Geriatrics最新文献

Background/Objectives: Hypertension (HTN) continues to be a leading cause of death and disability in older adults, especially in the southeastern United States. A cross-sectional study was conducted to evaluate the relationships among measured, diagnosed, and treated (HTN) in community-dwelling adults participating in student-led health screenings in eastern Alabama. Methods: Between 2017 and 2019, students from health-related disciplines facilitated screenings at 23 community and independent living sites to conduct health assessments, including measuring blood pressure (BP), obtaining medical history, and evaluating current prescriptions. Statistical analyses including chi-square tests, t-tests, and backward stepwise linear regression were performed. Results: The current sample includes data from 357 adults aged 60 to 99 years (mean age 74.6 ± 8.7), who were 70.9% females, 60.8% identifying as Black/African American (BA), and 36.8% residing in rural areas. The majority of clients had a prior HTN diagnosis (71.1%) and/or currently measured HTN (78.7%). Forty-three percent of adults screened had measured, diagnosed, and pharmaceutically treated HTN, while 31% had measured but untreated HTN. Black clients had higher measured systolic and diastolic BP and were more likely to also have been diagnosed with HTN (p < 0.05 for all). Linear regression indicated that lower systolic BP was predicted by not living alone (p = 0.003), White race (p = 0.004), and previous HTN diagnosis (p = 0.012), while female gender (p = 0.079) and decreasing body mass index (p = 0.053) had marginal predictive value. Conclusions: These results indicate that awareness and screening of HTN in this population are noteworthy, though management of the disease through ongoing screening and referrals is essential to reduce disparities.

Background: Falls are a major public health issue among older adults, often related to postural or orthostatic hypotension (OH). The optimal timing and methods for measuring blood pressure (BP) to assess OH and its relationship with falls are uncertain. Methods: We analyzed data from two older cohorts: the PROHEALTH study (n = 30, aged ≥ 65 years) and the NILVAD-CBF trial (n = 58, aged ≥ 50 years). Continuous beat-to-beat BP was measured during active stand tests. We assessed orthostatic BP responses during sit-to-stand and supine-to-stand maneuvers and calculated the associations between orthostatic BP response variables and falls. Results: In the PROHEALTH cohort, participants with a history of falls exhibited a significantly lower baseline BP (115 ± 13/68 ± 10 vs. 142 ± 21/79 ± 11 mmHg; p = 0.004/0.018) and lower systolic BP (SBP) nadir (90 ± 22 vs. 112 ± 25 mmHg; p = 0.043) than non-fallers. SBP recovery within three minutes post-stand was delayed in fallers but rapid in non-fallers. A lower resting BP was associated with fall risk, and a lower BP nadir within 10 s after standing showed a trend toward a higher fall risk. No significant associations were found in the NILVAD-CBF cohort (prospective falls). Conclusions: Our findings demonstrate that a lower resting SBP and diastolic BP (DBP) are associated with an increased fall risk in older adults, with a lower SBP and DBP nadir after standing also showing a potential association. Persistent OH or delayed BP recovery is identified as a potentially relevant fall risk factor. The supine-to-stand test was more sensitive in detecting OH than the sit-to-stand test. Continuous BP monitoring provides the advantage of detecting pathophysiologic orthostatic BP responses for fall risk assessment in older adults. Further research with larger cohorts is warranted to validate our findings.

Background: Metabolic syndrome (MetS) and obstructive sleep apnea (OSA) are prevalent and interrelated conditions in older adults, both contributing to decreased quality of life and increased health risks. Nutritional interventions, including dietary changes and probiotic supplementation, may offer effective non-pharmacological strategies to address these conditions. This study aimed to evaluate the impact of diet therapy alone and in combination with probiotics on quality of life and sleep apnea risk in older adults (>60 years) with MetS. Methods: In this controlled interventional study, 192 older adults with metabolic syndrome were assigned to one of three groups: control, diet therapy alone, or diet therapy plus probiotic supplementation. Participants were evaluated at baseline and after the intervention period using the SF-36 quality of life questionnaire and an apnea risk screening tool. Clinical and metabolic parameters, including BMI, HOMA index, and visceral fat, were also assessed. Results: Significant improvements in SF-36 scores were observed in both intervention groups compared to the control group (p < 0.05) (mean difference = -5.31, p = 0.016), with the diet + probiotics group showing the greatest enhancement. Participants who reduced their apnea risk also reported higher post-intervention SF-36 scores. The intervention led to reductions in visceral fat, inflammatory markers (CRP), and insulin resistance (HOMA index), which were correlated with improved quality of life. Conclusions: Integrated nutritional strategies, especially the combination of diet and probiotics, significantly improve quality of life and reduce apnea risk in older adults with metabolic syndrome. These findings support the use of personalized, non-pharmacological interventions targeting both metabolic health and sleep-related outcomes in geriatric populations.

