Geriatrics最新文献

Background/Objectives: Family physicians are essential to a well-functioning healthcare system; however, they face significant administrative and cognitive burdens that contribute to their burnout and reduce the quality of patient care they provide. Digital health tools offer potential solutions to these problems. This study examined the interface design and features of a digital health platform, Carmi, designed to mitigate administrative inefficiencies and cognitive overload by asynchronous patient data gathering and automated report generation. Methods: We conducted semi-structured interviews with nine family physicians practicing in Alberta, Canada, to gather their feedback on Carmi's interface design and features. Participants were asked to view a 20 min virtual demonstration of Carmi and provide input on its interface, navigation, potential impact on their clinic workflow, and suggestions for additional features. Interviews were transcribed and thematically analyzed using NVivo. Results: Participants found Carmi's interface user-friendly; most agreed that Carmi could reduce cognitive burden by automatically generating summary reports of assessments completed by patients and facilitating care coordination. Participants thought integration within existing electronic medical records was important, albeit Care of the Elderly physicians saw the value of Carmi as a standalone platform, noting that it can become a collaborative space where all healthcare providers can contribute to patient care. Conclusions: Carmi has the potential to improve primary care efficiency, especially for older adults with complex health needs. Work is underway at several pilot sites that have implemented Carmi so far to gather physicians, patients, and their caregivers' feedback on its usability.

Background/Objectives: To describe the effects of muscle-targeted oral nutritional supplementation (MT-ONS) on nutrition, functional capacity, and other health outcomes in patients after femur fracture surgery. Methods: A prospective, open-label, single-centre study was conducted. Patients aged 80+ post-femur fracture were recruited. They were assessed at baseline and after 90 days with MT-ONS, 100% whey protein enriched with leucine and vitamin D. Demographics, clinical and nutritional status (MNA^®-SF), functional capacity [Barthel Index (BI), Lawton and Brody (LB) scale], muscle strength (dynamometry), cognition [Global Deterioration Scale (GDS)], tolerability, and satisfaction data were collected. Descriptive statistics were performed. Ethical approval was obtained. Results: Thirty-one patients (74% women, mean age 87 ± 3.99 years) were enrolled. At baseline, 32% were malnourished and 65% were at risk. After ≥90 days of MT-ONS, malnutrition decreased to 13% and well-nourishment increased to 32%. Ninety percent gained weight, with significant muscle strength improvements (+2 kg, p < 0.001). Eighty-one percent achieved a BI score ≥ 60 points [mean 84.8 (±17.82)]. BI score improvements correlated with higher baseline muscle strength (rho = 0.413, p = 0.021) and better nutritional status (rho = 0.464, p = 0.009). The mean LB score was 4.84 (±2.26). Improvements correlated with the pre-fracture BI score (rho = 0.475, p = 0.007). Positive correlations were noted between nutritional status, muscle strength, and functional outcomes. Cognition remained stable (GDS = 1 in 67.7% patients). Tolerability and satisfaction with MT-ONS were high at 90%. Conclusions: MT-ONS, 100% whey protein enriched with leucine and vitamin D, for ≥90 days enhances nutritional status and functional recovery in patients after femur fracture surgery.

Background: Anticholinergic burden (ACB) from medications has been associated with adverse outcomes in older adults. Aim: The aim was to conduct a non-randomized feasibility study of an intervention to reduce the anticholinergic burden in older patients (REGENERATE) to inform a subsequent definitive trial. Methods: The development and evaluation of an ACB reduction intervention was guided by the Medical Research Council framework. Findings from preliminary studies, two systematic reviews, and two qualitative studies informed the design of a mixed-method feasibility study. The study was conducted in one UK primary care site. The clinical pharmacist identified and invited potentially eligible patients, reviewed their medications, and made recommendations to reduce the ACB as needed. Patients completed surveys at baseline and 6 and 12 weeks post-intervention. A purposive sample of patients and healthcare professionals was interviewed. Results: There was a response of 16/20; 14/16 attended the pharmacist-led consultation and completed the baseline questionnaire, and 13/14 completed both follow-up questionnaires. The sustainability of deprescribing was confirmed. The results suggest the potential of the intervention to reduce side effects from medications and improve quality of life (EQ-5D-5L). The interviews showed patients were happy with the study processes and the medication changes and were satisfied with the pharmacist's consultation. Conclusions: This feasibility study demonstrated that a deprescribing/reducing ACB intervention in older adults is feasible in a primary care setting and may benefit patients. Well-designed RCTs and cost-effectiveness studies should be undertaken to confirm the benefits of ACB deprescribing in primary care settings.

