Geriatrics最新文献

Background/Objective: Hip fractures in older adults are a major public health concern due to their high rates of morbidity, mortality, and long-term disability. Although surgical and postoperative care have improved, recovery outcomes remain highly variable. Identifying early functional recovery patterns could support individualized rehabilitation and discharge planning. This study aimed to identify distinct early recovery trajectories of motor function within 30 days after hip fracture surgery using growth mixture modeling (GMM) and to examine patient- and hospital-level factors associated with these patterns. Methods: A retrospective cohort study was conducted using data from the Nagano Hip Fracture Database, including 2423 patients aged ≥65 years across 17 acute care hospitals in Japan (2019-2024). Functional recovery was measured using the motor subscale of the Functional Independence Measure (FIM-motor) at 0, 7, and 28 days post-admission. Latent trajectory model was used to identify distinct recovery patterns. Multinomial logistic regression analyzed predictors of class membership. Results: Three recovery trajectories were identified: high/rapid improvement (26.7%), intermediate (32.6%), and poor/flat recovery (40.7%). Older age, cognitive impairment, and lower baseline mobility were strongly associated with membership in the poor-recovery class. Early trajectory classes significantly predicted discharge outcomes, including FIM-motor scores and discharge destination. Sensitivity analysis confirmed the robustness of findings, with minimal impact from hospital-level clustering. Conclusions: Distinct early recovery trajectories exist after hip fracture surgery and are strongly influenced by baseline cognitive and functional status. Early identification of recovery patterns can enhance personalized rehabilitation and inform discharge planning, offering valuable insights for clinical practice.

Objective: The non-verbal nature of the Clock Drawing Test (CDT) suggests it is a suitable cognitive screening instrument for populations with lower educational levels and/or language barriers. This study evaluates whether the CDT is a valid screening instrument for low-educated patients and includes a qualitative analysis of CDT errors. Method: A total of 503 participants were included, divided into four groups (dementia, MCI, no cognitive impairment, and other diagnosis), based on a clinical diagnosis by a geriatrician. Educational levels were categorized into four groups: no education and low, middle, and high education. CDT scores were assessed using the seven-point scoring system (Freedman), and two cutoff points were evaluated. Results: Results showed that in all education categories, the dementia group scored significantly lower on the CDT compared to the non-dementia group. The difference was smallest in participants with no education. Two cut-off points were assessed: <4 and <3. A cut-off of <4 showed better sensitivity versus <3, particularly for low-educated groups. A cut-off of <3 provided better specificity versus <4. Error analysis showed that errors made by low-educated participants without dementia were similar to those of patients with dementia. Conclusions: These findings show that the CDT (both total score and qualitative error analysis) has limited value in dementia case-finding in low-educated groups. The CDT is recommended primarily for middle- and high-educated groups.

Aim: The present study aimed to evaluate the agreement between calf circumference (CC) and dual-energy X-ray absorptiometry (DEXA) in assessing muscle mass, and to determine how possible discrepancies influence the diagnosis of malnutrition and its relationship with frailty and disability in older adults. Methods: We analyzed cross-sectional data from 1048 adults aged 65 years and older who participated in the 2001-2002 National Health and Nutrition Examination Survey (NHANES). Malnutrition was defined using the Global Leadership Initiative on Malnutrition (GLIM) criteria, and muscle mass was estimated using both DEXA and CC. Agreement between the two assessment methods was tested with Kappa statistics, while multivariable logistic regression models were used to explore the associations between malnutrition (as determined by each method) and frailty or disability, controlling for age, sex, physical activity, polypharmacy, and urinary albumin levels. Results: CC and DEXA-based appendicular skeletal muscle mass (ASM) showed a moderate correlation (r = 0.592). The prevalence of malnutrition was 10.3% when defined by CC and 9.1% when defined by DEXA (κ = 0.635, p = 0.001). In both cases, malnutrition was significantly associated with frailty (OR: 1.56; 95% CI: 1.240, 1.970, p < 0.001), but not with disability. Adjusting for albumin levels did not substantially change these associations. Conclusions: CC and DEXA demonstrate moderate concordance in estimating ASM. While this level of agreement slightly affects malnutrition prevalence estimates, it does not alter the observed relationship between malnutrition and frailty or disability in older adults.

