Geriatrics最新文献

Objective: This study aimed to explore the direct relationships between social determinants and behavioral clusters, as well as their potential indirect associations mediated by edentulism. Methods: Information on social variables (collected in Wave 3, 2006/07), edentulism (Wave 5, 2010/11), and health-related behaviors (Wave 7, 2014/15) was drawn from the English Longitudinal Study of Ageing (ELSA). Baseline sociodemographic characteristics, including age, gender, ethnicity, education, and wealth, were accounted for. Latent class analysis (LCA) was applied to four behavioral indicators-smoking status, alcohol consumption, fruit and vegetable intake, and physical activity-to identify behavioral clusters. A confirmatory factor analysis (CFA) was then used to construct a latent variable representing social support and social networks. Two structural equation models (SEM) were developed to examine both the direct associations between social support/network and behavioral clusters, and the indirect associations mediated by edentulism. Results: In LCA, the two-class model was the best fit for the data. Class 1 (risky behaviors) had 7%, while Class 2 (healthy behaviors) had 93%. In SEM Model 1, higher social support/network levels predicted being in the healthy cluster directly (SC = 0.147) and indirectly (SC = 0.009). In Model 2, accounting for wealth and education, higher levels of social support/network maintained the direct association with the healthy cluster (SC = 0.132), but the indirect path lost significance. Conclusions: This study found that greater social support was associated with healthier behaviors, and this relationship may be mediated by edentulism. Health policies that encourage social interaction could therefore improve both general and oral health.

Background/Objectives: Alzheimer's disease (AD) often begins with episodic memory deficits, detectable in Mild Cognitive Impairment (MCI). The Loewenstein-Acevedo Scales of Semantic Interference and Learning (LASSI-L) shows promise for early detection, but lacks validation in Mexico. Methods: We assessed 355 adults ≥ 60 years, classified as cognitively healthy (CHG), MCI, or mild AD, using DSM-V criteria. Participants completed neuropsychological testing including the LASSI-L. Construct, concurrent, and predictive validity were analyzed via ANOVA, correlations with the Hopkins Verbal Learning Test (HVLT), and logistic regression models controlling for age, education, and comorbidity. Results: LASSI-L scores significantly differed between groups (p < 0.0001), with recovery from proactive interference best discriminating CHG from MCI and mild AD. Strong correlations with HVLT indices supported concurrent validity. Predictive models identified semantically cued recall and free recall (CRA2 and FRB1) as robust markers, independent of education. Conclusions: LASSI-L is a valid, accessible tool for identifying typical AD-related memory impairment in older Mexican adults, supporting earlier diagnosis in low-biomarker-access settings.

Background: Given the healthcare challenges older people and people who identify as LGBTQ+ are faced with, it becomes critical to explore how older transgender individuals experience discrimination in healthcare settings. Objectives: We followed the PRISMA guidelines for scoping reviews to map existing literature, and identify key themes, specific to transgender adults aged 65 and older and how they experience discrimination in healthcare.

Eligibility criteria: This scoping review explored studies that focused on discrimination against transgender people older than 65 in any healthcare settings, which were published in English in the last twenty years.

Sources of evidence: Evidence was extracted from Scopus, ProQuest Central, Health & Medical Collection, PubMed, CINAHL, Medline, and Psychology and Social Sciences databases.

Charting methods: We used streams of search with specific keywords. Two researchers were involved in the screening of articles, coding and analysis. Results: The search showed that research focusing on transgender people older than 65 and discrimination in healthcare was rather limited. The findings revealed that older transgender individuals frequently anticipated or experienced discrimination in healthcare settings, resulting in service avoidance and adverse health outcomes. Despite sometimes reporting lower overt discrimination than younger cohorts, older trans people faced comparable levels of victimization, compounded by age-related vulnerabilities and socioeconomic marginalization. Structural barriers, such as misaligned documentation, lack of provider competence, and financial constraints, further hindered access to healthcare. However, the presence of empathetic, culturally competent providers and access to LGBTQ+-specialized services might improve care engagement and outcomes. Conclusions: This review concluded that targeted policy reforms, inclusive clinical practices, and community-based support systems were essential to address these disparities. It called for greater institutional accountability and interdisciplinary research to ensure safe, affirming, and equitable healthcare for aging transgender populations.

