Geriatrics最新文献

Background/Objectives: Life events and lack of social support are risk factors for a relapse or recurrence in patients with a bipolar disorder, yet studies focusing on older adults remain limited. Our aim was to investigate the influence of life events and social support on the course of bipolar disorder in older adults. Methods: A retrospective cohort study included patients aged 55 years and older in treatment for bipolar disorder and who used lithium. During a follow-up of maximum 5 years, relapses and recurrences, life events and six social support variables were constructed based on patients' electronic medical files. Results: We included 100 older patients with a mean age of 68.1 (SD 8.6) years; 69% were female. At least one relapse or recurrence was observed within the 5 years of observation in 52% of our patients. Life events were noted in the medical files in 24 out of these 52 (46.2%) patients. Living alone, a lower quality of social support and having at least two children was significantly associated with the onset of a relapse or recurrence (p = 0.024, p < 0.001, p = 0.022, respectively). Conclusions: Older adults with bipolar disorder have a high rate of relapses or recurrences within 5 years of observation, and half of the relapses or recurrences were preceded by life events. Social factors may also play a significant role in the onset of relapses and recurrences. Our results underline the necessity for incorporating social and environmental factors into prevention of relapses or recurrences for older bipolar patients.

Introduction: Information on the long-term maintenance of short-term exercise fitness gains measured by field-based tests is scarce in older adults. This study aimed to investigate short- and long-term changes in various physical fitness parameters after an 8-week exercise program. Methods: In this longitudinal study, a total of 265 participants (62% women; mean age 71.4 ± 4.7 years) completed a field-based test battery of 12 fitness tests (22 parameters) at 2 pre-tests and 1 post-test following an 8-week exercise program (2 sessions/week, combining aerobic and strength activities) in 2 consecutive years. The tests assessed muscle endurance, muscle strength, cardiorespiratory fitness, and motor fitness. Results: Significant short-term improvements were observed, e.g., in isometric trunk flexion and extension endurance (21-37%) for both sexes in both years. Lower-body muscular endurance improved in the first year (9-12%) for both sexes, while cardiorespiratory fitness (6-min walk test) improved only for men in both years (3%). No changes were seen in submaximal cycle test heart rates or any balance tests in any year. Most fitness parameters did not significantly decrease during the 9-month inter-intervention period, with a few exceptions in trunk strength and walking distance. Conclusions: This study demonstrates physical fitness improvements in older adults following short-term exercise interventions and that some of these improvements were maintained long term, whereas a few of these physical fitness test improvements decreased significantly over 9 months in older adults.

Background: There is a paucity of evidence on the association between genetic propensity for hippocampal atrophy with cognitive outcomes. Therefore, we examined the relationship of the polygenic risk score for hippocampal atrophy (PRShp) with the incidence of amnestic mild cognitive impairment (aMCI) and Alzheimer's disease (AD) as well as the rates of cognitive decline.

Methods: Participants were drawn from the population-based HELIAD cohort. Comprehensive neuropsychological assessments were performed at baseline and at follow-up. PRShp was derived from the summary statistics of a large genome-wide association study for hippocampal volume. Cox proportional hazards models as well as generalized estimating equations (GEEs) were used to evaluate the association of PRShp with the combined incidence of aMCI/AD and cognitive changes over time, respectively. All models were adjusted for age, sex, education, and apolipoprotein E (APOE) genotype.

Results: Our analysis included 618 older adults, among whom 73 developed aMCI/AD after an average follow-up of 2.96 ± 0.8 years. Each additional SD of PRShp elevated the relative hazard for incident aMCI/AD by 46%. Participants at the top quartile of PRShp had an almost three times higher risk of converting to aMCI/AD compared to the lowest quartile group. Higher PRShp scores were also linked to steeper global cognitive and memory decline. The impact of PRShp was greater among women and younger adults.

Conclusions: Our findings support the association of PRShp with aMCI/AD incidence and with global cognitive and memory decline over time. The PRS association was sex- and age-dependent, suggesting that these factors should be considered in genetic modelling for AD.

Background: Malnutrition is a widespread issue among older people, significantly impacting health outcomes. Nutritional interventions can improve health, but their success often depends on the attitudes and knowledge of healthcare workers. Aim: This study assesses healthcare workers' attitudes toward older people's nutrition using the validated Italian version of the Staff Attitudes to Nutritional Nursing Geriatric care scale (SANN-G), focusing on staff in nursing homes in Northern Italy. Methods: A cross-sectional study was conducted with 1789 healthcare workers from 41 facilities. The SANN-G questionnaire measured attitudes across five dimensions: nutritional norms, habits, assessment, intervention, and individualization. Data were collected online and on paper, with descriptive and inferential statistical analyses (chi-square and ANOVA) performed using R software (R-4.4.2 for Windows). Results: Most healthcare workers were female (68.59%) and aged 41-50 (33.31%), with nursing assistants comprising 35.83%. Only 23.48% scored positively on the SANN-G scale, with most exhibiting neutral or negative attitudes. Healthcare workers who attended a malnutrition course were more likely to exhibit positive attitudes toward nutrition, particularly in the dimension of norms, assessment, intervention, and individualization. Younger healthcare workers, with the role of nurses and who attended a course on malnutrition, were more likely to have positive attitudes, while older healthcare workers and with the role of physicians tended to show neutral or negative attitudes. Conclusions: Education on malnutrition improves healthcare workers' attitudes toward older adults' nutrition, especially among younger nurses. The low percentage of positive attitudes (23.48%) underscores the need for broader education programs to enhance nutritional care quality.

