total of 272 older adults infected with COVID-19 admitted from December 2022 to February 2023 were retrospectively recruited. Risk factor selection was determined using the logistic and the least absolute shrinkage and selection operator (LASSO) regression. A nomogram was then created to predict early progression, followed by the internal validation and assessment of its performance through plotting the receiver operating characteristic (ROC), calibration, and decision curves.<br/><strong>Results:</strong> A total of 83 (30.5%) older adult patients presented an early progression on chest CT after 3– 5 days of admission under standard initiate therapy. Six independent predictive factors were incorporated into the nomogram to predict the early progression, including CRP > 10 mg/L, IL-6 > 6.6 pg/mL, LDH > 245 U/L, CD4<sup>+</sup> T-lymphocyte count < 400/μL, the Activities of Daily Living (ADL) score ≤ 40 points, and the Mini Nutritional Assessment Scale-Short Form (MNA-SF) score ≤ 7 points. The area under the curve (AUC) of the nomogram in discriminating older adult patients who had risk factors in the training and validation cohort was 0.857 (95% CI 0.798, 0.916) and 0.774 (95% CI 0.667, 0.881), respectively. The calibration and decision curves demonstrated a high agreement in the predicted and observed risks, and the acceptable net benefit in predicting the early progression, respectively.<br/><strong>Conclusion:</strong> We created a nomogram incorporating highly available laboratory data and the Comprehensive Geriatric Assessment (CGA) findings that effectively predict early-stage progression in older adult patients with COVID-19 in the Omicron era.<br/><br/><strong>Keywords:</strong> early progression, CGA, nomogram, COVID-19, omicron era<br/>","PeriodicalId":10417,"journal":{"name":"Clinical Interventions in Aging","volume":"38 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2024-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140099929","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract: The anorexia of aging is a widespread problem amongst older people, particularly in the hospital setting with up to 60% affected. Despite its high prevalence anorexia often goes undiagnosed in hospital, due to a lack of standardized assessment and evidence-based management, but also lack of knowledge regarding consequences. This review summarizes current evidence for anorexia of aging specific to the hospital setting, giving an overview of correlates of appetite in hospital and consequences of anorexia. It highlights an overall scarcity of research on this important clinical problem for hospitalized cohorts. The few studies point to the importance of anorexia of aging in major health burdens for older people, namely malnutrition, sarcopenia and reduced physical performance, as well as higher mortality. Further research is needed to assess temporal sequence in pathways of causality and to develop effective interventions to combat anorexia.
{"title":"Consequences of Anorexia of Aging in Hospital Settings: An Updated Review","authors":"Natalie J Cox","doi":"10.2147/cia.s431547","DOIUrl":"https://doi.org/10.2147/cia.s431547","url":null,"abstract":"<strong>Abstract:</strong> The anorexia of aging is a widespread problem amongst older people, particularly in the hospital setting with up to 60% affected. Despite its high prevalence anorexia often goes undiagnosed in hospital, due to a lack of standardized assessment and evidence-based management, but also lack of knowledge regarding consequences. This review summarizes current evidence for anorexia of aging specific to the hospital setting, giving an overview of correlates of appetite in hospital and consequences of anorexia. It highlights an overall scarcity of research on this important clinical problem for hospitalized cohorts. The few studies point to the importance of anorexia of aging in major health burdens for older people, namely malnutrition, sarcopenia and reduced physical performance, as well as higher mortality. Further research is needed to assess temporal sequence in pathways of causality and to develop effective interventions to combat anorexia.