Background/Objectives: In rural communities, caregivers of people living with dementia face limited access to support services. Digital interventions offer potential solutions for support. This paper reports on the evaluation of Verily Connect, a web-based multicomponent intervention developed to support caregivers. The aim of this qualitative study was to critically evaluate the implementation of Verily Connect to better understand its barriers and enablers. Methods: Using the Consolidated Framework for Implementation Research (CFIR), qualitative data were collected through semi-structured interviews with 24 health service professionals across 12 rural Australian communities. Thematic analysis was conducted to identify barriers and facilitators to implementation. Results: Key barriers included limited digital literacy, resistance to technology and privacy concerns, as well as competing organisational priorities, and inadequate technological infrastructure. Facilitators included organisational alignment and supportive management. Conclusions: The perceived relevance and usability of Verily Connect were enhanced by its co-design with caregivers and integration into health service models. Addressing digital literacy for caregivers, infrastructure limitations, and organisational readiness is essential for future technology-based health interventions in rural dementia care.

Background: Parkinson's disease (PD) is a prevalent neurodegenerative disorder among the elderly, with its incidence increasing as the population ages. Despite the predominance of patients with PD aged 75 years and older in clinical settings, limited research has focused on their rehabilitation. This study aimed to compare the clinical characteristics and rehabilitation outcomes of elderly patients aged 75 years and older. Methods: A retrospective analysis was conducted on 141 patients with PD aged 65 years and older who underwent intensive inpatient rehabilitation. Patients were categorized into two subgroups: the young-old group (65-74 years, n = 58) and the old-old group (≥75 years, n = 83). The rehabilitation program included daily 2 h sessions, 6 days a week, combining physical, occupational, and speech-language-hearing therapies to enhance functional impairments and activities of daily living (ADL). Clinical characteristics and rehabilitation outcomes were compared between these groups. Results: The old-old group exhibited significantly higher rates of sarcopenia, higher Unified Parkinson's Disease Rating Scale (UPDRS) scores, poorer balance scores and cognitive function, and lower ADL scores compared with the young-old group. However, both groups demonstrated significant improvements in UPDRS, Berg Balance Scale, 10 m walk test, and Functional Independence Measure scores, indicating enhanced motor function and ADL. Conclusions: Our retrospective study suggests that inpatient rehabilitation is associated with improvement in parkinsonism, motor symptoms, and ADL in patients with PD aged 75 years or older, highlighting the potential benefits of intensive rehabilitation even in advanced age. These findings underscore the need for prospective studies to confirm these effects. Trial registration: UMIN000056042 (last amendment 5 November 2024, retrospectively registered).

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Background/Objectives: Although information and communication technology (ICT) offers opportunities to address challenges, evidence among frail populations is limited. We aimed to evaluate the effectiveness and feasibility of an ICT-based intervention incorporating an artificial intelligence (AI)-assisted smartphone dietary application and group communication tools to improve dietary quality and social connection among community-dwelling older adults with frailty. Methods: A non-randomized, quasi-experimental study was conducted among 29 older adults (≥65 years) in Tokyo, Japan. Participants were assigned to the intervention (n = 11) or control (n = 18) group. The 3-month intervention included weekly photo uploads of meals via an AI-based dietary application providing automated image analysis and personalized feedback, supervised by registered dietitians, along with peer communication through a group chat. The primary outcome was dietary quality. The secondary outcomes included body weight, body mass index (BMI), skin carotenoid score, and loneliness. Results: The adjusted Japanese Food Guide Spinning Top Score at 3-month follow-up was 49.0 (standard error [SE] = 2.6) and 39.5 (SE = 2.0) in the intervention and control groups, respectively. The adjusted mean difference between groups was +9.5 (95% confidence interval: 2.3 to 16.7, p = 0.01). After using analysis of covariance for adjusting for respective baseline values, age, education status, and antihypertension drug use, no statistically significant between-group differences were observed at 3-month follow-up for any secondary outcomes. Conclusions: AI-based dietary intervention and peer communication effectively improved dietary quality among older adults, highlighting the potential of such an intervention to promote healthier eating habits in this population.

Background: Clostridioides difficile infections (CDIs) are caused by a Gram-positive, spore-forming bacillus and are defined by more than three episodes of watery diarrhoea per day. CDI is a major cause of morbidity and mortality in older adults, particularly over 65 years. Recurrent CDI leads to higher mortality and prolonged, debilitating illness.

