Geriatrics最新文献

Background/Objectives: Postoperative Delirium (POD) is a frequent complication in older patients undergoing elective surgery. Although multicomponent interventions are effective, deficits in interdisciplinary communication and intersectoral collaboration persist. This study developed and evaluated the "Geriatric Delirium Pass (GeDePa)", a paper-based tool to systematically document risk factors for POD across care settings. Methods: A multi-method design was applied, comprising (i) a structured literature review, (ii) semi-structured expert interviews, and (iii) a standardized online survey utilizing the RAND/UCLA Appropriateness Method (RAM). A total of 21 healthcare professionals (general practitioners, geriatricians, anaesthetists, surgeons, and nurses) were recruited from Salzburg, Austria, and South Tyrol, Italy (2023-2024). Results: Healthcare professionals confirmed the GeDePa's practical applicability for early POD risk detection across care settings. The expert rating using the RAM Disagreement Index (DI) method deemed all 45 risk factors as sufficiently relevant and, with the exemption of two risk factors (alcohol use, intraoperative complications), feasible. A detailed analysis provided a more differentiated picture, with full consensus reached for only 18 items. Several factors with uncertain consensus (e.g., cognitive impairment and polypharmacy) were retained based on strong evidence in the literature. Others were excluded despite high ratings if they were considered redundant or impractical (e.g., detailed intraoperative complications). In total, 38 of the 45 risk factors were retained. Conclusions: The GeDePa is a feasible and relevant tool for structured delirium risk assessment and enhancing interdisciplinary communication between primary and hospital care. The finalized German and Italian versions are now available and will undergo further testing and implementation in clinical practice.

Background/objectives: Current studies have shown that caregiving anxiety is associated with an individual's dysfunctional thoughts. The aim of this study was to assess the mediating effect of caregivers' forgiveness (benevolence, lack of avoidance and lack of revenge) on the relationship between dysfunctional thoughts and anxiety in the informal caregivers of dependent older adults.

Methods: Participants were 222 family caregivers. We conducted path analysis to test the hypothesized model.

Results: We found a model that showed a good fit (χ² = 3.410; χ²/gL = 5; p = 0.63; GFI = 0.994; CFI = 0.999; RMSEA = 0.001). It showed a direct and negative association between dysfunctional thoughts and lack of revenge, and this variable was related positively with both benevolence and lack of avoidance. In turn, benevolence was associated with lower levels of anxiety. The associations between dysfunctional thoughts and anxiety were mediated by caregiver forgiveness.

Conclusions: Our research suggests the importance of health workers seeking to understand how individuals judge their avoidance, revenge and lack of benevolence, which affect individuals' anxiety, for change. This study demonstrates the relevance of forgiving strategies in developing and testing informal caregiving assessments. It is necessary to detect and reduce avoidance and revenge related to caregivers. It is also necessary to detect and improve benevolence.

The global population aged 65 and older is expected to double from 761 million in 2021 to 1.6 billion by 2050. Despite often being treated separately in clinical practice and policy, oral health and mental health are fundamentally interconnected in older adulthood, forming a bidirectional relationship that exacerbates disability, social inequity, and systemic healthcare challenges. This narrative review aims to summarize the two-way relationship between mental and oral health and emphasize their combined impact on systemic health, social engagement, and independence among ageing populations. The bidirectional relationship has profound clinical significance. Untreated oral diseases induce chronic pain and cause social embarrassment, aggravating pre-existing depression and anxiety. Periodontal disease can worsen systemic conditions such as diabetes, cardiovascular disease, and dementia via a shared inflammatory pathway. Conversely, mental health issues-including depression, anxiety, cognitive decline, and the use of psychotropic medications-reduce motivation for oral care, prompt dental neglect, and affect salivary function, deteriorating oral health. Despite clear connections, systemic gaps persist, including fragmented healthcare systems, financial barriers, stigma, lack of awareness, and caregiver burnout. To address these challenges, strategies such as developing integrated care models to unify dental and mental health services, reforming policies to prioritize oral and mental health parity, advocating anti-stigma campaigns to clear the misconceptions, and implementing community-based healthcare programmes to reach underserved older adults are essential. By recognizing oral health as a vital component of mental resilience, societies can transform ageing into an era of empowered well-being, where the mouth-mind connection promotes holistic health rather than functional decline.

Background: Sarcopenia is highly prevalent among hospitalized older adults and is associated with poor clinical outcomes. Multiple diagnostic criteria exist, but the comparative implications of different handgrip strength (HGS) thresholds and measurement tools are less explored.