<br/><br/><strong>Keywords:</strong> appetite, older people, outcomes, sarcopenia<br/>","PeriodicalId":10417,"journal":{"name":"Clinical Interventions in Aging","volume":"47 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2024-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140099824","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Purpose: Building and validating a clinical prediction model for novel coronavirus (COVID-19) re-positive cases in malnourished older adults. Patients and Methods: Malnourished older adults from January to May 2023 were retrospectively collected from the Department of Geriatrics of the Affiliated Hospital of Chengdu University of Traditional Chinese Medicine. They were divided into a “non-re-positive” group and a “re-positive” group based on the number of COVID-19 infections, and into a training set and a validation set at a 7:3 ratio. The least absolute shrinkage and selection operator (LASSO) regression analysis was used to identify predictive factors for COVID-19 re-positivity in malnourished older adults, and a nomogram was constructed. Independent influencing factors were screened by multivariate logistic regression. The model’s goodness-of-fit, discrimination, calibration, and clinical impact were assessed by Hosmer-Lemeshow test, area under the curve (AUC), calibration curve, decision curve analysis (DCA), and clinical impact curve analysis (CIC), respectively. Results: We included 347 cases, 243 in the training set, and 104 in the validation set. We screened 10 variables as factors influencing the outcome. By multivariate logistic regression analysis, preliminary identified protective factors, risk factors, and independent influencing factors that affect the re-positive outcome. We constructed a clinical prediction model for COVID-19 re-positivity in malnourished older adults. The Hosmer-Lemeshow test yielded χ2 =5.916, P =0.657; the AUC was 0.881; when the threshold probability was > 8%, using this model to predict whether malnourished older adults were re-positive for COVID-19 was more beneficial than implementing intervention programs for all patients; when the threshold was > 80%, the positive estimated value was closer to the actual number of cases. Conclusion: This model can help identify the risk of COVID-19 re-positivity in malnourished older adults early, facilitate early clinical decision-making and intervention, and have important implications for improving patient outcomes. We also expect more large-scale, multicenter studies to further validate, refine, and update this model.
Keywords: malnutrition, COVID-19, re-positive, clinical prediction model
{"title":"Predicting COVID-19 Re-Positive Cases in Malnourished Older Adults: A Clinical Model Development and Validation","authors":"Jiao Chen, Danmei Luo, Chengxia Sun, Xiaolan Sun, Changmao Dai, Xiaohong Hu, Liangqing Wu, Haiyan Lei, Fang Ding, Wei Chen, Xueping Li","doi":"10.2147/cia.s449338","DOIUrl":"https://doi.org/10.2147/cia.s449338","url":null,"abstract":"<strong>Purpose:</strong> Building and validating a clinical prediction model for novel coronavirus (COVID-19) re-positive cases in malnourished older adults.<br/><strong>Patients and Methods:</strong> Malnourished older adults from January to May 2023 were retrospectively collected from the Department of Geriatrics of the Affiliated Hospital of Chengdu University of Traditional Chinese Medicine. They were divided into a “non-re-positive” group and a “re-positive” group based on the number of COVID-19 infections, and into a training set and a validation set at a 7:3 ratio. The least absolute shrinkage and selection operator (LASSO) regression analysis was used to identify predictive factors for COVID-19 re-positivity in malnourished older adults, and a nomogram was constructed. Independent influencing factors were screened by multivariate logistic regression. The model’s goodness-of-fit, discrimination, calibration, and clinical impact were assessed by Hosmer-Lemeshow test, area under the curve (AUC), calibration curve, decision curve analysis (DCA), and clinical impact curve analysis (CIC), respectively.