Geriatrics & Gerontology International最新文献

Incorporating tongue pressure as an indicator of oral frailty allows for a comprehensive approach to frailty management in older adults.

Unno et al. [1] recently highlighted the importance of preoperative intramuscular adipose tissue content (IMAC) in early functional recovery after hip fracture.

In daily rehabilitation practice, we frequently encounter patients who demonstrate preserved systemic stability—adequate nutritional indices and stable vital parameters—yet remain unable to initiate effective gait despite intensive therapy. The findings by Unno et al. provide a compelling physiological explanation for this clinical discrepancy: a dissociation between “systemic metabolic reserve” (reflected by PhA) [2] and “locomotor mechanical integrity” (reflected by IMAC) [1].

The authors' observation that IMAC independently predicts walking recovery, while PhA does not, raises a critical question regarding our current therapeutic strategies: Are conventional resistance-based rehabilitation paradigms sufficient for patients with high IMAC? [3] The presence of myosteatosis implies a qualitative deficit in motor unit recruitment and force transmission. Consequently, we propose that patients identified with high preoperative IMAC might require distinct interventions, such as targeted neuromuscular re-education or high-velocity power training, rather than standard strengthening protocols alone.

Finally, while the authors acknowledge the 2-week follow-up limitation, this early period is often just the beginning of the functional journey. In models like Taiwan's nationwide Post-Acute Care (PAC) program, patients undergo high-intensity rehabilitation for several weeks to months [4]. Whether IMAC retains its strong predictive value for ambulatory recovery during such prolonged, high-intensity rehabilitation remains an important and clinically actionable question that warrants further investigation.

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The authors have nothing to report.

The authors declare no conflicts of interest.

Data sharing is not applicable to this article as no new data were created or analyzed in this study.

Research into the relationship between Satoyama activities and the health status of older people should be conducted scientifically based on the biopsychosocial model, with appropriate control groups and neuroscience-based monitoring of changes in brain function.

Introduction: In Korea, obesity is nearly twice as high in older women as in men, and it plays a central role in the prevalence of metabolic syndrome (MetS). Obesity acts as a direct risk factor for increased mortality and decreased quality of life by inducing a decline in physical function. However, exercise in normobaric hypoxia can induce improvements in physical function and risk factors for MetS. Therefore, we investigated whether concurrent strength and aerobic exercise training (CT) in normobaric hypoxia induce improvements in the risk of MetS and physical function in elderly Korean women.

Methods: Subjects were randomly divided into two groups (normoxia (NMX; n = 12) and hypoxia (HPX; n = 12)), and both groups performed CT program three times a week for 12 weeks. HPX performed an exercise program in a hypoxic chamber. Muscle strength and aerobic function (VO_2max) were measured by isokinetic device and respiratory gas analyzer respectively. Lipid profiles, glucose, and insulin were measured by isolating plasma after 10 h of fasting.

Results: CT showed significant changes in all variables in the HPX compared to the NMX. The HPX showed significant improvements in physical function (muscle strength, p < 0.001; aerobic function, p < 0.01), lipid profile (TG, p < 0.01; HDL-C, p < 0.0001; LDL-C, p < 0.001; FFA, p < 0.001), glucose metabolism (glucose, p < 0.0001; insulin, p < 0.0001; HOMA-IR, p < 0.0001; HOMA-β, p < 0.0001), and MetS variables (p = 0.0011).

Conclusion: This study suggests that CT under normobaric hypoxic conditions may help improve physical function and reduce the risk of MetS in obese elderly Korean women.

Aim: Cerebral small vessel disease (CSVD)-related MRI findings, including white matter hyperintensities (WMHs), are not rare in general elderly populations. The aim of this study was to elucidate the contribution of hereditary CSVD-related genes to CSVD-related MRI findings in a general Japanese population.

