Geriatrics最新文献

Background/Objectives: The aim of this study was to compare the efficacy and safety of a single cycle of incobotulinumtoxinA versus placebo in pooled data from older patients (aged ≥65 years) with upper limb spasticity (ULS). Methods: This study was a post hoc analysis of pooled data from seven prospective, multicenter, phase II or III trials of incobotulinumtoxinA in adult patients aged ≥65 years from across the world with post-stroke ULS or upper and lower limb spasticity, including a subgroup with moderate-to-severe ULS. Changes from baseline in ULS severity were evaluated using the (modified) Ashworth Scale across different spasticity patterns at 4 and 12 weeks after incobotulinumtoxinA injection. Results: In 267 older patients with ULS, including a subgroup of 207 with moderate-to-severe ULS, all ULS patterns statistically analyzed (elbow flexion, thumb-in-palm, clenched fist, wrist flexion, and pronated forearm) were improved more by incobotulinumtoxinA than placebo at week 4 (p < 0.05). For most of these patterns, the difference remained significant at week 12 (p < 0.05). IncobotulinumtoxinA was generally well tolerated. Conclusions: This study, which analyzed data from the largest cohort of older patients in the literature, provides information regarding the use of incobotulinumtoxinA in ULS, the efficacy and favorable safety profile of incobotulinumtoxinA for the treatment of ULS in older patients, particularly in those with moderate-to-severe spasticity, was confirmed.

Background: With the global population rapidly aging, resilience has emerged as a critical determinant of healthy aging. While many factors are associated with resilience, a comprehensive synthesis is needed to inform targeted interventions and policy. Objectives: This systematic review aimed to identify and synthesize the conceptual models and key protective factors associated with resilience in older people. Methods: Following PRISMA guidelines, a systematic literature search was conducted in Web of Science, PubMed, PsycNet, and JSTOR for studies published between 2017 and 2025. Search terms included (including synonyms and closely related words) "resilience," "older people," and "models." Studies were screened based on relevance to resilience models, measurement tools, and associated factors. Included studies underwent a formal risk of bias assessment. Results: From 7109 initial records, 54 studies met the inclusion criteria. Ten studies explored conceptual models, while 44 investigated contributing factors. Resilience was predominantly assessed using standardized psychometric tools. Findings were synthesized by mapping key determinants across Macro-Environmental, Meso-Social, Micro-Individual and Bio-Physiological domains. Conclusions: Resilience in later life is a dynamic and multifactorial process, not a fixed trait. The evidence suggests a range of modifiable factors at various levels that can be targeted to support wellbeing. An integrated, systems-based perspective is essential for guiding future research and developing effective interventions to promote resilience across the aging trajectory.

Background: Advances in diagnosis and treatment have led to a growing population of adults with congenital heart disease (ACHD). Despite increasing life expectancy, their clinical needs-especially in older age-remain poorly defined. Cardiac and non-cardiac comorbidities are prevalent, and emerging evidence suggests accelerated biological aging compared to the general population. However, data on older patients and geriatric patients with CHD are limited. Objectives: This study aimed to characterize patients with CHD aged ≥50 years, focusing on functional status, comorbidities, sex-specific differences, and therapeutic patterns. Methods: The PATHFINDER-CHD Registry is a prospective, observational, multicenter registry enrolling patients with CHD with manifest heart failure (HF), HF history, or high HF risk. Data include anatomy, prior treatments, comorbidities, and medication use. Results: Among 1935 patients, 297 were ≥50 years old. Most had acyanotic CHD (62%); Tetralogy of Fallot (21%) was the most frequent diagnosis. A morphologic right systemic ventricle was present in 12%, and 5% had univentricular hearts. HF was manifest in 21%; 44% were classified as ACC/AHA stage B, 51% as stage C, yet 77% were in Perloff class I/II. Common cardiovascular comorbidities included aortopathy (55%), hypertension (37%), and arrhythmia (33%). Non-cardiac comorbidities included thyroid dysfunction (25%), renal impairment (18%), and neurological disease (13%). Sex-specific differences were observed. Despite HF burden, SGLT2 inhibitors and ARNIs were used in only 17% and 8.4%, respectively. Conclusions: Older patients with CHD represent a clinically complex cohort with high comorbidity burden. The findings support the concept of accelerated aging and emphasize the need for tailored interdisciplinary care strategies.

Background/objective: The first-year postoperative mortality in elderly hip fracture patients is between 15 and 36%. Current scientific evidence indicates that morbidity and mortality are impacted by time of admission to surgery in hip fracture patients, although anticoagulation (AC) medication status specific optimization is unknown. Our objectives were to identify an ideal preoperative wait time by anticoagulation status in patients before hip fracture repair based on the incidence of postoperative morbidity and mortality.

Methods: A total of 35,463 patients age ≥ 65 undergoing hip fracture repair were selected from a United States hip fracture registry (2009-2019). Patients were separated into strata (yes/no) based on whether they received anticoagulation (AC) medications ≤ 100 days prior to surgery. Multivariable logistic regression was adjusted for non-linear surgical wait time trends with prespecified percentiles using cubic splines.

