Geriatrics最新文献

Background/Objectives: Hospitalization among older adults is a growing challenge in Mexico due to the high prevalence of chronic diseases and limited public healthcare resources. This study aims to develop a predictive model for hospitalization using longitudinal data from the Mexican Health and Aging Study (MHAS) using the random forest (RF) algorithm. Methods: An RF-based machine learning model was designed and evaluated under different data partition strategies (ST) with and without variable interaction. Variable importance was assessed based on the mean decrease in impurity and permutation importance, enhancing our understanding of predictors of hospitalization. The model's robustness was ensured through modified nested cross-validation, with evaluation metrics including sensitivity, specificity, and the kappa coefficient. Results: The model with ST2, incorporating interaction and a 20% test proportion, achieved the best balance between sensitivity (0.7215, standard error ± 0.0038), and specificity (0.4935, standard error ± 0.0039). Variable importance analysis revealed that functional limitations (e.g., abvd3, 31.1% importance), age (12.75%), and history of cerebrovascular accidents (12.4%) were the strongest predictors. Socioeconomic factors, including education level (12.08%), also emerged as critical predictors, highlighting the model's ability to capture complex interactions between health and socioeconomic variables. Conclusions: The integration of variable importance analysis enhances the interpretability of the RF model, providing novel insights into the predictors of hospitalization in older adults. These findings underscore the potential for clinical applications, including anticipating hospital demand and optimizing resource allocation. Future research will focus on integrating subgroup analyses for comorbidities and advanced techniques for handling missing data to further improve predictive accuracy.

The Coronavirus disease 2019 (COVID-19) pandemic seriously threatened the health and well-being of the population. This study aims to investigate the relevance of the COVID-19 pandemic on the stress, mental distress, and well-being of older people in Spain. The design was quantitative repeated cross-sectional. The sample was non-probability and consisted of 1436 persons from the general population divided into two groups: (1) the study group, composed of 718 women (61.3%) and men aged 60 to 89; (2) the comparison group, composed of the same number of women and men aged 30 to 45. All were assessed in three phases of the COVID-19 pandemic: the first pandemic year, the last pandemic year, and the post-pandemic period. The results showed that during the first year of the pandemic, the prevalence of mental distress was higher in older women (50%) than in older men (37.2%), while the rates in the comparison group were 57.2% for women and 53.2% for men. In the post-pandemic period, the rates of mental distress were 30.2% for older women and 29.8% for older men while in the comparison group, the rates were 48.5% for women and 26.5% for men. No significant differences in well-being were found between the groups or between the different phases of the pandemic. The most common stressors reported by older people were illness and death of family and/or loved ones, followed by personal illness. In the post-pandemic period, more stressful events and lower stress resilience were found to predict mental distress in older women and men. Greater perceived vulnerability to infection was another important predictor for women. Low self-esteem and younger age were also predictors of mental distress for men. High self-esteem, high social support, greater stress resilience and fewer stressful events were predictors of well-being for both genders. The results of this study are relevant for the design of policies, programs, and strategies to improve the health and well-being of older people.

Background/Objectives: Ageing is associated with several cognitive, physical, and emotional changes, including a decrease in sleep quality and mental health issues. This study studies NESA (Spanish acronym for Neuromodulación Superficial Aplicada) non-invasive neuromodulation using microcurrents as something that may provide a potential improvement in the quality of sleep and general health of older adults and residents in a healthcare institution. Methods: This observational study recruited 24 people who were residents at a long-term care facility. Participants were divided into two groups: one intervention group, who underwent NESA therapy twice a week for a total of 20 sessions, and a control group, who did not receive this treatment. The outcomes measured include sleep quality (Pittsburgh Sleep Quality Index), diary of sleep, symptoms of depressed mood (Yesavage Geriatric Depression Scale), and quality of life with the World Health Organization Quality of Life-Old (WHOQOL-OLD). Scores were collected at baseline, after 10 and 20 sessions, and 3 months after finishing the treatment. Results: The intervention group exhibited a notable improvement in sleep quality (p = 0.05). Additionally, there were fewer nocturnal awakenings. The quality of life also showed better scores, especially in relation to social relations and physical and mental health, which matches the slight decrease in scores and clinical improvement regarding depressive symptoms. In contrast, the control group demonstrated no improvement in symptoms, and in some cases, there was a worsening of symptoms. Conclusions: Our findings indicate that NESA non-invasive neuromodulation therapy is likely to enhance sleep quality and health-related measures in institutionalized older adults. Despite the limitations of the current study, the results support the potential of NESA microcurrents to enhance the well-being of this population.