Background/Objectives: Aging is often accompanied by physical and cognitive decline, affecting older adults' mobility. Virtual reality (VR) offers innovative opportunities to safely practice everyday tasks, such as street crossing. This study was designed as a feasibility and pilot study to explore acceptance, usability, and preliminary effects of a VR-based road-crossing intervention for older adults. It investigates the use of virtual reality (VR) as an innovative training tool to support senior citizens in safely navigating everyday challenges such as crossing roads. By providing an immersive environment with realistic traffic scenarios, VR enables participants to practice in a safe and controlled setting, minimizing the risks associated with real-world road traffic. Methods: A VR training application called "Wegfest" was developed to facilitate targeted road-crossing practice. The application simulates various scenarios commonly encountered by older adults, such as crossing busy streets or waiting at traffic lights. The study applied a single-group pre-post design. Outcomes included the Timed Up and Go test (TUG), Falls Efficacy Scale-International (FES-I), and Montreal Cognitive Assessment (MoCA). Results: The development process of "Wegfest" demonstrates how a highly realistic street environment can be created for VR-based road-crossing training. Significant improvements were found in the Timed Up and Go test (p = 0.002, d = 0.784) and fall-related self-efficacy (FES-I, p = 0.005). No change was observed in cognitive function (MoCA, p = 0.56). Participants reported increased subjective safety (p < 0.001). Discussion: The development of the VR training application "Wegfest" highlights the feasibility of creating realistic virtual environments for skill development. By leveraging immersive technology, both physical and cognitive skills required for road-crossing can be effectively trained. The findings suggest that "Wegfest" has the potential to enhance the mobility and safety of older adults in road traffic through immersive experiences and targeted training interventions. Conclusions: As an innovative training tool, the VR application not only provides an engaging and enjoyable learning environment but also fosters self-confidence and independence among older adults in traffic settings. Regular training within the virtual world enables senior citizens to continuously refine their skills, ultimately improving their quality of life.

Background: This paper aims to conduct an umbrella review of the effects of physical activity programmes for older adults (aged 70 and above). Methods: Comprehensive literature searches were conducted in MEDLINE, PubMed, EMBASE, PsychINFO, and Cochrane Library databases for English SRs. Inclusion criteria were systematic reviews that included randomised controlled trials examining physical activity interventions in older adults. The data extracted were participant characteristics, physical activity interventions, and outcomes examined. A synthesis of results was conducted using the PRISMA guidelines, and the quality of the studies was assessed using the Assessment of Multiple Systematic Reviews-2 (AMSTAR-2). Results: Ten systematic reviews on 186 research articles were included. The AMSTAR-2 revealed that 4 out of 10 reviews were of high quality and 1 out of 10 were of moderate quality. The study samples in each systematic review ranged from 6 to 1254 participants. The total overall sample size for the 10 included studies was 22,652 participants. Across the included reviews, there was mixed evidence on whether physical activity interventions could improve outcomes in older adults across various settings. Conclusions: Sample sizes and findings in each included systematic review varied. The findings of this review emphasise the importance of physical activity as a vital component in maintaining and enhancing health, as well as combating poor health as we age. It also highlights the need for a deeper understanding of the specific physical activity requirements for those aged 70 and above. Future systematic reviews may focus on streamlined reporting of dosing of physical activity and specific intervention types, such as group versus single.

Periodontal disease is a common and serious oral disease among older adults. As the global older population increases, preventing periodontal disease is vital for healthy ageing. Poor oral hygiene, uncontrolled diabetes, and smoking are key risk factors of periodontal disease. Improving oral hygiene, diabetes management, and quitting smoking are essential health behavioural change interventions to manage periodontal disease. The objective of this study is to review the prevention of periodontal disease among older adults through health behavioural change interventions. Effective strategies to improve oral hygiene include personalised education on proper brushing and interdental cleaning. Educating caregivers is equally important as they supervise care-dependent older adults to maintain oral health. For those with diabetes, physical activity improves glycated haemoglobin levels and clinical periodontal parameters by reducing reactive oxygen species and systemic inflammation. Smoking cessation could be achieved through a multi-faceted approach. Effective smoking cessation combines brief interventions with intensive behavioural/pharmacological support for long-term success, especially in highly dependent individuals. Tailored strategies for older adults, integrated care, and expanded research improve outcomes and health equity in ageing populations. In conclusion, health behavioural change interventions are non-invasive preventive measures that include oral hygiene reinforcement, diabetic management, and smoking cessation. Prioritising these interventions empowers older adults to maintain oral health, reducing disease burden and enhancing overall well-being for healthy ageing.

Background: The biological mediators for the epidemiologic overlap between osteoporosis and dementia are unclear. We undertook a scoping review of clinical studies to identify genetic and biological factors linked with these degenerative conditions, exploring the mechanisms and pathways connecting both conditions.

Methods: Studies selected (1) involved clinical research investigating genetic factors or biomarkers associated with dementia or osteoporosis, and (2) were published in English in a peer-reviewed journal between July 1993 and March 2025. We searched Medline Ovid, Embase, PsycINFO, the Cochrane Library, the Web of Science databases, Google Scholar, and the reference lists of studies following the guidelines for Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews (PRISMA-ScR).