Case presentations: This article presents two patients, aged over 80 years old, who developed recurrent CDI causing complicated and prolonged treatment courses. Patient 1 required an extended course of antibiotics for treatment of discitis and a congruent psoas abscess. Patient 2 developed CDI after multiple short courses of antibiotics for urinary tract infections (UTIs) in the context of multiple comorbidities. Both patients experienced three distinct episodes of CDI and were treated in collaboration with microbiology specialists. Following the third episode, both were successfully treated with oral capsule faecal microbiome transplants (FMTs). Their cases highlight the challenge of balancing systemic antibiotic use against CDI risk.

Discussions: These cases underscore known risk factors for recurrent CDI, including advanced age and prolonged antibiotic exposure. Recurrence rates in patients over 65 can reach 58%. The British Society of Gastroenterology and Healthcare Infection Society support the use of FMTs in recurrent cases. Environmental decontamination, including terminal cleaning with sporicidal agents, is critical in reducing reinfection in hospital settings.

Conclusions: Recurrent CDI in elderly patients reflects a complex interplay between infection control and managing comorbidities. New guidelines suggest that FMTs can significantly reduce morbidity and mortality. These cases emphasise the need for individualised, multidisciplinary care, adherence to guidelines, and further research to improve safe, effective CDI management in older adults.

Background/Objectives: The study aimed to examine the impact of allostatic load on healthy ageing over a decade and whether social participation attenuates this relationship among older American adults. Methods: Data were extracted from three waves (wave 8, wave 10, wave 13) of the Health and Retirement Study, a longitudinal survey of American adults. The analysis included allostatic load, socioeconomic (education) and demographic (gender, age, ethnicity, and marital status) factors at baseline, social participation in wave 10, and healthy ageing in wave 10 and wave 13. A latent variable was created for allostatic load that included waist circumference, C-reactive protein, glycated hemoglobin, and blood pressure. Healthy ageing was defined as an aggregate measure including freedom from disability, freedom from cognitive impairment, and high physical functioning. Social participation was a dichotomous variable that included individuals' work status, perceived neighbourhood safety, and partaking in volunteer work. Structural equation modelling was used to examine the direct and indirect relationships between these factors and healthy ageing. Results: A total of 14,537 participants with complete data in all waves were included in the analysis. The mean age at baseline was 68.7 years. Results showed a significant association between higher allostatic load and lower healthy ageing (estimate = -0.12, 95% CI: -0.14, -0.11). Allostatic load was negatively associated with social participation (estimate = -0.32, 95% CI: -0.34, -0.30). Social participation showed a positive significant association with healthy ageing, indicating partial buffering that accounted for 12% of the total effect. Higher educational attainment was associated with better healthy-ageing outcomes, whereas non-Black ethnicity was linked to poorer healthy ageing. Conclusions: Elevated allostatic load was associated with poorer ageing outcomes, with social participation partially attenuating the relationship. Higher education predicted more favourable trajectories, while ethnic differences suggested resilience among older Black adults. These results indicate that both physiological and social factors contribute to variations in healthy ageing.

Introduction: While pet ownership (PO) is generally associated with better psychological health, research does not consistently demonstrate this relationship among community living older adults. Pet attachment has been suggested as a mechanism for the health benefits associated with pet ownership. We examine the contributions of PO and pet attachment to maintaining psychological health among generally healthy, cognitively intact, community-dwelling older adults as they age.

Methods: Older adults (N = 596; age: ≥50, M = 67.6, SD = 9.5 years, pet owners N = 178) completed PO history and assessments of anxiety, depression, happiness, and mental wellbeing every 1-4 years. Pet owners completed demographic and pet attachment assessments. Linear mixed models with random intercepts and covariates of initial age, sex, race, live alone, married, and comorbidities quantified longitudinal changes (M = 7.5, SD = 3.6 years) according to time-varying PO, pet attachment, and dog walking to these changes.

Results: PO moderated changes in anxiety (p = 0.011) and happiness (p = 0.037), which improved in pet owners and deteriorated in non-owners, and in mental wellbeing (p = 0.007), which deteriorated faster in pet owners; PO was not related to changes in depression. Pet attachment was related to worsening mental wellbeing (p = 0.012). Dog walking was related to slower increases in anxiety (p = 0.005) and depression (p = 0.004).

Conclusions: This study provides important longitudinal evidence that PO may reduce age-related decline in owners' psychological health later in life. Pet attachment does not appear to be the mechanism for the advantages of PO. We suggest potential reasons. Additional research is needed to confirm mechanisms.