Geriatrics最新文献

Significance: Hepatic encephalopathy (HE) occurs in 20-80% of patients with liver cirrhosis, impacting attention, memory, processing speed, and visuospatial skills. HE standard-of-care psychometric assessments are time-consuming and require staff training. Oculometrics may provide a fast, non-invasive brain health assessment that can be self-administered in a medical environment.

Purpose: We investigated whether an oculometric assessment could measure the severity of HE as accurately as standard-of-care psychometric methods.

Methods: Forty-eight participants (19 with decompensated cirrhosis, 10 with compensated cirrhosis, 19 controls) completed a previously validated five-minute oculometric test and the standard-of-care psychometric hepatic encephalopathy (PHE) battery. The oculometric test consists of following a dot as it moves across a computer screen and generates 10 metrics including a summary score called nFit. The PHE battery entails five standard cognitive tests, generating seven metrics including a PHE composite score (PHES).

Results: The oculometric summary score, nFit, correlated with the current diagnostic standard, the PHES (r = 0.51, p < 0.001), the presence or absence of HE as determined by PHES composite (r = -0.44, p < 0.001), as well as the severity of cirrhosis (r = -0.59, p < 0.001). Additionally, performance on both nFit and PHES distinguished compensated (ROC: nFit: 0.71, PHES: 0.68) and decompensated (ROC: nFit: 0.88, PHES: 0.85) patient groups from control participants comparably. Finally, compared to participants with decompensated cirrhosis, control participants had better scores for almost all oculometrics: acceleration, catch-up saccade amplitude, proportion smooth, direction noise, and speed noise.

Conclusions: Patients with liver disease showed impairment on multiple aspects of visual processing compared to a control group. These functional visual processing impairments correlate with the presence or absence of HE, showing significant sensitivity in distinguishing people with HE from controls. Oculometric tests provide a quick, non-invasive functional assessment of brain health in patients with liver disease, with sensitivity indistinguishable from standard-of-case psychometric tests.

Backgrounds: Adverse Childhood Experiences (ACEs) are linked to early and long-lasting mental health issues and somatic multimorbidity. Emerging evidence suggests ACEs may also accelerate physical frailty in old age. This study examines the association between ACEs and sarcopenia, an ageing-related disease and core component of frailty.

Methods: Baseline data from the Canadian Longitudinal Study on Aging (CLSA), including 25,327 participants aged 45-85 years (50.3% female sex) were analyzed. Sarcopenia was defined using the revised European Working Group of Sarcopenia in Older People (EWGSOP2) guidelines. ACE were assessed via the Childhood Experiences of Violence Questionnaire and the National Longitudinal Study of Adolescent to Adult Health Wave III questionnaire, covering eight ACE categories. Multiple logistic regression models examined the association between the number of ACE count and sarcopenia, which were adjusted for age, sex, education, income, and ethnicity.

Results: Given a significant interaction between age and ACE (p < 0.01), analyses were stratified into four age groups (45-54, 55-64, 65-74, and 75-85 years). A significant association only emerged in the oldest group (75-85 years; OR = 0.93 [95% CI: 0.86-1.00], p = 0.043), but this result was in the opposite direction we hypothesized. Sensitivity analyses confirmed findings across different operationalisations of ACE and sarcopenia.

Conclusions: Higher ACE exposure was not associated with sarcopenia in middle aged and older adults. The unexpected protective association in the oldest-old subgroup may reflect survival bias. Age-stratified longitudinal studies are needed to clarify this relationship.

Pain is a fundamental yet complex biological and psychosocial phenomenon. While acute pain serves as a defense mechanism, alerting the body to potential tissue damage, chronic pain loses this protective function and becomes a persistent, independent condition. Chronic pain in the elderly is particularly significant due to age-related changes in pain perception, a higher prevalence of comorbidities, and an increased susceptibility to pharmacological side effects. Diagnosing pain in older adults presents unique challenges owing to cognitive decline, multimorbidity, and impaired communication. This narrative review aims to summarize the current knowledge on chronic pain in the elderly, with a particular emphasis on diagnostic difficulties, therapeutic strategies, and the essential role of nurses in multidisciplinary management. Both objective scales and subjective assessment tools are essential for an accurate evaluation. Effective management requires a multidisciplinary approach that integrates individualized pharmacological and non-pharmacological therapies. Analgesic use must be tailored to account for altered pharmacokinetics and risks such as sedation or falls. Non-drug interventions, including physiotherapy and psychological techniques, are especially valuable in geriatric care. Nurses play a pivotal role in the recognition, assessment, and ongoing management of pain in this population. Developing age-appropriate, personalized strategies is essential for improving the quality of life in older adults living with chronic pain.

Background/objectives: the assessment and prevention of fall risk is an essential component of healthcare, particularly for vulnerable populations such as older adults with or without diabetes. The use of objective and validated tools to assess balance, gait, and other risk factors enables healthcare professionals to make informed clinical decisions and design personalized prevention programs. An observational cross-sectional study was conducted with a probabilistic sample of older patients, with and without diabetes, attending a podiatric clinic (Valencia, Spain).