Background/Objectives: With ageing population projections, promoting positive ageing trajectories is critical. While health is often emphasised, eudaimonic psychological factors remain underexamined. A qualitative study presented throughout the main text highlighted the importance of psychological factors like purpose in life and resilience in fostering participation and subjective well-being, even amidst declining health. This model bridges the most recent updates from governmental organisations-the International Longevity Center, Brazil and the World Health Organization. Building on this model, the current research seeks to empirically assess the impact of health and eudaimonic psychological factors on the frequency and satisfaction of participation among older adults. Methods: This study involved 289 participants (56.74% women) aged 65+ in Madrid. Data on participation, self-perceived health, and eudaimonic factors were collected through an online survey. Hierarchical regression and cluster analyses explored the predictors and profiles of participation. Results: Resilience, positive relationships, and autonomy explained 8.8% of variance in participation frequency. Satisfaction was influenced by health, meaning in life, and autonomy, accounting for 11% of variance. Profiles showed the highest participation and satisfaction in individuals with high eudaimonic scores, despite moderate health. Conclusions: Eudaimonic factors significantly influence participation and mitigate health limitations, reinforcing the qualitative study model mentioned. By uniting updates from governmental organisations proposals, this model underscores the role of psychological well-being in active ageing. Future research should explore hedonic well-being as a key outcome of active ageing.

Objective: In this study, the objective is to analyze the efficacy of different aquatic physical exercise programs in the treatment of osteoarthritis in older people. Material and Methods: The systematic review was conducted until April 2024 and updated in November 2024 in five electronic databases. Randomized controlled studies in people over 60 years of age with a diagnosis of osteoarthritis were included. Water-based exercise interventions were assessed for their impact on osteoarthritis symptoms, walking ability, muscle strength, depressive symptoms, range of motion, body composition, fear of falling, fall risk, quality of life, range of motion, and dual task function. The methodological quality of included studies was assessed using the Physiotherapy Evidence Database. Results: A total of 12 studies were included, with sample sizes ranging from 35 to 312 participants. The presence of osteoarthritis in the sample was manifested in different joints. The methodological quality of the included studies varied from fair to good. Based on the results of this review, aquatic exercise significantly improved balance, stiffness, pain, and walking ability compared to non-exercise controls (p < 0.05). Compared with land-based exercise groups, only one study found significant differences between the two groups. Conclusions: Water-based exercise programs do not provide significantly superior benefits compared to other exercise modalities and appear to have limited effectiveness in the management of OA. However, the feasibility and high adherence make these programs a recommendable option for older people with OA. Future studies should investigate the impact of exercise intensity on the short- and long-term efficacy of aquatic therapy.

Background/Objectives: Spinal Phenol IN Glycerol (SPING) block is a novel palliative pain treatment for the non-operative management of proximal femur fractures (PFFs) in older adults living with frailty. Effective pain management that aligns with patient preferences and minimizes opioid use is critical in this setting. This study evaluated the patient, safety, and process outcomes of SPING block in this population. Methods: A retrospective cohort study was conducted in a suburban teaching hospital from March 2021 to June 2024, which included sixty-eight older adults living with frailty that suffered from a PFF and received SPING block. Data were collected from the Electronic Patient Records. The patient living situation was visualized with a Sankey diagram. Changes in pain scores and opioid use were assessed using the Wilcoxon Signed Rank test. Results: The median patient age was 89 years (Interquartile range (IQR) 83-92). Most were severely or terminally ill (American Society of Anesthesiologists (ASA) ≥ 4, 72%) and had cognitive impairment or dementia (68%). SPING block was effective in 93% of patients, significantly reducing median pain scores (4 [IQR 3-5] to 0 [IQR 0-1], p < 0.001) and opioid use (15 mg/day [IQR 4-30] to 0 mg/day [IQR 0-0], p < 0.001). Within 24 h, 84% could sit upright and 44% could transfer between their bed and chair. The median time to discharge was one day (IQR 0-3), with a median survival of 13 days (IQR 7-44). Conclusions: This study supports SPING block as a viable option for older adults living with frailty suffering from a PFF who opt for non-operative management in a palliative setting. SPING block for PFFs in a palliative setting offers effective pain relief, reduces opioid use, and enables mobility for older adults living with frailty. Follow-up is essential to monitor efficacy and safety. Prospective studies are needed to confirm these findings.