Background/Objective: The sequelae of COVID-19 on geriatric health is profound, yet its consequences on mental well-being remain insufficiently elucidated, particularly in older adults with musculoskeletal conditions. This study aimed to explore the interrelationships and magnitude of the effects of fear of COVID-19, fear of falls, physical activity, and social frailty on depressive symptoms in this population. Methods: Purposive sampling was applied to recruit 292 older adults with musculoskeletal conditions. Data were collected through structured interviews (face-to-face and telephone) using standard questionnaires. Path analysis with Satorra-Bentler correction examined the relationships in the proposed model of depressive symptoms. The model fit indices were evaluated using the chi-square (χ²); the goodness-of-fit test was assessed with standard criteria of the comparative fit index (CFI ≥ 0.95), the Tucker-Lewis index (TLI ≥ 0.95), the root mean squared error of approximation (RMSEA < 0.08), and the standardized root mean square residual (SRMR < 0.05). Results: Mean participant age was 70.30 ± 6.56 years, with 74.3% female. The path analysis model demonstrated an excellent fit indicating χ² = 0.007 (p = 0.933), CFI and TLI = 1.000, RMSEA = 0.000, SRMR = 0.001. Fear of COVID-19 negatively indirectly impacted depressive symptoms (β = -0.07, p = 0.017), while physical activity had a positive direct effect (β = 0.16, p = 0.004). Fear of COVID-19 directly influenced social frailty (β = 0.18, p = 0.003) but had a negative direct impact on physical activity (β = -0.37, p = 0.000). However, fear of falling did not show a significant relationship with the other study variables. Conclusions: Depressive symptoms entail physical and psychosocial consequences. Physical activity has a positive effect on depressive symptoms. Fear of COVID-19 increases social frailty, while increasing physical activity reduces this fear. Future research should evaluate longitudinal effects and investigate evidence-based public health interventions or tailored cognitive-behavioral interventions to reduce pandemic-related fear and prevent mental health sequelae.

Introduction: Older patients are often exposed to medications with anticholinergic activity. Anticholinergic burden (ACB) from medicines is linked to adverse health outcomes. However, healthcare professionals' familiarity with ACB remains poor, and there is a lack of research on knowledge, attitudes, or practices (KAPs) of ACB among Emergency department (ED) clinicians. Methods: A nationwide survey of ACB based on a pilot survey was developed using the KAP framework and assessed for face and content validity by ACB experts. It was distributed to ED physicians across the UK using REDCap through social media and professional networks. Results: Among the 108 ED physicians who responded, 54.6% (n = 59) were aware of the term ACB, but 54.2% (n = 32/59) of them were unable to describe it. Their mean scores for quantifying the ACB score and identifying side effects in older patients were 2.9 and 4.1 out of 10, respectively. 88.9% (n = 96) believed that ACB is an important consideration in older patients. 67.6% (n = 73) agreed that awareness of the consequences of prescribing anticholinergic medications to older patients is important. 50% (n = 54) emphasized the importance of being able to assess and quantify the ACB score. Of the 75 physicians who prescribed these medications, 40% (n = 30/75) were unaware of ACB. 38.7% (n = 29/75) rarely considered ACB, 30.7% (n = 23/75) never considered it, and only 1.3% (n = 1/75) always considered it. The majority of respondents (88.9%, n = 96) agreed that more education on ACB is needed in the ED. Conclusions: ED physicians in the UK have limited knowledge and awareness of ACB management and prescribing practices for older patients. However, they show positive attitudes towards their role in ACB management and a willingness to receive further education. The low response rate suggests that findings may reflect a motivated subset of clinicians. These results highlight the need for targeted education and further investigation into curricular coverage of prescribing safety and anticholinergic burden.