Results: A total of 87.1% (N = 30,902) of patients did not have AC preoperatively. Their median wait time was 20.3 h (IQR 13-27 h), and a positive linear trend was observed between surgical wait time and mortality. In patients with pre-operative AC, there was a "U"-shaped trend for all mortality time points although the breakpoint slopes were not significantly different from zero.

Conclusions: In the study of more than 30,000 patients, short-term mortality was lowest for non-AC patients, undergoing surgery within the first 6-15 h of admission but remained uniform throughout the first 24 h of admission. These findings can be used to optimize patients prior to hip fracture surgery based on preoperative AC use and can positively affect resource planning and perioperative protocols.

Ageing literature, while growing in huge volume in the past decades, is still largely dominated by frameworks and topics of frailty and decline. A shift in attention to conceptualising ageing more holistically to include psychosocial and emotional aspects as well as subjective experience is much needed, in order to better account for the ageing (well) experience and processes in today's times. There is a large portion of older adults with relatively good health. As life expectancy increases around the world, many older adults are living longer and healthier overall, often wishing for their lives to continue being active, meaningful, and fulfilling. With this changing demographic in mind, we argue for a framework of positive ageing. We define positive ageing as a subjective, intentional experience, which includes the multi-dimensional construction of ageing well. The notion of positive ageing has the potential to widen the scope of gerontological research and to help guide policy and intervention development. Furthermore, this conceptual framework and a cyclic model of positive ageing presented in the current work can effectively complement current models and practices of care in geriatrics by taking a more person-centred and holistic approach to understanding and managing health and well-being.

Background: Population aging in Poland has led to rising healthcare needs, but comprehensive evidence on long-term utilization patterns is limited. This study aimed to analyze healthcare use and disease burden among older adults, with particular focus on the impact of the COVID-19 pandemic, including its effects on care pathways, continuity of services, and differences between urban and rural populations. Methods: We conducted a retrospective study using anonymized medical records from a primary healthcare network in Poland between January 2020 and December 2024. The sample included 42,844 patients aged 60 years or older patients aged ≥60 years, with a total of 738,300 consultations. Data on demographics, visit type, prescriptions, referrals, diagnostic tests, and follow up were analyzed using chi-square tests, logistic regression, and nonparametric comparisons. Results: The mean age of patients was 77.5 years (SD 9.4), and 63.7% were women. The mean number of visits in the preceding 12 months was 10.3 (range 0-460). Prescriptions were issued in 56.9% of visits, referrals in 33.5%, and diagnostic tests in 21.4%. Patients with chronic diseases were more likely to receive diagnostic tests than those without (32.4% vs. 21.1%, χ² = 1570.42, p < 0.0001), but less likely to return within 30 days (23.4% vs. 39.4%, χ² = 2243.76, p < 0.0001). First visits generated more referrals than follow ups (41.6% vs. 32.9%, χ² = 1620.51, p < 0.0001). Completed visits were strongly associated with prescription issuance (63.2% vs. 16.4%, χ² = 1048.76, p < 0.0001). Return analyses showed that patients with more prior visits were significantly more likely to re-engage at 30, 60, and 90 days (all p < 0.0001). Age correlated positively with total number of visits (ρ = 0.136, p < 0.05) with the oldest adults more likely to return at 60 and 90 days. Visit realization decreased during early pandemic phases but increased significantly post-COVID (OR = 1.76, p < 0.001). Psychiatric referrals increased the odds of return within 30 days (OR = 1.42) and 60 days (OR = 1.36). Conclusions: Older adults in Poland demonstrate high healthcare utilization, with patterns shaped by age, chronic disease status, and pandemic-related disruptions. While statistical associations were robust, effect sizes were small, highlighting the need to focus on clinically meaningful differences in planning geriatric care. The findings highlight that COVID-19 acted as a major modifying factor of healthcare engagement, revealing the vulnerability of geriatric care continuity to system-level disruptions.

Background: Locus of control (LoC) may shape how older adults appraise aging, particularly in acute geriatric rehabilitation. Evidence linking internal/external LoC to domain-specific Views on Aging (VoA, containing Physical Loss, Social Loss, Personal Growth, Self-awareness/Gains) remains limited.

Methods: We analyzed a cross-sectional cohort of patients aged 70 and above from an acute geriatric rehabilitation unit (N = 103) and contextualized findings with a 1:1 Mahalanobis-matched subsample from the German Ageing Survey. Internal and external LoC and covariates (age, sex, Barthel, cognitive function, depressive symptoms, health satisfaction) were standardized (z). Associations were estimated using (i) ordinary least squares (OLS) regression across eight LoC effects, as well as (ii) proportional-odds ordinal models (quartiles; logit link), as a complementary, distribution-robust approach.