Objectives: This study aimed to assess the prevalence of sarcopenia, comparing the diagnostic yield of different HGS thresholds using two measurement instruments (dynamometer and vigorimeter) in hospitalized older adults.

Design: This was a cross-sectional observational study.

Setting: A tertiary geriatric hospital with acute, rehabilitation, and long-term care wards was included.

Participants: A total of 376 hospitalized older adults with complete HGS and bioelectrical impedance analysis (BIA) data were recruited.

Measurements: HGS was measured using both a hydraulic dynamometer and a pneumatic vigorimeter. Sarcopenia was defined using cut-offs from EWGSOP2, SDOC, and two DO-HEALTH-derived thresholds. Low muscle mass was identified using the fat-free mass index (FFMI) by BIA. Multivariate logistic regression was used to identify predictors of sarcopenia.

Results: The prevalence of probable sarcopenia ranged from 68.1% to 89.4%, and confirmed sarcopenia from 39.6% to 50.3%, depending on the thresholds applied. Sarcopenic patients were older (86.1 ± 9.8 vs. 80.4 ± 11.0 years; p < 0.001), had lower BMI (20.7 ± 2.9 vs. 26.1 ± 4.8 kg/m²; p < 0.001), and were more frequently in long-term care (p = 0.014-0.043). Older age (OR 1.03-1.07 per year; p < 0.05) and lower BMI (OR 0.59-0.68 per kg/m²; p < 0.001) were independently associated with sarcopenia; sex and fall history were not.

Conclusions: Sarcopenia prevalence was high and varied widely across diagnostic definitions and measurement tools, reflecting both methodological variability and the high vulnerability of hospitalized older adults. These findings highlight the need for standardized, context-adapted diagnostic strategies to guide timely intervention in high-risk hospitalized older adults.

Background/Objectives: This study aimed to assess the impact of a physio-feedback exercise program (PEER) on the static balance of community-dwelling older adults. Methods: A clustered randomized controlled trial involving community-dwelling older adults (≥60 years of age) in the Central Florida area was conducted. Participants were randomized by research site into either (1) an 8-week exercise intervention program consisting of group-based and at-home exercises, along with a discussion with a researcher regarding their physiological health before and after the intervention period, or (2) a control group. Static balance outcomes included anterior-posterior root mean square (AP RMS), medial-lateral RMS (ML RMS), sway speed variability, and sway area measured using the Balance Tracking System (BTrackS) at baseline (T1), post-intervention (T2), one-month post-intervention (T3), and three months post-intervention (T4). Results: Among 373 community-dwelling older adults (mean age = 74.3 ± 7.1 years), a trend towards short-term improvement of sway area was observed for the intervention group, as seen through a small, marginally significant reduction in sway area at T2 (standardized β = -0.07; p = 0.050). However, the trend dissipated during post-intervention follow-up periods (T3 and T4). Sway speed variability significantly increased for the intervention group at T4 (standardized β = 0.10; p = 0.014). Conclusions: The PEER intervention may need to increase the total duration of the intervention, the frequency of the weekly exercise sessions, and the amount of standing stance exercises during the group-based and at-home exercise sessions to elicit improvements in static balance among older community-dwelling adults.

Background: Depression in older adults is a multifactorial condition influenced by health status, functional capacity, and lifestyle factors. This study aimed to investigate the individual and combined associations of these factors with late-life depression.

Methods: Using data from the National Health and Nutrition Examination Survey (NHANES), this study evaluated the associations of general health, chronic conditions, functioning, and lifestyle behaviors (including physical activity, sleep, diet quality, smoking, and alcohol use) with depressive symptoms among U.S. adults 65 years and older. Weighted logistic regression models, accounting for the complex survey design of NHANES, were used to examine the factors both individually and in combination.

Results: Depressive symptoms were more prevalent among individuals with poor self-rated health, physical and cognitive functional limitations, hypertension, obesity, current smoking, physical inactivity, and alcohol abstinence. A clear cumulative risk gradient was observed with increasing numbers of risk factors: older adults with six or more risk factors had at least 20-fold higher likelihood of depressive symptoms compared with those with one or no risk factors.

Conclusions: These findings highlight the interdependent influences of health, function, and lifestyle on late-life depressive symptoms and underscore the need for integrative prevention and intervention strategies to promote mental well-being in aging populations.