Background/Objective: In the context of global aging, maintaining daily habits such as adequate nutrition and regular exercise are essential to achieve healthy aging. Therefore, the preservation of swallowing and physical functions is fundamental. Jaw-opening force, an important swallowing function, is linked to physical function. Daily health behaviors are shaped by decision-making biases, which influence decision-making. Individuals with high procrastination tendencies may be less likely to engage in health-promoting behaviors, potentially leading to functional decline. While such tendencies are associated with general health behaviors, little is known about their associations with swallowing and physical functions among older adults. The objective of this study was to examine the associations between decision-making biases and swallowing and physical functions in community-dwelling older adults. Methods: A questionnaire survey was conducted to collect basic information and assess decision-making biases. The jaw-opening force (swallowing function) and grip strength (physical function) were measured. Associations of decision-making biases with jaw-opening force and grip strength were examined using multivariable linear regression analysis. We further conducted sex-stratified sensitivity analyses. Results: This cross-sectional study targeted 107 community-dwelling older adults. There was a significant negative association between procrastination tendency and jaw-opening force (B = -0.715, p = 0.005), and grip strength (B = -1.552, p = 0.003), indicating that individuals with a propensity for procrastination had lower jaw-opening force and grip strength. Conclusions: Procrastination tendency may be used as an indicator to detect swallowing and physical functions. Moreover, incorporating this modifiable factor to promote behavior change may prevent functional decline. The study results highlight the significance of considering individuals' decision-making biases-particularly procrastination tendency-in clinical settings.

Background/Objectives: Obesity is currently a global pandemic and a major risk factor for the development of chronic disease and increased mortality. Common methods used to define obesity, such as body mass index (BMI), do not accurately reflect body fat content or distribution. Methods: We investigated the prognostic significance of the body roundness index (BRI) on incident death in 12,642 participants (60.2% women, mean age: 39, standard deviation (SD): 12 years) from the "Seguimiento Universidad de Navarra" prospective cohort and compared it to waist-to-height ratio (WtHR) and waist circumference (WC). Participants were monitored through biennial questionnaires. The mean of the baseline BRI was 3.6 (SD: 1.4) units. Multivariable-adjusted Cox models were used to estimate hazard ratios (HR) and confidence intervals (CI) of death. Results: Over a median follow-up period of 11.5 years, 380 participants died (absolute mortality rate 1.74 × 10^-3). In multivariable-adjusted models, higher quartiles of BRI were significantly associated with all-cause death, specifically in those ≥ 60 years (Quartile 4 vs. Quartile 1: HR 1.64; 95% CI: 1.00, 2.70). Considering the whole group (all ages), each 2-unit increase in BRI was linked to a 21% higher all-cause mortality risk in both men and women. This association was even stronger for participants aged over 60 years (multivariate adjusted HR for 2-unit BRI increase: 1.31; CI: 1.00, 1.72), while it was not significant when considering only those under 60 years. The associations of z-WtHR and z-WC with incident mortality for all participants were also significant in the fully adjusted model (HRs: 1.14; CI: 1.01, 1.27, and HRs: 1.16; CI: 1.04, 1.30, respectively). Mortality associations assessed using the BRI, WtHR, and WC were superior to associations based on the BMI. Conclusions: BRI shows a linear link with all-cause mortality in healthy adults ≥ 60, while WtHR and WC were also mortality predictors. Thus, lower central fat may help reduce early death risk.

Background: Sarcopenia, characterized by loss of muscle mass, strength, and function, reduces independence and quality of life in older adults. Strength exercise (STR) mitigates these age-related declines, but evidence of short-term effectiveness remains limited. This study aimed to evaluate the effects of eight weeks of STR on body composition, muscle strength, and psycho-emotional state in community-dwelling elderly women. Methods: A prospective, controlled, non-randomized study included 44 women assigned to an STR (n = 20) or control (CON, n = 22) group. The STR group performed supervised exercise twice weekly for eight weeks. The outcomes were body composition, handgrip strength (HGS), quadriceps (Q) and hamstrings (H) strength, and perceived stress (PSS-10), assessed at baseline and after intervention. Within-group changes were analyzed using paired t-tests, and between-group differences were evaluated using analysis of covariance (ANCOVA) adjusted for baseline values. Results: After baseline adjustment, body mass (p = 0.041, partial η² = 0.103), BMI (body mass index, p = 0.030, partial η² = 0.115), and body fat percentage (p = 0.047, partial η² = 0.098) were significantly reduced in the STR group. Significant improvements were observed for H strength in both legs (p < 0.05, partial η² = 0.128-0.131), right HGS (p = 0.025, partial η² = 0.122), right HGS:BMI ratio (p = 0.013, partial η² = 0.150), and H:Q ratios on both sides (p < 0.05, partial η² = 0.109-0.118). No significant differences were observed for left-hand grip strength, knee extensor strength, or other body composition variables (p > 0.05). The perceived stress scores were significantly lower in the STR group post-intervention (p = 0.036, partial η² = 0.108). Conclusions: An eight-week supervised strength exercise program was associated with favorable changes in muscle strength, body composition, and psycho-emotional state in elderly women.