Methods: fall risk was assessed using the Tinetti Scale and the FallSkip^® device, which measures posture (i.e., medial-lateral and anterior-posterior displacements), gait (vertical and medial-lateral ranges), turn-to-sit (time) and sit-to-stand (power) tests, total time and gait reaction time.

Results: the results showed a significant association between the values obtained with FallSkip^® and the Tinetti Scale (p < 0.001), identifying the older individuals at high risk of falls. The "reaction time" parameter measured by FallSkip^® showed a significant difference between diabetic and non-diabetic patients (p < 0.05), as well as the balance score assessed by the Tinetti Scale (p < 0.05). Having experienced falls in the previous year had a strong (p < 0.001) significant influence on the results evaluated using both the Tinetti Scale and FallSkip^®. Among the FallSkip^® parameters in the multivariate analysis, the 'Total Time (%)' parameter significantly (p < 0.01, Exp(B) = 0.974 (CI 95%: 0.961-0.988) discriminates individuals with or without falls in the previous year.

Conclusions: this study supports the usefulness of the FallSkip^® device as an objective, efficient, and easy-to-use tool for fall risk assessment in primary care settings.

Background: Type 2 diabetes mellitus (T2DM) increases sepsis risk due to immune dysfunction and chronic inflammation. Antidiabetic medications, while primarily used for glycemic control, may modulate sepsis susceptibility through immune and inflammatory pathways. This study investigates the association between antidiabetic medication use and sepsis risk in T2DM patients. Methods: A longitudinal cohort study was conducted using clinical registry data from 5009 T2DM patients at the University Hospital, Debrecen, Hungary (2016-2020). Sepsis cases were identified via ICD-10 code A41, and antidiabetic medication use was categorized using ATC codes. Baseline comorbidities and laboratory parameters were extracted. Chi-square and Wilcoxon rank-sum tests assessed associations between sepsis and categorical/numerical variables, respectively. Time-adjusted multivariate logistic regression evaluated predictors of sepsis risk, with odds ratios (ORs) and 95% confidence intervals (CIs) reported. Results: Age, hypertension, ischemic heart disease, nephropathy, elevated blood glucose, C-reactive protein, and creatinine also independently increased sepsis risk. Insulin use was associated with a 2.6-fold increased sepsis risk (OR = 2.6, 95% CI: 2.09-3.34, p < 0.001), while SGLT2 inhibitors (OR = 0.56, 95% CI: 0.34-0.91, p = 0.02) and GLP-1 receptor agonists (OR = 0.39, 95% CI: 0.19-0.79, p = 0.009) were protective. Conclusions: Insulin-treated patients may require closer infection monitoring, while SGLT2 inhibitors and GLP-1 RAs could be prioritized in high-risk individuals. These findings highlight the potential to inform risk stratification and guide personalized antidiabetic therapy to reduce sepsis risk in T2DM.

Background/objectives: Pressure injuries are a significant concern among older adults, particularly in community-based long-term care settings where prolonged immobility is prevalent. This study aimed to identify factors influencing sacral interface pressure in community-dwelling older adults, with an emphasis on support surface usage and clinical risk indicators.

Methods: A total of 210 participants aged 65 years and older, all receiving long-term care services in South Korea, were enrolled in this study. Sacral interface pressure was measured in the supine position using a portable pressure mapping device (Palm Q7). General characteristics, Braden Scale scores, Huhn Scale scores, and mattress usage were assessed. Data were analyzed using descriptive statistics, t-tests, chi-square tests, and logistic regression.

Results: Mattress non-use was identified as the strongest predictor of elevated sacral interface pressure (OR = 6.71, p < 0.001), followed by Braden Scale scores indicating moderate risk (OR = 4.8, p = 0.006). Huhn Scale scores were not significantly associated with interface pressure. These results suggest that support surface quality and skin condition have a stronger impact on interface pressure than mobility-related risk factors.

Conclusions: The findings highlight the importance of providing high-quality pressure-relieving mattresses and implementing standardized nursing assessments to reduce the risk of pressure injuries. Integrating smart technologies and expanding access to advanced support surfaces may aid in developing tailored preventive strategies for vulnerable older adults.

Background: This cross-sectional study examined the association between body mass index (BMI) and executive function (EF) in older adults, with a focus on the moderating role of attitudes toward own aging (ATOA). Method: A total of 431 community-dwelling elderly individuals from Yakumo Town and Kyoto City, Japan, participated between 2023 and 2024. EF was assessed using the Digit Cancellation Test (D-CAT), and ATOA was measured via a validated subscale of the Philadelphia Geriatric Center Morale Scale. Results: Multiple linear regression analyses adjusted for demographic and health covariates revealed a significant interaction between BMI and ATOA in the younger-old cohort. Specifically, higher BMI was associated with lower executive function only in individuals with lower ATOA scores. No such association was observed in those with more positive views on aging. Conclusions: These results indicate that positive psychological constructs, particularly favorable self-perceptions of aging, may serve as protective factors against the detrimental cognitive consequences of increased body mass index in younger-old populations.