Objective: This study aimed to explore self-care understanding and behaviours among aged-care workers in Australia. It was conducted as part of a project to co-produce a self-care resource for the Australian aged-care workforce. Methods: Semi-structured interviews with eleven aged-care staff and a focus group with four staff at an aged-care facility were undertaken to understand how staff understand and practice self-care and how death and dying affect workers. Thematic analysis was performed using software to generate a data coding tree. Results: Aged-care workers view self-care as taking care of oneself and as being a way to manage and maintain wellbeing so that they can continue to care. As practiced in daily life, self-care is highly individualised, with actions at work and at home having significant impact on a person's wellbeing. Supportive organisational cultures and collegial teams were found to be particularly relevant in helping staff to deal with death and dying. Conclusions: Aged-care workers may benefit from an online self-care resource tailored to their specific needs and based on their first-hand experiences of working in aged-care. Organisations can support aged-care workers by creating space and time for self-care.

Introduction. Primary progressive aphasia (PPA) is a clinical syndrome characterized by a progressive deterioration in language and speech. It is classified into three variants based on symptom patterns: logopenic, semantic, and non-fluent. Due to the lack of fully reliable and valid screening tests for diagnosing PPA and its variants, a Spanish version of the Mini Linguistic State Examination (MLSE) has recently been introduced. Materials and methods. This study aimed to describe the language impairments in a small sample of six patients with PPA and classify them into the three variants using the decision tree and syndrome guide proposed by the MLSE authors. Results. The findings demonstrate the test's utility in classifying some PPA variants through a qualitative analysis of patient performance and error types. The study revealed a 50% accuracy rate for the decision tree and an 83.33% accuracy rate when using the syndrome guide. Discussion. This discrepancy arises because the decision tree often classified cases as logopenic variant PPA (lvPPA) when working memory was significantly impaired. Specifically, it tended to misclassify patients with semantic, motor, or speech impairments as having lvPPA due to its reliance on the sentence repetition task for assessing working memory.

Introduction. Frailty is a common condition among older individuals and is associated with increased vulnerability to adverse health outcomes. The COVID-19 pandemic further highlighted the impact of viral infections on frail populations. The present work aimed to determine frailty, functional and cognitive status, and clinical analysis of older persons in a long-term care facility in Chile, before and following the outbreak of COVID-19. Methods. A single-center, pre-post, and Pearson's correlational study was conducted in a cohort of 20 persons positive for COVID-19 from a total of 45 residents. Data on demographic, clinical, functional (Barthel Index (BI) and Katz) and cognitive (Mini mental Examination) status, and physiological function (hematology, lipidic and biochemical profiles) were collected. Results. The mean age was 84 ± 2.4 years, and 80% were females. The most common comorbidities were Arterial Hypertension, Diabetes Mellitus type II, and Alzheimer's disease. Physical frailty was confirmed by body weight, body mass index, and calf circumference. Pre-infection, BI was negatively correlated with lipidic profile and erythrocyte sedimentation rate (ESR), and positively with frailty (calf circumference). Pre-post analysis showed that frailty and most analytical results were not modified. However, functional dependence on daily live activities significantly increased as measured by BI, with worse grooming and bowel and bladder controls. Post-infection, correlations were lost except between BI and ESR, and decreased albumin levels were found. Conclusions. The worsening of specific functional limitations emphasizes the need for targeted interventions that can be correlated with ESR. Albumin appears as a potential biomarker for physiological dysfunction associated with their infectious/inflammatory processes.

Background/Objectives: The annual incidence of falls is high in older adults with impaired cognitive function and dementia, and injuries have a detrimental effect on disability-adjusted life-years and public health spending. In this registry-based study, fall incidence and characteristics of the fallers were explored in a large population with cognitive impairment. Methods: NorCog, "The Norwegian Registry of Persons Assessed for Cognitive Symptoms", is a national research and quality registry with a biomaterial collection. This study included 9525 persons from the registry who had answered the question about falls. Fall incidence was studied, and the characteristics of fallers and non-fallers were compared. Results: The annual fall incidence was 3774/9525 (39.6%). The incidence varied between types of dementia, from 22.4% in persons with the debut of Alzheimer's disease before 65 years of age to 55.3% in persons with vascular dementia and with increasing degrees of cognitive impairment. A wide range of personal characteristics, symptoms, signs, laboratory tests, and physical, psychological, and cognitive tests differed between fallers and non-fallers, most in disfavour of the fallers. Age, reduced Personal Activities of Daily Living, reduced gait speed, delayed recall, use of a walking aid, and depression were independent predictors of falls. Conclusions: Among cognitively impaired persons with a history of falls, frailty was an independent predictor of falls. Neither the type of dementia nor the degree of cognitive impairment were independent predictors of falls. Prevention of frailty by physical training and social activity may be important in mitigating fall risk among older adults with impaired cognition.

