Geriatrics最新文献

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.

Introduction: White coat hypertension in geriatric patients can complicate dental procedures in the presence of intense anxiety.

Objective: To evaluate the effectiveness of a combined approach of psychological intervention and sedation for the control of the syndrome during multiple extractions.

Case presentation: A 76-year-old woman with a diagnosis of white coat hypertension (WCH) and a history of dental anxiety. In two previous attempts, the surgery was suspended due to blood pressure elevation. The Dental Perception Reprogramming Protocol (DPRP) was applied along with conscious sedation (midazolam, fentanyl, dexmedetomidine) which allowed agitation, so deep sedation with propofol was used.

Result: The patient had stable blood pressure (119/82 mmHg) and successfully completed the intervention without complications.

Conclusions: The integration of psycho-behavioral and pharmacological techniques allowed effective hemodynamic control, and a key interdisciplinary approach is suggested for the management of the syndrome in older adults.

Background and objectives: Osteoarthritis (OA) is a common cause of chronic pain. In refractory cases, cooled radiofrequency (CRF) of the genicular nerves is indicated. However, recent studies suggest that traditional targets may be insufficient, proposing the inclusion of the recurrent fibular nerve and the infrapatellar branch of the saphenous nerve. This study reports a prospective four-case series evaluating short-term outcomes of CRF at five revised targets in elderly Brazilian patients.

Case report: The study (CAAE No.: 55647722.5.0000.5142) included four patients (three women, one man; mean age 73.8 years) with moderate to severe refractory knee pain underwent diagnostic nerve block followed by ultrasound-guided CRF. After 30 days, three patients reported pain reduction, including two who experienced substantial improvement. One patient maintained severe pain. Improvements in physical performance, knee flexion, and extension were observed in patients who responded clinically, while individuals with coexisting myofascial pain showed limited functional gains. One patient experienced mild transient pruritus. In this prospective case series, CRF applied to five revised targets appeared feasible and well tolerated, with short-term improvement in pain and function in some patients. These preliminary descriptive findings support further investigation in larger controlled studies.

Background/Objectives: Conversations about end-of-life care or advance care planning are often difficult and emotionally challenging to initiate. Tailoring messages to the specific audiences can make these sensitive discussions more manageable and effective. The Evidence-based Model for the Transfer and Exchange of Research Knowledge (EMTReK), compromising six core components (message, stakeholders, processes, context, facilitation, and evaluation) offers a structured framework for research dissemination and knowledge transfer in palliative and long-term care settings. Knowledge translation bridges research and practice, with its effectiveness depending on stakeholder engagement, tailored communication, and systematic application of evidence in policy and practice. This study explores stakeholder perspectives on a dementia care intervention, using EMTReK as an analytical framework to examine how knowledge transfer and exchange (KTE) actions were implemented across long-term care settings. Methods: A qualitative analysis was conducted on primary data comprising case narratives from multinational research groups involved in the "Caregiver Decision Support" (mySupport) study (2019-2023). Teams from Canada, the Czech Republic, Ireland, Italy, the Netherlands, and the United Kingdom evaluated the mySupport intervention through interviews, with analysis guided by components of the EMTReK model. Results: Facilitated Family Care Conferences were found to be effective mechanisms for supporting knowledge transfer and intervention uptake in dementia care across nursing homes in Europe and Canada. Despite challenges posed by the COVID-19 pandemic, Family Care Conferences adapted through stakeholder engagement, interactive learning, and innovative communication methods. Using EMTReK as an analytical framework, the research team identified key elements that contributed to successful implementation, including the importance of flexibility to accommodate local contexts. Conclusions: The transnational application of the EMTReK model for advance care planning in long-term dementia care highlights the importance of tailored, culturally relevant knowledge translation strategies, which, despite challenges from the COVID-19 pandemic, were successfully implemented through local adaptations and diverse dissemination methods, emphasising the need for further research on their impact on resident and family outcomes.

Background: Population aging has led to a rise in dementia prevalence, increasing the demand for innovative care models. Telemedicine offers an opportunity to improve access, continuity, and caregiver support for older adults with cognitive impairment. Methods: This qualitative descriptive study was conducted at the Geriatrics and Gerontology Service of Cassiano Antônio de Moraes University Hospital (HUCAM-UFES), Brazil. Semi-structured interviews were carried out with 11 caregivers of older adults living with dementia who participated in telemedicine consultations. Data was analyzed thematically using a reflexive thematic analysis approach. Results: Caregivers considered telemedicine useful, accessible, and safe, facilitating the continuity of care and strengthening the caregiver-professional relationship. The main limitations were the absence of physical examination and occasional technical difficulties. Most caregivers favored a hybrid care model, combining remote and in-person visits. Conclusions: Telemedicine proved to be a feasible and well-accepted strategy for the care of older adults with dementia, improving caregiver support and communication with healthcare teams. Public policies should foster digital inclusion and training for both caregivers and professionals, consolidating hybrid, person-centered models of care.