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Background/Objectives: The cardiometabolic index (CMI) is a simple anthropometric-metabolic indicator that has recently gained attention as a marker of cardiometabolic risk. This study compared the associations and predictive utility of CMI, body mass index (BMI), and waist circumference (WC) for cardiometabolic multimorbidity (CMM). Methods: Data were drawn from 3348 adults (mean age 63.5 years; 45.1% male) in the English Longitudinal Study of Ageing who were free of hypertension, coronary heart disease, diabetes, and stroke at wave 4 (2008-2009). CMI was calculated using the triglyceride-to-HDL-cholesterol ratio and the waist-to-height ratio. Incident CMM at wave 10 (2021-2023) was defined as the presence of ≥2 of these conditions: hypertension, cardiovascular disease, diabetes, or stroke. Odds ratios (ORs) with 95% confidence intervals (CIs) and measures of discrimination were estimated. Results: During 12-15 years of follow-up, 197 CMM cases were recorded. CMI, BMI, and WC were each linearly related to CMM. Higher CMI was associated with increased CMM risk (per 1-SD increase: OR 1.25, 95% CI 1.08-1.44; highest vs. lowest tertile: OR 1.88, 95% CI 1.09-3.25), with similar effect sizes for BMI. WC showed stronger associations (per 1-SD increase: OR 1.46, 95% CI 1.25-1.71; highest vs. lowest tertile: OR 2.16, 95% CI 1.35-3.44). Adding CMI to a base model resulted in a small, non-significant improvement in discrimination (ΔC-index = 0.0032; p = 0.55) but significantly improved model fit (-2 log-likelihood p = 0.004), with comparable effects for BMI and greater improvements for WC. Conclusions: In this older UK cohort, higher CMI levels were associated with increased long-term risk of CMM but did not outperform traditional adiposity measures such as BMI and WC.

Background/Objectives: Apathy, characterized by diminished motivation and reduced engagement in goal-directed behavior, is a prevalent concern among older adults, particularly in rural communities where opportunities for meaningful engagement may be limited. This study explores the preliminary impact of an in-person eBook club program on apathy among community-dwelling older adults in Northern British Columbia. Methods: This eight-week pilot single-group, pre-post mixed-methods study combined the use of eReaders to access weekly reading materials with facilitated in-person group discussions designed to foster emotional and social connection. Apathy was assessed using the 3-item Geriatric Depression Scale (GDS-3A) before and after the program. Results: A Wilcoxon signed-rank test revealed a statistically significant reduction in apathy scores (Z = -4.01, p < 0.001), with a large effect size (r = 0.76). While not powered for hypothesis testing, these findings suggest the program may have a meaningful effect. Qualitative analysis of participants who reported higher baseline apathy scores identified three key mechanisms of change: positivity effect, selective pruning of social networks, and adaptive coping, consistent with socioemotional selectivity theory. Conclusions: These preliminary results support the feasibility and potential value of theory-informed, low-cost group reading programs for addressing apathy in older adults and can inform the design of a larger, controlled study.

Background/Objectives: Ageism is a pervasive form of prejudice that undermines health, social participation, and intergenerational solidarity, yet validated research tools for measuring ageism are lacking in many countries. The Fraboni Scale of Ageism (FSA) is one of the widely used instruments, but its psychometric properties have not previously been examined in the Czech context. This study aimed to translate the 29-item FSA, evaluate its reliability and validity, and describe ageism across generations. Methods: A quantitative cross-sectional survey based on face-to-face interviews was conducted in March 2024 among the Czech population aged 15-74 years (n = 1096). Data analysis included descriptive statistics, internal consistency indices (Cronbach's α, McDonald's ω, Composite Reliability, Average Variance Extracted), exploratory factor analysis (EFA) on a random half-sample, and confirmatory factor analysis (CFA) on the second half. Construct validity was also examined. Results: The Czech FSA showed very good distributional characteristics with no floor or ceiling effects and excellent internal consistency (α = 0.949; subscales α = 0.848-0.898). EFA replicated the original three-factor structure (Antilocution, Avoidance, and Discrimination) explaining 57.6% of variance. CFA supported this structure with good-to-excellent model fit. FSA scores increased systematically from Baby Boomers to Generation Z, indicating higher ageism among younger cohorts. Higher fear of old age, lower education, an earlier subjective boundary of old age, and absence of an older co-resident were associated with higher ageism scores. Conclusions: The Czech version of the FSA is a reliable and valid instrument for assessing ageist attitudes in the Czech population. Its robust psychometric properties and sensitivity to theoretically relevant correlates support its use for monitoring ageism, evaluating interventions, and enabling cross-national comparisons in aging research and policy.