Context: The best treatment for end-stage chronic kidney disease (ESKD) is kidney transplantation (KT). As a result of an aging population, each year more kidney transplants in older adults are performed. Nevertheless, older recipients, characterized by more comorbidities and frailty, raise concerns about the outcomes, potential complications, and the general approach. Aim: The aim of this literature review was to study the outcomes, graft and patient survival, as well as common complications, to establish safety and increase awareness of the potential complications of kidney transplantation in the older population. Methods: PubMed and Google scholar databases were searched. The cut-off age defining an old patient was 60 years. The inclusion criteria were as follows: first kidney transplantation, and studies in English language. The exclusion criteria were as follows: more than one organ transplant, dual transplants, articles published before 2015, meta-analysis, reviews, letter to the editor, case reports, and studies published only as a conference abstract. Comparative and noncomparative studies addressing patient survival, death-censored graft survival, surgical complications, and clinical complications, such as delayed graft function (DGF) and biopsy proven acute rejection (PBAR), were included. Results: After screening the papers, 17 studies met the inclusion criteria and were included for review. Eleven papers compared older recipients with younger recipients and in six papers only older patients were analysed. Two studies used paired deceased donors to eliminate donor bias. The rest of the studies used either deceased donors or both living and deceased donors. The majority of patients were male (61.83%) and received a kidney from a deceased donor (58.08%). Conclusions: Kidney transplantation is safe and can be beneficial for recipients over 60 years of age. Older patients suffered more infectious complications, which were also one of the main reasons for death. Most studies did not show a significant difference in death-censored graft survival compared to the younger population. More research is needed to establish the prevalence of surgical complications, and some clinical complications.

Objective: Imaging biomarkers of bone, muscle, and fat by magnetic resonance imaging (MRI) may depict osteopenia, sarcopenia, and adiposity as the three different conditions of osteosarcopenic adiposity (OSA). Methods: Subjects from a prospective, population-based case-control study underwent a health assessment and 3 Tesla whole-body MRI scan. Imaging biomarkers of bone (bone marrow fat-fraction (BMFF)), skeletal muscle (skeletal muscle FF (SMFF)), and fat (total adipose tissue (TAT)) were determined. Participants were allocated to one phenotype according to the OSA complex. Results: Among 363 participants forming the study cohort, 81 (22.3%, 48.1% males, 62.4 ± 6.9 years) were allocated into the OSA subgroup. Participants with an OSA phenotype were significantly older compared to all remaining subjects and showed the highest grades of SMFF (all p < 0.005). Together with subjects from the osteopenic sarcopenia group, OSA subjects exhibited the highest amounts of BMFF and together with the three other adiposity-containing subgroups also exhibited the highest BMIs. The highest prevalence of an impaired glucose tolerance as well as significantly higher blood pressure, blood dyslipidemia, and hepatic steatosis was found in the OSA subgroup (all p < 0.005). Conclusions: MR biomarkers of bone, skeletal muscle and fat are feasible for body composition phenotyping and may allow for targeted risk stratification in suspected OSA syndrome.

Background/objectives: A significant proportion of older adults with Alzheimer's disease or related disorders live in a long-term care facility. This study aimed to determine the time delay between admission and death for older adults with dementia.

Methods: A post hoc analysis was conducted using data from a French observational cohort, identifying older adults with dementia who were admitted to nursing homes. This study assessed median survival times after admission to care facilities by using Kaplan-Meier models and evaluated factors potentially associated with the time until death by using Cox models.

Results: A total of 201 individuals were included. The median survival time from admission to a nursing home to death was 39 months. Being male, an older age, and having higher cognitive impairment and comorbidities were associated with decreased survival rates.

Conclusions: This study provides survival results for institutionalised older adults with dementia in France and provides elements for the definition of future public policies.

Background: The chin-tuck maneuver has been suggested to increase suprahyoid muscle activation, but a method to measure the strength of the chin-tuck maneuver has not been established. We developed a method to measure the strength of the chin-tuck maneuver (chin-tuck strength) and examined the reliability and validity of chin-tuck-strength measurement in community-dwelling older adults. Participants and Methods: The participants were 233 older adults aged ≥65 years without dysphagia or physical disability. Chin-tuck strength was measured twice consecutively using the developed device, and reproducibility was analyzed using intraclass correlation coefficients (ICCs). In addition, maximum tongue pressure, oral diadochokinesis, grip strength, knee extension strength, and the timed up and go test (TUGT) were measured as indices of swallowing-related muscle function and appendicular muscle function. The associations of chin-tuck strength with swallowing-related muscle function and appendicular muscle function were analyzed statistically. Results: The ICCs for chin-tuck strength were 0.82 (95% confidence interval [CI]: 0.73-0.88) in males and 0.87 (95% CI: 0.70-0.93) in females. Chin-tuck strength was significantly associated with maximum tongue pressure, grip strength, knee extension strength, and TUGT. Conclusions: This study suggests that chin-tuck strength is a reliable and valid assessment of swallowing-related muscle strength.