<br/><strong>Results:</strong> We included 347 cases, 243 in the training set, and 104 in the validation set. We screened 10 variables as factors influencing the outcome. By multivariate logistic regression analysis, preliminary identified protective factors, risk factors, and independent influencing factors that affect the re-positive outcome. We constructed a clinical prediction model for COVID-19 re-positivity in malnourished older adults. The Hosmer-Lemeshow test yielded χ<sup>2</sup> =5.916, <em>P</em> =0.657; the AUC was 0.881; when the threshold probability was > 8%, using this model to predict whether malnourished older adults were re-positive for COVID-19 was more beneficial than implementing intervention programs for all patients; when the threshold was > 80%, the positive estimated value was closer to the actual number of cases.<br/><strong>Conclusion:</strong> This model can help identify the risk of COVID-19 re-positivity in malnourished older adults early, facilitate early clinical decision-making and intervention, and have important implications for improving patient outcomes. We also expect more large-scale, multicenter studies to further validate, refine, and update this model.<br/><br/><strong>Keywords:</strong> malnutrition, COVID-19, re-positive, clinical prediction model<br/>","PeriodicalId":10417,"journal":{"name":"Clinical Interventions in Aging","volume":"38 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2024-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140072028","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Purpose: The estimated glomerular filtration rate (eGFR) based on creatinine is crucial for the risk assessment of contrast-associated acute kidney injury (CA-AKI). In recent, the difference between cystatin C-based eGFR (eGFRcys) and creatinine-based eGFR (eGFRcr) has been widely documented. We aimed to explore whether intraindividual differences between eGFRcys and eGFRcr had potential value for CA-AKI risk assessment in patients undergoing elective percutaneous coronary intervention (PCI). Patients and Methods: From January 2012 to December 2018, we retrospectively observed 5049 patients receiving elective PCI. To determine eGFR, serum creatinine and cystatin C levels were measured. CA-AKI was defined as serum creatinine being increased ≥ 50% or 0.3 mg/dL within 48 h after contrast agents exposure. Chronic kidney disease (CKD) was defined as the eGFR < 60 mL/min/1.73 m2. Results: Approximately half of the participants (2479, 49.1%) had a baseline eGFRdiff (eGFRcys-eGFRcr) between − 15 and 15 mL/min/1.73 m2. Restricted cubic splines analysis revealed a nonlinear relationship between eGFRdiff and CA-AKI. Multivariable logistic regression analysis indicated that compared with the reference group (− 15 to 15 mL/min/1.73 m2), the negative-eGFRdiff group (less than − 15 mL/min/1.73 m2) had a higher risk of CA-AKI (OR, 3.44; 95% CI, 2.57– 4.64). Furthermore, patients were divided into four groups based on CKD identified by eGFRcys or eGFRcr. Multivariable logistic analysis revealed that patients with either CKDcys (OR, 2.94; 95% CI, 2.19– 3.95, P < 0.001) or CKDcr (OR, 2.44; 95% CI, 1.19– 4.63, P < 0.001) had an elevated risk of CA-AKI compared to those without CKDcys and CKDcr. Conclusion: There are frequent intraindividual differences between eGFRcys and eGFRcr, and these differences can be used to forecast the risk of CA-AKI.