Introduction: Hospitalisation and prolonged length of stay is associated with deconditioning that risks adverse outcomes after discharge. Less is known about the psychological impact on older people after hospital discharge. The purpose of this systematic review was to elucidate factors contributing to psychological stress in older patients post-discharge to inform better discharge planning. Methods: A systematic search for studies reporting poor discharge outcomes in older people between 2010 and 2022 was performed in Medline, CINAHL, and PsycINFO. Search terms were 'older patients > 65 year', 'post-discharge', 'psychological distress', 'loneliness', 'anxiety', 'depression', and 'length of hospital stay'. Exclusion criteria included COVID-19 disease, dementia (±severe cognitive impairment), individuals aged <65, and those under palliative care services. Results: A total of 1666 records were identified, of which 878 were excluded as they were outside of our date limits or were not written in the English language, 681 were excluded after application of exclusion criteria, and 699 were excluded because of insufficient details. A total of 31 duplicates were removed, leaving 38 articles that were assessed for eligibility; 7 of these reports were found suitable, comprising 1131 patients. Three highly relevant themes identified relating to post-discharge outcomes were social isolation, lack of support, depression and anxiety. Older patients with a tendency toward depressive symptoms had an increased likelihood of death. Conclusions: It appears that the discharge process from hospital fails to address psychological factors that permit a successful transition from hospital. Pre-discharge screening of psychological symptoms and coping ability may assist in identifying older patients who are at risk of mental as well as subsequent physical deterioration. Better knowledge of positive and negative predictors of a successful transition from hospital to home would enable more holistic, effective, and inclusive discharge planning processes for older adults.

Quality of life (QOL) has become an important public health issue. Adults presenting better QOL have shown reduced mortality and risk of chronic diseases and better mental health. Regular physical activity (PA) is consistently associated with a number of health benefits in older adults, including betted QOL, which is a key component of healthy aging. The purpose of the study was to examine how physical activity level and age influenced QOL in adults. Material and Methods: A total of 378 adults from Poland participated in the study (mean age of 57.89 ± 12.54). Respondents completed questionnaires to measure QOL (WHOQOL-BREF) and physical activity level (International Physical Activity Questionnaire-short form). Linear regression analysis was used to examine the effect of age and PA on QOL. Results: Weekly energy expenditure associated with recreational physical activity was correlated with better QOL in all domains: physical (R = 0.5, p < 0.001), physiological (R = 0.4, p < 0.001), social (R = 0.3, p < 0.001) and environmental (R = 0.39, p < 0.001). Increases in PA level predicted increases in the physiological domain (β = 0.41, SE = 0.05, p < 0.001), social domain (β = 0.34, SE = 0.05, p < 0.001) and environmental domain (β = 0.39, SE = 0.05, p < 0.001). In the physical domain, increases in both physical activity level (β = 0.41, SE = 0.04, p < 0.001) and age (β = 0.31, SE = 0.04, p < 0.001) predicted better QOL. Conclusions: Our findings emphasize the potential benefits of physical activity on QOL regardless of age. Although aging is combined with various age-related diseases, quality of life improves with age in physically active adults.

Background: Hand dexterity is affected by normal aging and neuroinflammatory processes in the brain. Understanding the relationship between hand dexterity and brain structure in neurotypical older adults may be informative about prodromal pathological processes, thus providing an opportunity for earlier diagnosis and intervention to improve functional outcomes.

Methods: this study investigates the associations between hand dexterity and brain measures in neurotypical older adults (≥65 years) using the Nine-Hole Peg Test (9HPT) and magnetic resonance imaging (MRI).

Results: Elastic net regularized regression revealed that reduced hand dexterity in dominant and non-dominant hands was associated with an enlarged volume of the left choroid plexus, the region implicated in neuroinflammatory and altered myelination processes, and reduced myelin content in the left frontal operculum, the region implicated in motor imagery, action production, and higher-order motor functions. Distinct neural mechanisms underlying hand dexterity in dominant and non-dominant hands included the differences in caudate and thalamic volumes as well as altered cortical myelin patterns in frontal, temporal, parietal, and occipital regions supporting sensorimotor and visual processing and integration, attentional control, and eye movements. Although elastic net identified more predictive features for the dominant vs. non-dominant hand, the feature stability was higher for the latter, thus indicating higher generalizability for the non-dominant hand model.

Conclusions: Our findings suggest that the 9HPT for hand dexterity might be a cost-effective screening tool for early detection of neuroinflammatory and neurodegenerative processes. Longitudinal studies are needed to validate our findings in a larger sample and explore the potential of hand dexterity as an early clinical marker.