Methods: We analyzed datasets from 324 individuals aged ≥ 50 years in Tohoku Medical Megabank (TMM), focusing on MRI markers and variants of NOTCH3, ABCC6, COL4A1, COL4A2, GLA, HTRA1, and TREX1 genes. Background factors included age, sex, hypertension, diabetes, dyslipidemia, hyperuricemia, alcohol drinking, and smoking.

Results: Pathogenic variant carriers were identified within ABCC6 (n = 20), but not other genes. To compare with previous studies including rare NOTCH3 variants regardless of pathogenicity, we included 24 rare functional variants of NOTCH3. We performed a gene-based analysis using the burden test and sequence kernel association test (SKAT) adjusted for background factors, between WMH/lacune and ABCC6/NOTCH3. The only significant finding was the correlation between WMH volume and rare NOTCH3 variants by SKAT, both with the basic model, adjusted for age, sex, and hypertension (p = 0.045), and full model, adjusted for all background factors (p = 0.027). We also analyzed the association between intracranial major artery stenosis/occlusion (ICASO) and RNF213 p.Arg4810Lys, the East Asian-specific variant susceptible to ICASO; however, we failed to identify a significant correlation.

Conclusions: This study suggests that NOTCH3 may contribute to WMH volume in a general Japanese population.

Aim: During the COVID-19 pandemic, some patients experienced difficulty attending regular in-hospital cardiac rehabilitation (CR) after discharge. This study investigated the impact of CR in older patients with cardiovascular disease (CVD) by comparing outcomes before, during, and after the COVID-19 pandemic.

Methods: In this post hoc analysis of a single-center registry, 505 patients aged ≥ 65 years (mean age 82) were included. Outcomes were compared between participants in a 4-month outpatient CR program after discharge and non-participants. Patients were categorized into three periods: before the COVID-19 pandemic (n = 173), during the COVID-19 pandemic (n = 217), and after the COVID-19 pandemic (n = 105). Cardiovascular (CV) events and non-CV events were followed.

Results: As the primary endpoint, cumulative hospitalization for worsening HF was significantly lower in the CR group across all time periods (p < 0.001, p < 0.001, and p = 0.019, respectively). Cumulative non-CV event-free survival was significantly higher in the CR group before and after the COVID-19 pandemic (p < 0.001, p = 0.030, respectively) but showed no significant differences during the pandemic. Before the pandemic, participation in CR was significantly associated with hospitalization for worsening HF (hazard ratio [HR], 0.538; 95% confidence interval [CI], 0.294-0.982; p = 0.043). During and after the pandemic, this association was not.

Conclusion: CR appears to have a protective effect against CV events in older patients with CVD. Although the COVID-19 pandemic disrupted this positive trend, the findings support CR as a cornerstone of recovery in this population.

Objective: To develop and validate a risk prediction model for digestive tract diseases in depressed individuals, facilitating early identification of high-risk populations and guiding personalized preventive interventions.

Methods: This study utilized data from the China Health and Retirement Longitudinal Study (CHARLS) for the years 2011 and 2015. Depressed patients from the 2011 dataset were randomly split into a training group (70%) and a validation group (30%). Independent prognostic factors were identified via eXtreme Gradient Boosting (XGBoost), Least absolute shrinkage and selection operator (LASSO) regression, and multivariate logistic regression. A nomogram model was constructed based on the contribution of these predictive factors and subsequently evaluated using the receiver operating characteristic (ROC) curve, calibration curve, decision curve analysis (DCA), and clinical impact curve (CIC). External validation was conducted using data from depressed patients in 2015.

Results: This study included 4006 patients with depression from the 2011 CHARLS, with a prevalence of gastrointestinal diseases of 31.4%. The final model included UA, HCT, sleep quality, difficulty running or jogging 1 km, hypertension, chest pain, chronic lung diseases, heart diseases, kidney diseases, and arthritis or rheumatism. The area under the curve (AUC) was 0.678 (95% CI: 0.657-0.699) in the training set, 0.651 (95% CI: 0.619-0.686) in internal validation, and 0.693 (95% CI: 0.674-0.713) in external validation. The ROC curve indicates that the model has good predictive accuracy, and the calibration curve shows a high consistency between the predicted and actual results. DCA and CIC confirm that the model has a high net clinical benefit.