{"title":"The Association of Intraindividual Difference Between Cystatin- and Creatinine-Based Estimated GFR and Contrast-Associated Acute Kidney Injury","authors":"Li-Wei Zhang, Man-Qing Luo, Ji-Lang Zeng, Zhe-Bin You, Li-Chuan Chen, Jun-Han Chen, Kai-Yang Lin, Yan-Song Guo","doi":"10.2147/cia.s447042","DOIUrl":"https://doi.org/10.2147/cia.s447042","url":null,"abstract":"<strong>Purpose:</strong> The estimated glomerular filtration rate (eGFR) based on creatinine is crucial for the risk assessment of contrast-associated acute kidney injury (CA-AKI). In recent, the difference between cystatin C-based eGFR (eGFRcys) and creatinine-based eGFR (eGFRcr) has been widely documented. We aimed to explore whether intraindividual differences between eGFRcys and eGFRcr had potential value for CA-AKI risk assessment in patients undergoing elective percutaneous coronary intervention (PCI).<br/><strong>Patients and Methods:</strong> From January 2012 to December 2018, we retrospectively observed 5049 patients receiving elective PCI. To determine eGFR, serum creatinine and cystatin C levels were measured. CA-AKI was defined as serum creatinine being increased ≥ 50% or 0.3 mg/dL within 48 h after contrast agents exposure. Chronic kidney disease (CKD) was defined as the eGFR < 60 mL/min/1.73 m<sup>2</sup>.<br/><strong>Results:</strong> Approximately half of the participants (2479, 49.1%) had a baseline eGFRdiff (eGFRcys-eGFRcr) between − 15 and 15 mL/min/1.73 m<sup>2</sup>. Restricted cubic splines analysis revealed a nonlinear relationship between eGFRdiff and CA-AKI. Multivariable logistic regression analysis indicated that compared with the reference group (− 15 to 15 mL/min/1.73 m<sup>2</sup>), the negative-eGFRdiff group (less than − 15 mL/min/1.73 m<sup>2</sup>) had a higher risk of CA-AKI (OR, 3.44; 95% CI, 2.57– 4.64). Furthermore, patients were divided into four groups based on CKD identified by eGFRcys or eGFRcr. Multivariable logistic analysis revealed that patients with either CKDcys (OR, 2.94; 95% CI, 2.19– 3.95, <em>P</em> < 0.001) or CKDcr (OR, 2.44; 95% CI, 1.19– 4.63, <em>P</em> < 0.001) had an elevated risk of CA-AKI compared to those without CKDcys and CKDcr.<br/><strong>Conclusion:</strong> There are frequent intraindividual differences between eGFRcys and eGFRcr, and these differences can be used to forecast the risk of CA-AKI.<br/><br/><strong>Keywords:</strong> estimated glomerular filtration rate, contrast-associated acute kidney injury, cystatin C, percutaneous coronary intervention<br/>","PeriodicalId":10417,"journal":{"name":"Clinical Interventions in Aging","volume":"41 5 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2024-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140053644","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Qiaoni Zhang, Weidong Yan, Sizhe Gao, Xiaolin Diao, Gang Liu, Jing Wang, Bingyang Ji
Purpose: There is currently no consensus on the most appropriate blood transfusion strategy for older adults undergoing cardiovascular surgery. We aimed to investigate the potential benefits of the patient blood management (PBM) program specifically for advanced age patients, and to evaluate the relationship of age and PBM in cardiovascular surgery. Patients and Methods: We collected data from patients over 60 years old who underwent on-pump cardiovascular surgery. We compared transfusion and clinical outcomes between the pre-PBM and post-PBM groups using a propensity score matching method. Then, we conducted a subgroup analysis within the original cohort, specifically focusing on patients aged of 75 and above with multivariable adjusted models. Results: Data of 9703 older adults were analyzed. Red blood cell (RBC) transfusion rates during cardiopulmonary bypass (CPB) (31.6% vs 13.1%, P< 0.001), during the operation (50.8% vs 39.0%, P< 0.001) and after the operation (5.6% vs 3.1%, P< 0.001) were significantly reduced, and mortality and the risk of some adverse events were also reduced after the PBM. Subgroup analysis showed that there was no interaction between age and PBM, and advanced age (over age 75) did not modify the effect of PBM program in reducing RBC transfusion (Pinteraction=0.245), on mortality (Pinteration=0.829) and on certain complications. Conclusion: The comprehensive PBM program could reduce RBC transfusion without adverse outcomes in older patients undergoing CPB. Even patients over age 75 may benefit from a more stringent transfusion indication. Comprehensive blood conservation measures should be applied to optimize the blood management for older patients.