Background/Objectives: Delirium, an acute cognitive disturbance, is often unrecognized by family or friend care partners, contributing to delayed interventions and negative health outcomes. UnderstandingDelirium.ca is an e-learning lesson developed to address this gap by improving delirium knowledge among the public, patients, and family/friend care partners. Our objective was to evaluate the acceptability, intention to use, and perceived impact of Understanding Delirium e-learning among public users. Methods: A convergent mixed-methods observational evaluation combining survey-based quantitative data and thematic analysis was conducted. The survey included the Net Promoter Score (NPS), the short-form Information Assessment Method for patients and consumers (IAM4all-SF), and an open-text feedback item. Descriptive statistics were used to summarize IAM4all-SF responses, assessing perceived relevance, understandability, intended use, and anticipated benefit. Open-text comments were analyzed thematically by two independent reviewers who reached consensus through discussion. Subgroup analysis of qualitative themes was performed by age, gender, and NPS category. Results: Among 629 survey respondents, over 90% of respondents agreed that the lesson was relevant, understandable, likely to be used, and beneficial. The NPS was rated 'excellent' (score of 71), and lesson uptake included over 7000 unique users with a 35% completion rate. Qualitative analysis revealed themes of high educational value, emotional resonance, and perceived gaps in prior healthcare communication. Respondents emphasized the lesson's clarity, intent to share, and potential for wider dissemination. Conclusions: UnderstandingDelirium.ca is a promising, guideline-aligned digital intervention that has potential to enhance delirium literacy and reduce care partner distress. Findings suggest that the Understanding Delirium e-learning can effectively improve public delirium literacy and should be integrated into care partner and clinical workflows.

Background: We report UK findings from Music Interventions for Depression and Dementia in Elderly care (MIDDEL), a cross-national, clustered, randomised trial undertaken in 2018-2023 to evaluate the effectiveness of music interventions for depression symptoms in care home residents living with dementia (NCT03496675, clinicaltrials.gov (accessed on 1 December 2024)). The trial compared the effects of Group Music Therapy (GMT) with Recreational Choir Singing (RCS); GMT and RCS combined; and treatment as usual (TAU). Methods: In the intervention arms, the protocolized music interventions were delivered in care home units twice per week for three months, then once per week for three months. The primary outcome was depressive symptoms after six months, measured by MADRS. Secondary outcomes included well-being-EQ-5D-5L, Visual Analogue Scale (VAS); quality of life-QOL-AD; symptoms of dementia-SIB-8, NPI-Q; and caregiver distress-NPI-Q. The change in MADRS score from baseline to 6 months was assessed using a linear mixed-effects model. We report the multivariate model having both treatments as predictors, both unadjusted and adjusted, for the interaction between the treatments. Results: The UK trial started in 2022 after the pandemic lockdown, when 16 care home units were recruited and randomised, four per arm; 192 residents aged over 65 with depression and dementia participated. An ITT analysis of 146 participants retained at 6 months found neither intervention had a significant positive effect on any outcome. Significant unfavourable effects were found for RCS participants on MADRS, NPI symptom severity, and EQ-VAS. The combination of RCS + GMT had a detrimental effect on caregiver distress. Conclusions: MIDDEL UK findings do not support the use of GMT or RCS to alleviate depression in care home residents with dementia.

Background/Objectives: Non-valvular atrial fibrillation (NVAF) is a common arrhythmia in the elderly and carries a high risk of cardioembolic stroke. Oral anticoagulation is central to prevention, with direct oral anticoagulants (DOACs) increasingly replacing warfarin due to better safety and convenience. However, major bleeding remains a key concern, particularly in older patients. This study aimed to determine the prevalence of major bleeding among elderly patients (≥65 years) with NVAF treated with oral anticoagulants. Methods: A retrospective cohort study was conducted on 886 elderly NVAF patients managed at a tertiary hospital between January 2012 and December 2023. Data on demographics, anticoagulant type, comorbidities, and bleeding events were collected. Associations between categorical variables were tested using Chi-square or Fisher's exact tests, while logistic regression identified predictors of major bleeding. Results: The mean age was 78.4 ± 7.2 years, with equal gender distribution. Most patients (87.1%) received DOACs, while 12.9% were prescribed warfarin. A total of 63 patients (7.1%) experienced major bleeding, including 51 (6.6%) in the DOAC group and 12 (10.5%) in the warfarin group. Intracranial and intra-/retroperitoneal hemorrhages were most common. Logistic regression showed older age, prior bleeding, a higher HASBLED score, and antiplatelet use as significant predictors. Among patients with a recorded weight (n = 70), dosing adherence was better for apixaban and edoxaban compared to dabigatran and rivaroxaban. Conclusions: DOACs were associated with fewer major bleeding events than warfarin. Bleeding risk was strongly linked to age, prior bleeding, HASBLED score, and concomitant antiplatelet therapy, highlighting the importance of appropriate DOAC dosing for safety.