Negative self-perceptions of aging have been linked to poorer health and quality of life and predict significantly depressive symptomatology. The support provided by the partner may have an impact on the effects of self-perceptions of aging on depressive symptoms; a close relationship can go along with additional stress or resources and benefits. The present study analyzes the relationship between negative self-stereotypes and depressive symptomatology, considering positive and negative dyadic coping (DC) as moderator variables in this association. Method: Participants were 365 individuals (convenience sample) 40 years or older (M = 60.86) involved in a partner relationship. Participants completed a questionnaire that included the following variables: negative self-perceptions of aging, positive DC (e.g., "My partner shows empathy and understanding to me"), negative DC (e.g., "When I am stressed, my partner tends to withdraw"), and depressive symptomatology. Two moderation models were tested by linear regression. Results: The effect of negative self-perceptions of aging on depressive symptoms was moderated by positive and negative DC only in women. The effect of negative self-perceptions of aging appears to be smaller among those women with higher levels of positive DC and lower levels of negative DC. Conclusions: Positive DC might buffer the association between negative self-perceptions of aging and depressive symptoms. Negative DC might amplify this association, as it is associated with lower well-being among women who express negative self-perceptions of aging. Implications: Training couples in strategies for providing supportive dyadic coping may be a resource to buffer the negative effect of negative self-perceptions of aging on well-being.

Background: Older people are more likely to have poor nutrition and low muscle mass, which leads to poor physical performance and anemia, resulting in a poor quality of life and risks to mobility and mortality. Furthermore, malnutrition may, in part, raise the level of inflammatory biomarkers as well as muscle catabolism. Moreover, a range of indices related to systemic inflammation, obtained from routine complete blood count (CBC) tests, have been applied to inflammation markers. However, these biomarkers remain insufficiently addressed in the evidence supporting the presence of sarcopenia and malnutrition. This study aimed to explore sarcopenia in terms of malnutrition, anemia, and inflammation among Thai community-dwelling older people. Methods: This study enrolled community-dwelling older people aged 60 years and above. All participants were requested to complete a questionnaire assessing for sarcopenia (SARC-F) and nutritional status using the mini nutritional assessment (MNA). In addition, blood samples were obtained for the CBC test. Logistic regression analysis explored the risk of sarcopenia, CBC, and malnutrition status. Results: Of 126 older people (aged 62-88 years) enrolled, 12 individuals (9.52%) had sarcopenia. Furthermore, 34.9% and 5.56% of the participants were demonstrated to have anemia and malnutrition, respectively. Nutrition status was positively associated with hemoglobin levels (r = 0.241, p = 0.007) and negatively related to SARC-F scores (r = -0.190, p = 0.034). Older people with anemia show an increased risk of malnutrition at an odds ratio (OR) of 3.375. Moreover, individuals with anemia were at a higher risk of developing sarcopenia (OR 4.982) than those with no anemia. However, individuals with a high level of inflammatory markers, e.g., a high systemic inflammatory response index (SIRI) and monocyte-to-lymphocyte ratio (MLR), had a higher risk of sarcopenia than those with low SIRI and MLR values. The systemic immune-inflammation index (SII) and platelet-to-lymphocyte ratio (PLR) were also positively associated with SARC-F scores. Conclusions: The association between sarcopenia, malnutrition status, and anemia might overlap in clinical manifestation. In addition, future research directions regarding the utility of routine CBC testing should focus on sarcopenia and malnutrition status.

Background/Objectives: Respiratory illnesses frequently lead to hospitalization in adults aged 60 and older, especially due to respiratory viral infectious (RVI). This study investigates hospitalization patterns and characteristics of RVI at HM Hospitals from October 2023 to March 2024; Methods: We retrospectively explored hospitalizations of patients aged 60 years and older with RVIs, gathering data on demographics, clinical profiles, comorbidities, and treatments. Outcomes included hospitalization, ICU admissions, and mortality, and independent factors associated with outcomes were identified using a multi-state model; Results: From October 2023 to March 2024, from a total of 3258 hospitalizations, 1933 (59.3%) were identified as positive for RVIs. Overall, SARS-CoV-2 was the most prevalent (52.6%), followed by influenza (32.7%), and RSV (11.8%). Most RVI involved single infections (88.2%). Hospitalization rates increased with age for SARS-CoV-2 (333.4 [95% CI: 295.0-375.2] to 651.6 [95% CI: 532.1-788.4]), influenza (169.8 [95% CI: 142.6-200.7] to 518.6 [95% CI: 412.1-643.1]), and RSV (69.2 [95% CI: 52.2-90.0] to 246.0 [95% CI: 173.8-337.5]), with SARS-CoV-2 showing the highest rate, followed by influenza and RSV. In the multi-state model, RSV infection significantly increased ICU admission risk (HR: 2.1, 95%, p = 0.037). Age on admission (HR: 1.1, 95%, p < 0.001) and Charlson score (HR: 1.4, 95%, p = 0.001) were associated with transitioning from admission to death. ICU to death risks included age at admission (HR: 1.7, 95%, p < 0.001); Conclusions: RVI in adults 60 years and older are associated with high hospitalization and mortality rates, primarily driven by influenza and SARS-CoV-2, followed by RSV. Age and comorbidities significantly impact disease severity, emphasizing the need for targeted prevention and management strategies for RSV in this vulnerable population.