目的：对于接受心血管手术的老年人最合适的输血策略，目前尚未达成共识。我们旨在研究患者血液管理（PBM）计划对高龄患者的潜在益处，并评估心血管手术中年龄与 PBM 的关系：我们收集了接受泵上心血管手术的 60 岁以上患者的数据。我们采用倾向得分匹配法比较了PBM前组和PBM后组的输血和临床结果。然后，我们在原始队列中进行了亚组分析，特别是通过多变量调整模型对 75 岁及以上的患者进行了分析：结果：我们分析了 9703 名老年人的数据。心肺旁路（CPB）期间（31.6% vs 13.1%，P< 0.001）、手术期间（50.8% vs 39.0%，P< 0.001）和手术后（5.6% vs 3.1%，P< 0.001）的红细胞（RBC）输注率显著降低，PBM 后死亡率和一些不良事件的风险也有所降低。亚组分析显示，年龄与PBM之间不存在交互作用，高龄（75岁以上）并不影响PBM项目在减少RBC输注（Pinteraction=0.245）、降低死亡率（Pinteration=0.829）和某些并发症方面的效果：综合 PBM 计划可减少接受 CPB 的老年患者的红细胞输注，且不会产生不良后果。即使是 75 岁以上的患者也可从更严格的输血指征中获益。关键词：心肺旁路；心血管手术；老年人；患者血液管理；红细胞输注
{"title":"A Comprehensive Patient Blood Management Program During Cardiopulmonary Bypass in Patients Over 60 Years of Age","authors":"Qiaoni Zhang, Weidong Yan, Sizhe Gao, Xiaolin Diao, Gang Liu, Jing Wang, Bingyang Ji","doi":"10.2147/cia.s443908","DOIUrl":"https://doi.org/10.2147/cia.s443908","url":null,"abstract":"<strong>Purpose:</strong> There is currently no consensus on the most appropriate blood transfusion strategy for older adults undergoing cardiovascular surgery. We aimed to investigate the potential benefits of the patient blood management (PBM) program specifically for advanced age patients, and to evaluate the relationship of age and PBM in cardiovascular surgery.<br/><strong>Patients and Methods:</strong> We collected data from patients over 60 years old who underwent on-pump cardiovascular surgery. We compared transfusion and clinical outcomes between the pre-PBM and post-PBM groups using a propensity score matching method. Then, we conducted a subgroup analysis within the original cohort, specifically focusing on patients aged of 75 and above with multivariable adjusted models.<br/><strong>Results:</strong> Data of 9703 older adults were analyzed. Red blood cell (RBC) transfusion rates during cardiopulmonary bypass (CPB) (31.6% vs 13.1%, P< 0.001), during the operation (50.8% vs 39.0%, P< 0.001) and after the operation (5.6% vs 3.1%, P< 0.001) were significantly reduced, and mortality and the risk of some adverse events were also reduced after the PBM. Subgroup analysis showed that there was no interaction between age and PBM, and advanced age (over age 75) did not modify the effect of PBM program in reducing RBC transfusion (Pinteraction=0.245), on mortality (Pinteration=0.829) and on certain complications.<br/><strong>Conclusion:</strong> The comprehensive PBM program could reduce RBC transfusion without adverse outcomes in older patients undergoing CPB. Even patients over age 75 may benefit from a more stringent transfusion indication. Comprehensive blood conservation measures should be applied to optimize the blood management for older patients.<br/><br/><strong>Keywords:</strong> cardiopulmonary bypass, cardiovascular surgery, older adults, patient blood management, red blood cell transfusion<br/>","PeriodicalId":10417,"journal":{"name":"Clinical Interventions in Aging","volume":"44 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2024-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140046442","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Letter for the article Predictive Value of Nutritional Risk for All-Cause Death and Functional Outcomes in Chinese Elderly Patients with Acute Stroke: A 3-Year Follow-Up Study
致中国急性脑卒中老年患者营养风险对全因死亡和功能预后的预测价值》一文的信：3年随访研究
{"title":"Predictive Value of Nutritional Risk for All-Cause Death and Functional Outcomes in Chinese Elderly Patients with Acute Stroke: A 3-Year Follow-Up Study [Letter]","authors":"Xiaoqin Qiu, Yuechou Nong","doi":"10.2147/cia.s464063","DOIUrl":"https://doi.org/10.2147/cia.s464063","url":null,"abstract":"Letter for the article Predictive Value of Nutritional Risk for All-Cause Death and Functional Outcomes in Chinese Elderly Patients with Acute Stroke: A 3-Year Follow-Up Study","PeriodicalId":10417,"journal":{"name":"Clinical Interventions in Aging","volume":"26 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2024-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140046328","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Priscila Matovelle, Bárbara Oliván-Blázquez, Marta Domínguez-García, Verónica Casado-Vicente, Beatriz Pascual de la Pisa, Rosa Magallón-Botaya