Conclusion: The model developed in this study is effective in predicting the occurrence of gastrointestinal diseases in people with depression and can be used for early identification and targeted preventive measures in high-risk populations to reduce the risk of gastrointestinal diseases.

Aim: The unique anatomical and functional features of the calcaneus pose continual challenges for orthopedic surgeons in treating calcaneal osteomyelitis (CO), particularly among older patients. Through a comprehensive analysis of cases documented in the literature, this study aims to provide a detailed overview of the clinical manifestations, therapeutic approaches, and treatment outcomes of geriatric calcaneal osteomyelitis (GCO).

Methods: A rigorous and systematic search was conducted across the PubMed, Embase, and the Cochrane Library databases to identify English language published studies that reported on CO among patients aged 60 years and above between the years 2000 and 2021. Quality assessment of the included studies was conducted using the National Institutes of Health (NIH) assessment scale, and effective data were extracted and pooled for analysis.

Results: A compilation of 59 articles encompassing 333 patients has been conducted, yielding a male-to-female ratio of 2.1 (215 males and 103 females). The median age at diagnosis was 62 years, and the median symptom duration was 6.6 months. The primary cause identified was diabetic foot-related infection (216 cases), with ulceration serving as the prominent symptom (285 cases). The positive pathogen culture rate was 94.6% (123/130), wherein polymicrobial infections accounted for 54.5% (67/123). Staphylococcus aureus emerged as the most frequently detected pathogen 17.1% (21/123), and fungal-related infections were isolated in five patients. Despite the majority of patients undergoing surgical interventions 97.6% (324/332), the overall recurrence rate was 30.7% (99/322). The infection relapse incidences following calcanectomy and debridement were 37.6% (82/218) and 19.4% (12/62), respectively. The cumulative risk of limb amputation amounted to 28.7% (95/331), with all-cause and CO-related mortality rates standing at 5.2% (17/328), in which one patient was reported to be related to CO.

Conclusions: This study indicated that GCO primarily impacts males, with diabetic foot as the primary contributing factor. Staphylococcus aureus remained the most frequently isolated pathogen. Surgical intervention was the primary treatment modality, and the incidences of infection recurrence and limb amputation were around 30%.

Aim: Preventing and mitigating frailty across physical, cognitive, social, and oral domains is vital for extending healthy life expectancy in older adults. Although apathy and depressive symptoms are reportedly associated with frailty domains, their domain-specific relationships remain unclear. This study aimed to compare the associations of apathy and depressive symptoms with frailty domains in older adults.

Methods: This cross-sectional study included 465 community-dwelling adults aged ≥ 75 years (median age, 78 years; interquartile range, 76.0-82.0; 49.7% women) from the 2024 Shimane CoHRE Study. Apathy and depressive symptoms were defined as scores of ≥ 16 on the Japanese version of the Starkstein Apathy Scale and ≥ 40 on the Self-rating Depression Scale, respectively. Frailty domains across physical, cognitive, social, and oral domains were assessed using the Questionnaire for Medical Checkup of the Old-Old. Logistic regression analyses adjusted for age, sex, and body mass index.

Results: The prevalence of apathy, depressive symptoms, and their coexistence was 30.8%, 29.9%, and 14.6%, respectively. Both apathy and depressive symptoms were significantly associated with a higher prevalence of physical frailty (lack of exercise), cognitive frailty (memory impairment), and social frailty (lack of interaction with others). Their coexistence was additionally associated with oral, physical, cognitive, and social frailty.

Conclusions: Apathy and depressive symptoms share some frailty domains but also exhibit domain-specific associations. Their coexistence may be associated with multidimensional frailty. These findings highlight the importance of assessing emotional function and tailoring frailty prevention to individual emotional profiles.