Results: Twenty-three studies were included in this review. These explored the role of the APOE polymorphism (n = 2) and the APOE4 allele (n = 13), associations between TREM2 mutation and late onset AD (n = 1), and associations between amyloid beta and bone remodeling (n = 1); bone-related biomarkers like DKK1, OPG, and TRAIL as predictors of cognitive change (n = 2); extracellular vesicles as bone-brain communication pathways (1); and the role of dementia-related genes (n = 1), AD-related CSF biomarkers (n = 1), and parathyroid hormone (PTH) (n = 1) in osteoporosis-dementia pathophysiology.

Conclusions: Bone-related biomarkers active in the Wnt/β-Catenin pathway (Dkk1 and sclerostin) and the RANKL/RANK/OPG pathway (OPG/TRAIL ratio) present consistent evidence of involvement in AD and osteoporosis development. Reports proposing APOE4 as a causal genetic link for both osteoporosis and AD in women are not corroborated by newer observational studies. The role of Aβ toxicity in osteoporosis development is unverified in a large clinical study.

Background: Pleural empyema remains a serious clinical condition with high morbidity and mortality, especially in elderly patients. As life expectancy increases, a growing number of older individuals require surgical treatment. This retrospective single-center study investigated age-related differences in clinical presentation, perioperative features, and postoperative outcomes in patients undergoing surgery for pleural empyema. Methods: We conducted this retrospective study at Helios University Hospital Wuppertal, Witten Herdecke University in Germany, from December 2019 to May 2024. We stratified the patients into two age groups: <65 and ≥65 years. We compared baseline characteristics, American Society of Anesthesiologists (ASA) physical status classification, empyema stage, hospital stay, drainage duration, complication rates, and in-hospital mortality. Results: A total of 103 patients were included, of whom 43 (41.7%) were aged ≥ 65 years. Older patients had significantly higher ASA scores and presented with more advanced empyema stages. Hospital stay was significantly longer in this group. However, complication rates (60.0% vs. 44.9%; p = 0.25), drainage duration, ICU admissions (91.4% vs. 83.7%; p = 0.48), and in-hospital mortality (0% in both groups) did not differ significantly. Conclusions: Although older patients had higher perioperative risks, their surgical outcomes were similar to those of younger patients. Chronological age alone should not be a limiting factor for surgical treatment of pleural empyema. Surgical decisions should be based on clinical condition rather than chronological age.

Background/objectives: Access to specialized care for patients with cognitive impairment in remote areas is often limited. Despite the increasing adoption of telemedicine, standardized guidelines have not yet been specified. This study aimed to develop a comprehensive protocol for the specialized neurological, neuropsychological, and neuropsychiatric assessment of patients with cognitive disorders in remote areas through telemedicine.

Methods: We analyzed data from (i) a comprehensive literature review of the existing recommendations, reliability studies, and telemedicine models for cognitive disorders, (ii) insights from a three-year experience of a specialized telemedicine outpatient clinic for cognitive movement disorders in Greece, and (iii) suggestions coming from dementia specialists experienced in telemedicine (neurologists, neuropsychologists, psychiatrists) who took part in three focus groups. A critical synthesis of the findings was performed in the end.

Results: The final protocol included: technical and organizational requirements (e.g., a high-resolution screen and a camera with zoom, room dimensions adequate for gait assessment, a noise-canceling microphone); medical history; neurological, neuropsychiatric, and neuropsychological assessment adapted to videoconferencing; ethical-legal aspects (e.g., data security, privacy, informed consent); clinician-patient interaction (e.g., empathy, eye contact); diagnostic work-up; linkage to other services (e.g., tele-psychoeducation, caregiver support); and instructions for treatment and follow-up.

Conclusions: This protocol is expected to serve as an example of good clinical practice and a source for official telemedicine guidelines for cognitive disorders. Ultimate outcomes include the potential enhanced access to specialized care, minimized financial and logistical costs, and the provision of a standardized, effective model for the remote diagnosis, treatment, and follow-up. This model could be applied not only in Greece, but also in other countries with similar healthcare systems and populations living in remote, difficult-to-access areas.

Background/Objectives: With aging linked to increased oral health conditions, the communication skills of dental professionals are vital to ensure patient satisfaction and improve the quality of geriatric dental care. This cross-sectional study evaluated geriatric patients' satisfaction with communication at a university dental clinic, comparing interactions with dentists and fifth-year dental students. Methods: A self-report questionnaire was administered to 111 patients, assessing sociodemographic data, general health, and satisfaction across six communication dimensions: verbal and nonverbal communication, empathy, respect, problem-solving, and support materials. The data were analyzed using Mann-Whitney U tests (α = 0.05). Results: The geriatric patients exhibited higher levels of satisfaction when interacting with dentists compared to students, particularly in the domains of nonverbal communication (p = 0.007), empathy (p = 0.035), and respect (p = 0.017). However, no statistically significant differences (p > 0.05) were observed in terms of verbal communication, problem-solving, and support materials. Conclusions: The geriatric patients demonstrated greater satisfaction with interactions with practicing dentists. These findings indicate that an attending dentist's clinical experience enhances interpersonal interactions with geriatric patients. Therefore, developing the interpersonal skills of future dentistry professionals, as well as adapting communication to the needs of the elderly, is essential to provide more satisfactory experiences in geriatric dental care.