Background: Falls are a frequent and serious problem for older adults, especially for those living with Parkinson's. The relationship between falls and physical activity is complex, and people often restrict activity following a fall. Exercise is an important aspect of reducing further risk of a fall and a key component of the management of Parkinson's. The aim of this study was to understand the types of activity they are engaged in, the environments in which they take place, and the experience of people with and without Parkinson's who have fallen. Method: Seventeen people with Parkinson's and thirteen older adults who had experienced at least one fall in the previous year were recruited to this mixed methods study. Activity levels were captured over one week using accelerometers and body-worn cameras, allowing the type and location of activity to be recorded and analysed. This information informed an interview. Results: Findings showed that although both groups often achieved up to 10,000 steps per day, this was in very short bouts of activity. Sedentary activity, such as watching television, dominated the findings. Participants were aware of the benefits of being active but described many barriers to achieving the level of activity they would like to.

Background/Objectives: Frailty screening facilitates the identification of older adults at risk of adverse health outcomes. The Program of Research to Integrate Services for the Maintenance of Autonomy 7 (PRISMA-7) is a widely utilised frailty tool; however, concerns regarding its potential sex bias persist due to item 2, which assigns a frailty point for male sex. This study compared the PRISMA-7 with a modified version, the PRISMA-6 (excluding item 2), to assess their suitability for frailty screening in South Tyrol, Italy. Objectives included evaluating the impact of item 2 on frailty classification and exploring the feasibility of the PRISMA-6 as a more equitable alternative. Methods: A cross-sectional survey of 1695 community-dwelling older adults aged ≥75 years was conducted in South Tyrol. Frailty was assessed using both the PRISMA-7 and PRISMA-6. Sociodemographic, health, and lifestyle data were collected to examine associations with frailty classifications. Logistic regression was applied to identify predictors of frailty for each tool. Agreement between the PRISMA-7 and PRISMA-6 was assessed, and internal consistency was evaluated using Cronbach's alpha. Results: Frailty prevalence was 33.9% with the PRISMA-7 and 27.0% with the PRISMA-6. The PRISMA-7 classified men as frail more frequently than women (34.7% vs. 33.0%), while the PRISMA-6 reversed this trend (men, 21.4%; women, 33.0%). Excluding item 2 improved internal consistency (Cronbach's alpha: PRISMA-7, 0.64; PRISMA-6, 0.75) and aligned frailty classifications with predictors such as age, health status, and physical activity. Logistic regression revealed significant sex differences with the PRISMA-7 but not with the PRISMA-6. Conclusions: The PRISMA-7 introduces sex bias by overestimating frailty in men, whereas the PRISMA-6 provides a more equitable and consistent alternative. The findings highlight the PRISMA-6's potential as a reliable tool for unbiased frailty screening. Future research should validate the PRISMA-6 against established frailty tools to support its integration into primary care settings.

Purpose: This study aimed to elucidate the relationship between early postoperative gait parameters after total hip arthroplasty (THA) and the Forgotten Joint Score-12 (FJS-12) score at the 2-year follow-up after surgery. In addition, the cutoff gait parameter values for predicting discomfort using specific FJS-12 subitems were evaluated. Methods: Among 313 patients who underwent THA between April and December 2019, 44 (14.0%) who responded to the FJS-12 questionnaire at 2 years postoperatively were included in this study. Gait parameters, including walking speed, stride length, and their coefficients of variation (CVs), were measured at 13.8 ± 3.6 (mean ± standard deviation) days postoperatively. The FJS-12 was used to evaluate patients at 2 years after surgery. The correlation between the FJS-12 score and gait parameters was analyzed using Spearman's rank correlation coefficient. To determine the significant predictors of the FJS-12 score, multiple regression analysis was performed after adjusting for age as a covariate. Furthermore, receiver operating characteristic curves were used to determine the cutoff gait parameter values for predicting discomfort using specific FJS-12 subitems. Results: The FJS-12 score was significantly positively correlated with walking speed (r_s = 0.38, p < 0.05) and stride length (r_s = 0.51, p < 0.01). Meanwhile, the FJS-12 score was significantly negatively correlated with the CVs of walking speed (r_s = -0.34, p < 0.05) and stride length (r_s = -0.35, p < 0.05). Based on multiple regression analysis, stride length was a significant predictor of discomfort assessed using the FJS-12 score (β = 0.48, p < 0.01). According to the receiver operating characteristic curves, the cutoff stride length values for predicting discomfort using the FJS-12 subitems 9, 10, 11, and 12 showed moderate accuracy (area under the curve > 0.7). Conclusions: Improved walking ability of patients who underwent THA through early rehabilitation is linked to joint discomfort and patient satisfaction in daily life 2 years postoperatively.