Geriatrics & Gerontology International最新文献

Aim: The study investigates end-of-life trajectories, focusing on the degree of oral intake function in older individuals with frailty aged over 90 years.

Methods: This retrospective observational study examined individuals aged 90 years and older who passed away at a long-term chronic care hospital and related facilities in Japan. We assessed their Clinical Frailty Scale (CFS) and Function Oral Intake Scale (FOIS), categorizing them into two groups-"preserved CFS" (CFS score ≤7) and "poor CFS" (CFS score ≥8)-considering evaluations conducted 6 months before death. We examined the transitional progression of their CFS and FOIS scores, along with a time-course assessment of low FOIS scores (≤3) in each group at various intervals.

Results: Among 66 cases, 38 were in the preserved CFS group, and 28 were in the poor CFS group. The CFS and FOIS scores of the preserved CFS group declined rapidly towards the end-of-life, with approximately half experiencing significant declines within 3 months. In contrast, both the CFS and the FOIS scores of the poor CFS group declined gradually within 6 months. The percentage of low FOIS score (≤3) was lower at 12 and 6 months than at 1 month prior to death in the preserved CFS group.

Conclusions: The end-of-life trajectories in older individuals with frailty aged over 90 years were heterogeneous. Clinicians should carefully monitor the degree of frailty and changes in food intake as crucial indications of the end-of-life phase, providing optimal support to manage potential vicious cycles. Geriatr Gerontol Int 2025; 25: 96-101.

Aim: Falls are a major global public health concern, requiring early screening and prevention. Cardiovascular disease (CVD) is associated with physical impairments and increased fall risk. Despite the link between CVD and sleep parameters, research on falls and sleep in CVD patients is limited. We aimed to compare the correlation between falls and sleep in populations with and without CVD to develop fall prevention strategies.

Methods: This longitudinal cohort study utilized data from the China Health and Retirement Longitudinal Study (CHARLS). Baseline data were collected in 2011, with follow-up in 2015. Falls and CVD were assessed based on self-reporting. Sleep parameters, including nighttime and total sleep duration, daytime napping, and sleep disturbance were collected via self-reported questionnaires. Data analysis was conducted using SPSS and R statistical.

Results: A cohort of 4349 individuals with an average age of 68.00 ± 5.97 years was analyzed. From these individuals, 21.5% reported falls during follow-up. Baseline CVD was significantly associated with follow-up falls (P < 0.001). After adjusting for multiple factors, nighttime sleep durations of <6 h (P = 0.004), 8 to 9 h (P = 0.016) and >9 h (P = 0.031) were significantly associated with follow-up falls among the CVD group. Total sleep duration <7 h was significantly associated with follow-up falls in both the total and non-CVD groups (P < 0.05).

Conclusions: Maintaining a moderate sleep duration is crucial for preventing falls among older adults. Both excessively short and long sleep durations are associated with fall risks, particularly for individuals with CVD. Geriatr Gerontol Int 2025; 25: 38-47.

Many older adults who are certified for long-term care services live or stay in long-term care facilities (LTCFs), where they receive medical and nursing care. These individuals often encounter medication-related problems, such as polypharmacy and complex medication regimens, including frequent administration schedules. Although considerable attention has been paid to polypharmacy in the context of optimizing medication use in older adults, little emphasis has been placed on simplifying these regimens. Recently, the Japanese Society of Geriatric Pharmacy issued statements on medication simplification in LTCFs based on a scoping review of the literature and expert opinions. In these statements, medication simplification is defined as the process of reducing the number of medication administration times, ideally to once during lunchtime. The statements outline principles and processes to achieve medication simplification through interprofessional collaboration, including consolidating and reducing the number of medication administration times a day to minimize the risk of medication errors and ensure medical safety. Medication simplification will play a substantial role in alleviating the burden of medication intake for residents, and in reducing and equalizing the workload of medication administration for staff members throughout the day in LTCFs. These statements suggest that administering medication during lunchtime is beneficial when an adequate number of staff members are available in LTCFs. We hope that these statements will help ensure patient safety, and facilitate successful medication optimization for all medical, nursing and social care professionals working in LTCFs. Geriatr Gerontol Int 2025; 25: 14-24.

Aim: In clinical practice, cardiologists frequently note substantial differences in coronary artery health among patients of the same age bracket. This observation led to our investigation into identifying genes that are shared between atherosclerosis and aging, as well as those that are specifically amplified in atherosclerosis alone.