Background: Worldwide, chronic diseases are prevalent among the older adults, significantly affecting their health and healthcare system. The COVID-19 pandemic exacerbated these challenges, disrupting healthcare services. Our study assesses the impact on older individuals with chronic diseases who were not infected with COVID-19, analyzing comorbidities, medication use, mortality rates, and resource utilization using real data from Aragon, Spain. Methods: A retrospective observational study, conducted in Aragon, Spain, focused on individuals aged 75 and older with at least one chronic disease, who were not infected of COVID-19. The research used actual data collected during three distinct periods: the first covered the six months prior to the pandemic, the second the six months after the lockdown, and the third the period between six and twelve months. Key variables included socio-demographics, comorbidities, clinical parameters, medication use, and health services utilization. Results: We included 128.130 older adults. Mean age was 82.88 years, with 60.3% being women. The most common chronic diseases were hypertension (73.2%), dyslipidemia (52.5%), and dorsopathies (31.5%). More than 90% had more than 2 conditions. A notable decline in new chronic disease diagnoses was observed, particularly pronounced in the six to twelve months period after lockdown. Although statistically significant differences were observed in all clinical variables analyzed, they were considered clinically irrelevant. Furthermore, a decrease in healthcare services utilization and medication prescriptions was reported. Conclusion: Our study highlights a decrease in new chronic disease diagnoses, ongoing reductions in healthcare utilization, and medication prescriptions for older adults with pre-existing chronic conditions, unaffected by COVID-19.
{"title":"Health Outcomes for Older Patients with Chronic Diseases During the First Pandemic Year","authors":"Priscila Matovelle, Bárbara Oliván-Blázquez, Marta Domínguez-García, Verónica Casado-Vicente, Beatriz Pascual de la Pisa, Rosa Magallón-Botaya","doi":"10.2147/cia.s444716","DOIUrl":"https://doi.org/10.2147/cia.s444716","url":null,"abstract":"<strong>Background:</strong> Worldwide, chronic diseases are prevalent among the older adults, significantly affecting their health and healthcare system. The COVID-19 pandemic exacerbated these challenges, disrupting healthcare services. Our study assesses the impact on older individuals with chronic diseases who were not infected with COVID-19, analyzing comorbidities, medication use, mortality rates, and resource utilization using real data from Aragon, Spain.<br/><strong>Methods:</strong> A retrospective observational study, conducted in Aragon, Spain, focused on individuals aged 75 and older with at least one chronic disease, who were not infected of COVID-19. The research used actual data collected during three distinct periods: the first covered the six months prior to the pandemic, the second the six months after the lockdown, and the third the period between six and twelve months. Key variables included socio-demographics, comorbidities, clinical parameters, medication use, and health services utilization.<br/><strong>Results:</strong> We included 128.130 older adults. Mean age was 82.88 years, with 60.3% being women. The most common chronic diseases were hypertension (73.2%), dyslipidemia (52.5%), and dorsopathies (31.5%). More than 90% had more than 2 conditions. A notable decline in new chronic disease diagnoses was observed, particularly pronounced in the six to twelve months period after lockdown. Although statistically significant differences were observed in all clinical variables analyzed, they were considered clinically irrelevant. Furthermore, a decrease in healthcare services utilization and medication prescriptions was reported.<br/><strong>Conclusion:</strong> Our study highlights a decrease in new chronic disease diagnoses, ongoing reductions in healthcare utilization, and medication prescriptions for older adults with pre-existing chronic conditions, unaffected by COVID-19.<br/><br/>","PeriodicalId":10417,"journal":{"name":"Clinical Interventions in Aging","volume":"52 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2024-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140046437","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Melissa Hawkins, Tori Goldhammer, Robin McClave, Edwinta Jenkins-Smith
