Geriatrics最新文献

Background/Objectives: Type 2 diabetes (T2D) and chronic kidney disease (CKD) frequently coexist in older adults. Sodium-glucose cotransporter-2 inhibitors (SGLT2i) are recommended for renal and heart protection, yet their use in routine care remains inconsistent. We aimed to investigate differences in SGLT2i prescribing between regional and university hospital settings and assess whether such disparities persist after accounting for patient characteristics. Methods: In this retrospective analysis, patients were stratified by follow-up site (regional vs. university hospital). The primary outcome was SGLT2i use. Logistic regression models were adjusted for strong determinants of prescribing decisions, including age, sex, hypertension, dyslipidemia, heart failure, and estimated glomerular filtration rate. We tested the robustness of the results using additional analyses, including exclusion of frail patients and adjustment with propensity score methods, such as matching and inverse probability weighting (IPTW). Results: The study included 135 patients, of whom 80 were followed at the regional hospital and 55 at the university hospital. SGLT2i use was significantly lower in the regional setting (27.5% vs. 63.6%, p < 0.001). In adjusted models, university follow-up remained strongly associated with SGLT2i prescription [odds ratio 3.60, 95% confidence interval (CI) 1.61-8.03, p = 0.0018]. IPTW demonstrated 4.40-fold higher odds of SGLT2i use in the university hospital setting (95% CI 2.07-9.36, p < 0.001). Conclusions: These findings indicate that the lower use of SGLT2i among older adults with T2D and CKD followed in regional hospitals may reflect patterns consistent with clinical inertia, underscoring the importance of efforts to promote equitable and guideline-aligned prescribing practices across levels of care.

Background: Although equine-assisted interventions (EAI) are gaining growing attention, their scientific evaluation among individuals with Alzheimer's disease (AD) living in nursing homes remains limited. This study aimed to explore the lived experiences of an EAI program from the perspectives of the participants living with AD as well as their families and professional caregivers. Methods: Thirty non-directive interviews were conducted between June and July 2024 across several nursing homes in the Centre-Val de Loire region (France). The interviews were recorded, transcribed, and analyzed using thematic analysis. Results: Four main themes emerged from the analysis: (1) the experience with the horse, reflecting a unique relationship with the animal, the activities carried out, and perceived personality traits; (2) the environment of EAI sessions, offering a break from daily routines, encouraging contact with nature, and taking place in a setting specific to this type of intervention; (3) the implementation of the program within the institutional context, highlighting logistical aspects, environmental factors, and the adherence; (4) the effects of the intervention, including enhanced social interactions, memory stimulation, emotional engagement, and behavioral benefits. Conclusions: These findings provide insight into the multiple dimensions involved in an EAI program. By giving voice to both participants and their caregivers, this study emphasizes the value of qualitative approaches in deeply understanding the meaning and impact of these non-pharmacological interventions.

Background/Objectives: The global aging population faces rising rates of cognitive decline and neurodegenerative disorders. This review explores how physical exercise influences brain health in aging, focusing on mechanisms, moderators, and personalized strategies to enhance cognitive resilience. Methods: A narrative review methodology was applied. Literature published between 2015 and 2025 was retrieved from PubMed, Scopus, and Web of Science using keywords and MeSH terms related to exercise, cognition, neuroplasticity, aging, and dementia. Inclusion criteria targeted peer-reviewed original studies in humans aged ≥60 years or aged animal models, examining exercise-induced cognitive or neurobiological outcomes. Results: Evidence shows that regular physical activity improves executive function, memory, and processing speed in older adults, including those with mild impairment or genetic risk (e.g., APOE ε4). Exercise promotes neuroplasticity through increased levels of BDNF, IGF-1, and irisin, and enhances brain structure and functional connectivity. It also improves glymphatic clearance and modulates inflammation and circadian rhythms. Myokines act as messengers between muscle and brain, mediating many of these effects. Cognitive benefits vary with exercise type, intensity, and individual factors such as age, sex, chronotype, and baseline fitness. Combined interventions-physical, cognitive, nutritional-show synergistic outcomes. Digital tools (e.g., tele-exercise, gamification) offer scalable ways to sustain engagement and cognitive function. Conclusions: Physical exercise is a key non-pharmacological strategy to support cognitive health in aging. It acts through diverse systemic, molecular, and neurofunctional pathways. Tailored exercise programs, informed by individual profiles and emerging technologies, hold promise for delaying or preventing cognitive decline.

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.