Methods: Our study leveraged existing gene expression datasets from the Gene Expression Omnibus (GEO), avoiding the need for new experimental research involving human or animal subjects. We focused on analyzing two specific datasets: one comprising artery samples from individuals with and without atherosclerosis, and the other featuring samples from people in middle age versus those in older age groups. To identify significant genes, we applied a technique known as the weighted average difference (WAD).

Results: Our analysis identified 14 genes that were upregulated in both aging and atherosclerosis, hinting at the involvement of the type I interferon response in both conditions. Conversely, 408 genes that exhibited heightened activity within atherosclerotic lesions indicated an augmentation in lysosome-related processes. While aging might create a groundwork that predisposes individuals to atherosclerosis, the progression of atherosclerosis also involves distinct factors such as type I interferon response and an increase in lysosomal activity.

Conclusions: Aging encompasses more than just the senescence of vascular cells; it is significantly affected by extracellular factors such as type I interferon. The onset of atherosclerosis, therefore, cannot be attributed solely to aging. Instead, it likely involves enhanced mechanisms such as phagocytosis and heighted lysosomal activity. Geriatr Gerontol Int 2025; 25: 108-115.

Aim: Malnutrition is reportedly associated with the development of delirium. As dental health is essential for nutritional intake, tooth loss may be a risk factor for the development of delirium. This study aimed to investigate the relationship between postoperative delirium and the number of remaining teeth in patients undergoing gastrointestinal surgery.

Methods: This retrospective study included 453 consecutive patients aged ≥65 years who underwent programmed gastrointestinal cancer surgery under general anesthesia at the Department of Surgery, Fujita Health University Hospital, between January 2022 and December 2022. Background factors were prepared between the participants with and without dental intervention. In the dental intervention group, associations between background and surgical factors and the presence of postoperative delirium were explored. Factors with significant associations with postoperative delirium in the univariate analysis were subjected to logistic regression analysis to determine their association with the number of remaining teeth.

Results: Overall, 189 participants underwent postoperative management. They had a significantly lower Prognostic Nutritional Index and higher cognitive decline than the 264 patients who underwent no dental intervention during this period. However, no significant difference was observed in the incidence of postoperative delirium between the two groups. In the dental intervention group, logistic regression analyses revealed that postoperative complications and the number of remaining teeth were significantly associated with postoperative delirium development.

Conclusion: The results revealed that a decrease in the number of remaining teeth is associated with postoperative delirium. The cause of this is not clear, but it is thought to be related to brain fragility. Geriatr Gerontol Int 2025; 25: 90-95.

Aim: Evidence is lacking regarding associations between smoking/drinking and falls. This study aimed to determine longitudinal associations between smoking, alcohol consumption, and fall risk in middle-aged and older people.

Methods: Participants of this cohort study were 7542 community-dwelling Japanese people aged 40-74 years. The baseline self-administered questionnaire survey was conducted in 2011-2013, and the second survey was conducted 5 years later. Predictors were smoking level and alcohol consumption. The outcome was the occurrence of recurrent falls. Information on self-reported falls in the previous year was obtained. Covariates were demographics, lifestyle factors, body mass index, general health status, and disease history.

Results: The mean age of participants was 60.3 years. Higher smoking levels were associated with a higher recurrent fall risk (adjusted P for trend = 0.0386), with the ≥20 cigarettes/day group having a higher risk (adjusted odds ratio [OR] = 1.93, 95% confidence interval [CI]: 1.20-3.10) than lifetime non-smokers. The association between smoking and recurrent fall risk tended to be stronger in drinkers than in non-drinkers (adjusted OR = 2.75, 95% CI: 1.57-4.81), suggesting a potential interaction (P for interaction = 0.1035). Although there were no dose-dependent associations between alcohol consumption and recurrent fall risk overall, moderate alcohol consumption (150-299 g ethanol/week) was associated with a lower risk (adjusted OR = 0.57, 95% CI: 0.33-0.98) compared with no consumption in men.

Conclusions: Smoking, but not alcohol consumption, is dose-dependently associated with high fall risk. However, moderate alcohol consumption may be associated with a decreased fall risk. Moreover, there may be a potential interaction between smoking and alcohol consumption on fall risk. Geriatr Gerontol Int 2025; 25: 67-74.