Background: Frailty is a common syndrome amongst older individuals characterized by a progressive long-term loss of physical and or cognitive resilience. Given the high prevalence and chronic conditions and the lack of literature on frailty among rural older individuals in South Africa, the present study aimed to investigate the prevalence of frailty and its associated factors in older individuals residing in Limpopo province. Methods: This was a cross-sectional study, comprising 546 participants (48.4% males and 51.6% females) using Africa Wits-INDEPTH Partnership for Genomic Research (AWI-Gen) phase 2 data. Convenient sampling was used to select the participants. Frailty was measured using the five criteria proposed by Fried. Data was analyzed using Statistical Package for the Social Sciences (SPSS) 27. Results: The mean age (SD) of the participants was 66.78 ± 5.72. The proportion of individuals living with frailty was 26.4%. Individuals living with frailty were significantly older than both pre-frail and non-frail individuals. Current smokers significantly had higher proportion of frailty compared to both pre-frail and non-frail. The proportion of frailty reduced as the level of education increased. The present study found no association between biological sex and frailty. The likelihood of having frailty increased with age. On the unadjusted model, there was a significant association between frailty and 66 and above age group (OR: 1.61; 95% CI: 1.00-2.60). On the fully adjusted model the same age group was 1.75 more likely to be frail with a p value of 0.001. The present study found no significant association between marital status, smoking, alcohol status, current smoker, hypertension, diabetes, and obesity with frailty. Centrally obese participants were 0.48 and 0.37 times less likely to have frailty on unadjusted and adjusted models, respectively. Participants with dyslipidemia indicated by high total cholesterol (TC) were 2.25 times more likely to be associated with frailty. Conclusions: The prevalence of frailty was 26.4% and it was associated with age, educational status and dyslipidemia. Based on the findings of the present study, the authors recommend implementation of screening programs, for frailty in healthcare settings, especially targeting older adults with comorbidities.

Background: Frailty is a multidimensional syndrome reflecting reduced physiological reserve, increasingly recognized as a relevant factor in the clinical assessment of older adults with cognitive disorders. Objective: To explore the association between frailty, as measured by the Multidimensional Prognostic Index (MPI), cognitive performance, and plasma biomarkers of Alzheimer's disease (AD), and to examine the correlation between plasma and cerebrospinal fluid (CSF) biomarkers. Methods: This cross-sectional observational study included 40 patients (mean age 68.0 ± 9.0 years; 42.5% female) undergoing a diagnostic workup for cognitive decline. Patients were classified into AD (n = 20) and non-AD (n = 20) groups based on CSF AT[N] profiles. Frailty was assessed using the MPI. Linear and logistic regression models adjusted for age, sex, and education examined associations between MPI, cognitive scores, and plasma biomarkers (Aβ42, Aβ42/40, p-tau181, NfL). Correlations between plasma and CSF biomarkers and ROC analyses were also performed. Results: The AD group showed significantly higher plasma p-tau181 levels and MPI scores. MPI was positively associated with plasma p-tau181 levels (β = 4.26, p = 0.009). Plasma p-tau181 correlated strongly with CSF p-tau181 (R = 0.523, p < 0.001) and with CSF Aβ42/40 ratio (R = -0.541, p < 0.001) and showed high diagnostic accuracy (AUC = 0.910). Combining MPI with plasma biomarkers improved classification between AD and non-AD cases (AUC = 0.941). Conclusions: These findings support the value of incorporating frailty assessment in the diagnostic process of AD. The integration of geriatric tools and blood-based biomarkers may improve early detection and promote a more comprehensive approach in dementia evaluation.