Results: For the Physical VoA domain, higher internal LoC related to more positive appraisals (OLS β = 0.133, 95% CI 0.043-0.223, p = 0.035; OR = 3.52), whereas higher external LoC related to less positive appraisals (β = -0.165, 95% CI -0.285 to -0.045, p = 0.035; OR = 0.274). Internal LoC also increased the odds of more positive Personal Growth (OR = 1.64, 95% CI 1.04-2.72), while effects on Social Loss (external LoC OR = 0.649, 95% CI 0.418-0.991) and Gains were smaller. Univariate Spearman correlations were directionally consistent. In the DEAS comparison, older patients showed greater endorsement of both physical losses and gains.

Conclusions: In acute geriatric rehabilitation, internal control beliefs align with more positive views of physical aging and growth, whereas external control aligns with less positive physical (and modestly social) views. The results position LoC as a clinically relevant correlate of aging appraisals.

Background/Objectives: Adjustment to aging is a key indicator of positive aging and psychological maturity, influenced by cultural and social contexts. This study aimed to translate and evaluate the psychometric properties of the Adjustment to Aging Scale (AtAS) among Iranian older adults. Material and methods: This cross-sectional study was conducted in Tehran, 2024. Following translation and cross-cultural adaptation, face validity, content validity, and reliability of the questionnaire were assessed. The WHO-5 well-being index was used to assess concurrent validity. A total of 328 older adults aged 60 years and above completed the study instruments. Data were analyzed using Confirmatory Factor Analysis (CFA), Cronbach's alpha, Pearson correlation, independent t-tests, and ANOVA via SPSS version 22 and AMOS 24. The significance level was set at p ≤ 0.05. Results: The mean (SD) age of the participants was 69.42 (6.8) years. Face and content validity were confirmed by fourteen experts (CVI = 0.94). CFA supported the five-factor structure of the questionnaire (χ²/df = 2.06, GFI = 0.90, PCLOSE = 0.07, RMSEA = 0.05), indicating a good model fit. The total questionnaire showed acceptable internal consistency (Cronbach's alpha = 0.80) and excellent test-retest reliability (ICC = 0.98). Pearson's correlation revealed a significant positive relationship between the WHO-5 Well-Being Index and AtAS scores (r = 0.56, p < 0.05), supporting criterion validity. Conclusions: The Persian AtAS showed strong psychometric properties, supporting its use in both research and clinical settings, although further studies are recommended to strengthen evidence for its clinical application.

Background/Objectives: Identifying adults at high risk of frailty and implementing appropriate interventions are critical for extending healthy life expectancy. This retrospective cohort study examined whether abdominal obesity predicts frailty progression over one year among 2962 community-dwelling adults aged 30-79 years in Osaka Prefecture, Japan. Methods: Data were collected from 2962 individuals (mean age, 62.7 ± 8.8 years) who completed annual surveys through a health application in both 2023 and 2024 and had available waist circumference data. Frailty was assessed using the Kihon Checklist. Logistic regression analysis was performed to identify predictors of frailty progression. Results: At baseline (2023), 23% of participants had abdominal obesity, and 18% were categorized as frail. Among 2431 participants who were non-frail at baseline, the incidence of frailty after one year was significantly higher among those with abdominal obesity than those without (10.5% vs. 7.2%, p = 0.011). However, in the multivariate logistic regression analysis, frailty awareness ("know well" vs. "do not know," adjusted odds ratio [aOR] = 0.341, 95% confidence interval [CI] 0.212-0.548), regular exercise habits (aOR = 0.596, 95% CI 0.382-0.930), and prefrailty status (aOR = 1.767, 95% CI 1.602-1.950) were significant predictors of frailty development, whereas abdominal obesity was not independently associated with frailty progression after adjustment. Conclusions: Although abdominal obesity was associated with frailty onset in crude analyses, this association became non-significant after adjustment. Greater frailty awareness and regular exercise appear to reduce the risk of frailty development, suggesting that lifestyle education and public awareness initiatives may help mitigate the impact of abdominal obesity on frailty progression.

Background: Apathy is a neuropsychiatric symptom that is frequently present in nursing-home residents, including residents with Korsakoff's syndrome (KS). Although apathy is common in KS, treatment guidelines are lacking. The Shared Action for Breaking through Apathy (SABA) program, developed for people with dementia, was previously shown to be feasible in that group. The applicability of this program for the KS population seems promising, yet it was expected that the program would need to be adapted. This study aims to 1) explore what is important in identifying and managing apathy in individuals with KS, and 2) investigate the appropriate adjustments to the SABA program. Methods: This qualitative study consisted of semi-structured interviews with people with KS (n = 3), family caregivers (one spouse and one sibling) and professional caregivers (two nurses), and a multidisciplinary focus group meeting with professional caregivers (n = 12) experienced in care for people with KS. The focus group meeting was performed to deepen the understanding of the interview findings and further explore recommendations for adjustments to the SABA program. Thematic analysis was used to process the data. Results: Addressing aim 1, two themes were identified: (1) the challenge to appraise signals of apathy, and (2) the challenge to assess the needs of people with KS. Based on these themes, specific adjustments were formulated to respond to aim 2. Conclusions: The themes that were identified in this study gave direction to a KS tailored SABA program, the feasibility of which needs to be studied next.