Aim: In recent years, the majority of patients eligible for endoscopic retrograde cholangiopancreatography (ERCP) have been aged ≥75 years. We investigated ERCP safety in very elderly patients (aged ≥90 years).

Methods: We included patients aged ≥75 years who underwent ERCP between January 2015 and December 2020. We compared background factors, comorbidities, ERCP indications, complications, and outcomes and identified risk factors for complications using binary logistic regression and inverse probability of treatment weighting with propensity scores.

Results: The study included 1344 patients aged ≥75 years (137 and 1207 very elderly and elderly patients, respectively). The very elderly group had more women, less frequent diabetes, fewer antithrombotic medications, more frequent parapapillary diverticulum, less frequent post-cholecystectomy, and worse performance status. No significant differences were observed in the ERCP indications. Experienced endoscopists were likely to perform the procedure, and the procedure time was shorter for the very elderly. Complications occurred in 21 (15%) very elderly patients and 120 (10%) elderly patients, with no significant differences. The very elderly did not have an increased risk of complications but were less likely to be discharged home and had a significantly worse performance status at discharge.

Conclusions: ERCP could be safely performed in the very elderly, and age did not increase the risk of complications. Geriatr Gerontol Int 2025; 25: 54-60.

Aim: The effectiveness of early surgery in preventing complications in elderly Japanese hip fracture patients and the impact of weekend hospitalization need further investigation. The purpose of this study was to determine whether weekend hospitalization affects the incidence of various sequelae and death during hospitalization in elderly hip fracture patients using a comprehensive Japanese hip fracture case database.

Methods: We retrospectively analyzed the Japanese National Administrative DPC (Diagnosis Procedure Combination) database from April 2016 to March 2022. During this period, approximately 1100 DPC-affiliated hospitals consistently provided medical records with consent for the study. The study focused on weekend hospitalizations and investigated the associations with postoperative pneumonia, pulmonary embolism, myocardial infarction, urinary tract infection, acute renal dysfunction, dementia, and in-hospital mortality after propensity score matching. Owing to the large population size of the study, significance levels were strictly enforced, and a P-value < 0.001 was considered statistically significant.

Results: After performing propensity score matching based on age, sex, and comorbidities, 111 035 patient pairs were identified, comparing those admitted on weekends versus weekdays. The analysis showed no heightened risk of sequelae for those admitted during the weekend compared with weekdays. Additionally, there was a slight trend toward higher mortality risk during weekend hospital stays; however, the increase was insignificant, with a hazard ratio of 1.071 (95% confidence interval: 1.005-1.140, P = 0.03).

Conclusion: The results of this study indicate that weekend hospitalization for elderly patients with hip fractures is not definitively associated with an increase in various sequelae or in-hospital mortality and that the importance of early surgery for elderly patients with hip fractures may be recognized and promoted in Japan. Geriatr Gerontol Int 2025; 25: 75-81.

Background: Anticholinergic burden, reflecting the cumulative impact of medications with anticholinergic properties, significantly predicts adverse drug reactions and geriatric syndromes in older adults. Although anticholinergic risk scales (ARS) have been developed and validated in various countries, none have been tailored specifically for Japan. The Japanese Anticholinergic Risk Scale (JARS) was developed to adapt the existing ARS frameworks to the Japanese context, considering unique medication profiles and cultural factors.

Process: First, a systematic review was performed to follow the protocol registered in PROSPERO (CRD42017076510). A PubMed search from October 2017 to March 2023 was conducted to identify ARS publications post-September 2017. Based on two algorithms, average scores from the existing scores were used to develop JARS. The Delphi method, an expert consensus approach, was applied to determine the scores for medications that were not established by the algorithms. Sixteen articles identified in our systematic review contributed to JARS development. JARS categorizes 158 medications into three potency groups: 37 drugs scored as 3 (strong), 27 as 2 (moderate), and 94 as 1 (weak).

Conclusion: JARS, the newly developed ARS, could be a critical tool for anticholinergic burden assessment in older Japanese populations. Developed through a systematic review and Delphi-based expert consensus, it encompasses 158 medications, offering a comprehensive anticholinergic burden assessment. Future studies and updates should be conducted to improve the accuracy and clinical applicability of this scale. Geriatr Gerontol Int 2025; 25: 5-13.