Purpose: The overarching goal of the program evaluation was to determine the reach and impact of the District-funded Safe At Home (SAH) modification program in reducing falls, fall injuries, and fear of falls among community-dwelling older adults and adults with disabilities. The SAH program has served over 6000 adults since 2016, the majority of whom are women (79%) and over age 60 (92%). Materials and Methods: Letters were mailed in September 2022 to clients (n=492) who had home modifications completed between October 2021-March 2022 inviting them to participate in a brief phone survey about program satisfaction, falls, fall location, and severity. The validated Fall Efficacy Scale (FES) was administered pre (at first visit), post (at last visit), and during the phone survey (within 6 months to 1 year of program completion) to assess fear of falling. The response rate was 55% (n=241). Results: Older adults (n=219) and adults with disabilities (n=22) reported high program satisfaction. Most clients, 79%, did not report a fall since the completion of the home modifications. The majority of falls reported, 76%, occurred inside the home. The average evaluation FES score was 32.5 (SD=22.6, range 10– 100), indicating relatively low fear of falling. Higher FES scores were associated with a greater likelihood of reporting a fall (r=0.44, p < 0.001, n=51) and older age (r = 0.17, p < 0.01). FES scores were not related to gender. Evaluation FES scores were significantly lower than the pre-FES scores, indicating a reduction in fear of falling and positive impact of the home modifications (T(107) = 5.14, p < 0.001). Conclusion: The client-centered SAH program demonstrates significant reductions in falls, fear of falling, and high satisfaction among clients. Recommendations include program expansion to offer other evidence-based components to reduce falls and support safe aging in place.
Keywords: program evaluation, home modification, fall efficacy scale, FES, injury, prevention, independent living
{"title":"Evaluation of a Fall Prevention Program to Reduce Fall Risk and Fear of Falling Among Community-Dwelling Older Adults and Adults with Disabilities","authors":"Melissa Hawkins, Tori Goldhammer, Robin McClave, Edwinta Jenkins-Smith","doi":"10.2147/cia.s448196","DOIUrl":"https://doi.org/10.2147/cia.s448196","url":null,"abstract":"<strong>Purpose:</strong> The overarching goal of the program evaluation was to determine the reach and impact of the District-funded Safe At Home (SAH) modification program in reducing falls, fall injuries, and fear of falls among community-dwelling older adults and adults with disabilities. The SAH program has served over 6000 adults since 2016, the majority of whom are women (79%) and over age 60 (92%).<br/><strong>Materials and Methods:</strong> Letters were mailed in September 2022 to clients (n=492) who had home modifications completed between October 2021-March 2022 inviting them to participate in a brief phone survey about program satisfaction, falls, fall location, and severity. The validated Fall Efficacy Scale (FES) was administered pre (at first visit), post (at last visit), and during the phone survey (within 6 months to 1 year of program completion) to assess fear of falling. The response rate was 55% (n=241).<br/><strong>Results:</strong> Older adults (n=219) and adults with disabilities (n=22) reported high program satisfaction. Most clients, 79%, did not report a fall since the completion of the home modifications. The majority of falls reported, 76%, occurred inside the home. The average evaluation FES score was 32.5 (SD=22.6, range 10– 100), indicating relatively low fear of falling. Higher FES scores were associated with a greater likelihood of reporting a fall (<em>r</em>=0.44, <em>p</em> < 0.001, n=51) and older age (<em>r</em> = 0.17, <em>p</em> < 0.01). FES scores were not related to gender. Evaluation FES scores were significantly lower than the pre-FES scores, indicating a reduction in fear of falling and positive impact of the home modifications (T(107) = 5.14, <em>p</em> < 0.001).<br/><strong>Conclusion:</strong> The client-centered SAH program demonstrates significant reductions in falls, fear of falling, and high satisfaction among clients. Recommendations include program expansion to offer other evidence-based components to reduce falls and support safe aging in place.<br/><br/><strong>Keywords:</strong> program evaluation, home modification, fall efficacy scale, FES, injury, prevention, independent living<br/>","PeriodicalId":10417,"journal":{"name":"Clinical Interventions in Aging","volume":"36 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2024-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140046326","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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