Background/objectives: Multifactorial prevention of falls in persons with dementia has minimal or non-significant effects. Personalised prevention is recommended. We have previously shown that gait speed, basic activities of daily living (ADL), and depression (high Cornell scores) were independent predictors of falls in persons with mild and moderate cognitive impairment. This study explored person-specific risks of falls related to physical, mental, and cognitive functions and types of dementia: Alzheimer's disease (AD), vascular dementia (VD), mixed Alzheimer's disease/vascular dementia (MixADVD), frontotemporal dementia (FTD), and dementia with Lewy bodies (DLB).

Methods: The study used data from "The Norwegian Registry of Persons Assessed for Cognitive Symptoms" (NorCog). Differences between the dementia groups and predictors of falls, gait speed, ADL, and Cornell scores were analysed.

Results: Among study participants, 537/1321 (40.7%) reported a fall in the past year, with significant variations between dementia diagnoses. Fall incidence increased with age, comorbidity/polypharmacy, depression, and MAYO fluctuation score and with reduced physical activity, gait speed, and ADL. Persons with VD and MixADVD had high fall incidences and impaired gait speed and ADL. Training of physical fitness, endurance, muscular strength, coordination, and balance and optimising treatment of comorbidities and medication enhance gait speed. Improving ADL necessitates, in addition, relief of cognitive impairment and fluctuations. Relief of depression and fluctuations by psychological and pharmacological interventions is necessary to reduce the high fall risk in persons with DLB.

Conclusions: The fall incidence and fall predictors varied significantly. Personalised interventions presuppose knowledge of each individual's fall risk factors.

Cardiorenal syndrome (CRS) is a term used to describe the combined dysfunction of the heart and kidneys. This complex disorder is widely acknowledged to be challenging in both its diagnosis and management, and this is the case particularly in the elderly population, due to multi-morbidity, polypharmacy, and age-related physiological changes. Given advancements in medicine and more prolonged cumulative exposure to risk factors in the elderly population, it is likely that the prevalence of chronic kidney disease (CKD) and heart failure (HF) will continue to rise going forward. Hence, understanding the mechanisms involved in the development of CRS is paramount. There are five different CRS types-they are categorised depending on the primary organ involved the acuity of disease. The pathophysiological process behind CRS is complex, involving the interplay of many processes including hemodynamic changes, neurohormonal activation, inflammation, oxidative stress, and endothelial dysfunction and vascular stiffness. The numerous diagnostic and management challenges associated with CRS are significantly further exacerbated in an elderly population. Biomarkers used to aid the diagnosis of CRS, such as serum creatinine and brain natriuretic peptide (BNP), can be challenging to interpret in the elderly population due to age-related renal senescence and multiple comorbidities. Polypharmacy can contribute to the development of CRS and therefore, before initiating treatment, coordinating a patient-centred, multi-speciality, holistic review to assess potential risks versus benefits of prescribed treatments is crucial. The overall prognosis of CRS in the elderly remains poor. Treatments are primarily directed at addressing the sequelae of the underlying aetiology, which often involves the removal of fluid through diuretics or ultrafiltration. Careful considerations when managing elderly patients with CRS is essential due to the high prevalence of frailty and functional decline. As such, in these patients, early discussions around advance care planning should be prioritised.

Background: The waist-calf circumference ratio (WCR) is an index that combines waist and calf circumference measurements, offering a potentially effective method for evaluating the imbalance between abdominal fat and leg muscle mass in older adults. Objective: To assess the association between WCR and indicators of body composition, muscle strength, and physical performance in community-dwelling older women. Methods: This was a cross-sectional study involving 133 older women (≥65 years) from an urban-marginal community in Guayaquil, Ecuador. The WCR was categorized into quartiles (Q1: 2.07-2.57; Q2: 2.58-2.75; Q3: 2.76-3.05; Q4: 3.06-4.76). Body indicators included fat-free mass (FFM), skeletal muscle mass (SMM), appendicular muscle mass (ASM), appendicular muscle mass index (ASMI), visceral fat (VF), fat mass (FM), and fat mass index (FMI). Handgrip strength (HGS) and the Short Physical Performance Battery test (SPPB) score were used to assess muscle strength and function, respectively. Results: The median age of the participants was 75 [IQR: 65-82] years. The mean WCR was 2.92 ± 0.93. Statistically significant associations were found between WCR and VF (p < 0.001), WCR and SMM (p = 0.039), and WCR and ASM (p = 0.016). Regarding muscle function, WCR was associated with HGS (p = 0.025) and SPPB score (p = 0.029). Conclusions: A significant association was observed between WCR and body composition, and muscle strength and function in older women.