Gerontology最新文献

Introduction The pathogenesis of aging nephropathy is yet to be elucidated. Intrarenal Angiotensin-II (AngII) and activation of the NF-κB and NLRP3 inflammasome pathways exert a relevant pathogenic role in the progression of chronic kidney disease (CKD). We sought to investigate whether monotherapy with Losartan and combined treatment with Losartan and the NF-κB inhibitor pyrrolidine dithiocarbamate (PDTC) would attenuate experimental aging nephropathy. Materials and Methods Forty adult Male Munich-Wistar rats were distributed among four groups: 12M (n=10), untreated 12-month-old rats; 15M (n=10), untreated 15-month-old rats; 15MLos (n=8), rats receiving Losartan (50 mg/kg/d) and 15MLos+PDTC (n=8), rats receiving Losartan and PDTC (60 mg/kg/d). All treatments were given by mouth from 12 to 15 months of age. Results Group 15M exhibited slightly decreased tail-cuff pressure, and marked increase in albuminuria, sclerotic glomeruli, cortical collagen-1 deposition and infiltration by myofibroblasts, AngII-positive cells and proinflammatory M1 macrophages, whereas the amount of anti-inflammatory M2 macrophages was reduced. In addition, the renal abundance of TLR4, nuclear p65 and IL-6 was increased, indicating activation of the NF-κB pathway, without evidence of simultaneous activation of the NLRP3 cascade. Losartan treatment decreased cortical collagen-1 deposition, myofibroblasts and AngII-positive cells, and partially restored renal M2, but had no significant effect on albuminuria, glomerulosclerosis or NF-κB activation. Combined Losartan+PDTC prevented all the observed abnormalities. Discussion/conclusion Simultaneous blockade of renal AngII and inhibition of the NF-κB pathway may represent a novel alternative to limit the decline of renal function with age.

Introduction: Views of aging have been linked with many important outcomes in older adults. Subjective cognition, or one's perception of their cognitive functioning, may be a valuable indicator of cognitive changes as individuals age, but is known to be impacted by a variety of factors. The aim of this systematic review was to synthesize the evidence on relationships between views of aging and subjective cognition, including whether and how these relationships may differ based on age.

Methods: Guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria, we conducted a comprehensive literature search in four databases: PubMed, CINAHL, PsycINFO, and ProQuest Dissertations and Theses. Critical appraisal utilized the Critical Appraisal Skills Programme (CASP) checklists. Twenty sources (including 21 studies) met inclusion and exclusion criteria, from which data were systematically extracted and results narratively synthesized.

Results: Seventeen out of the 21 identified studies (81%) found a relationship between more positive views of aging and better subjective cognition; however, some studies reported mixed results based on the domain of aging views. Domains that were consistently associated with subjective cognition were subjective age, attitudes toward one's own aging, aging well, and essentialist beliefs about aging. Only three studies reported age group differences or changes in associations over time, precluding conclusions about differences across middle- and older ages.

Conclusion: Most studies supported associations between views of aging and subjective cognition. More longitudinal as well as qualitative research is needed to advance understanding of factors that influence these relationships.

Introduction: The objective is to investigate the role of digital exclusion in the association between diabetes and cognitive function among adults aged 50 and above.

Methods: 107,188 participants aged 50 years old and above across 31 countries from 2010-2018 were involved. The mixed-effects linear regression models were used to analyze the data.

Results: The presence of diabetes was found to be associated with a notable reduction in the global cognitive function score (unadjusted β=-0.27, 95% CI: -0.28, -0.25). The presence of digital exclusion was found to have a significant association with the decline in cognitive function scores related to diabetes. Similar trends were observed in the scores for memory, numeracy, and orientation.

Discussion: These findings underscore the importance of addressing the digital divide to promote healthy aging. Developing digital interventions targeting diabetes-related cognitive impairments and fostering digital inclusion among older adults with diabetes hold significant value in preventing cognitive impairment.

Introduction Hearing loss is common in ageing populations, but thorough investigation of factors associated with objective hearing loss in otherwise healthy, community dwelling older individuals is rare. We examined prevalence of age-related hearing loss (ARHL) in healthy, community-dwelling older adults, and determined whether sociodemographic, lifestyle or health factors associate with hearing thresholds. Audiometry assessment was investigated with self-reports of hearing loss and hearing handicap. Methods Australian participants (n=1260) of median age 73 years (IQR 71-76) joined ASPREE-Hearing, a sub-study of the ASPREE (ASPirin in Reducing Events in the Elderly) trial with exclusions including cognitive impairment, cardiovascular disease (CVD), independence-limiting physical disability, and uncontrolled hypertension. ASPREE collected demographics, anthropometrics, lifestyle, and health data. Audiometry measured better ear pure-tone-average (PTA) across four frequencies (0.5-4kHz) to establish hearing thresholds, categorised as normal or mild, moderate and severe hearing loss. Questionnaires collected perceived hearing problems and noise exposure. Results ARHL prevalence by audiometry was 49.7%, affecting men (59%) more than women (41%). A majority (54.5%) self-reported some hearing problems which mostly aligned with objective assessments; 45.6% self-reported a "little trouble" with hearing, while 35% had objective mild hearing loss; (8.3%) reported having a "lot of trouble" hearing while 13% had moderate hearing loss; and (0.6%) reported being "deaf" with 2% demonstrated severe hearing loss. There was a significant association (p<0.001) between self-reported hearing handicap and audiometric measures of hearing loss. In multivariate analysis of health, demographics and lifestyle risk factors only age, gender (men), and education years (<12) remained associated (P<0.05) with hearing loss. Hearing thresholds were not associated with smoking, living situation, alcohol use, hypertension, diabetes, or chronic kidney disease. Conclusion ARHL robustly assessed by audiometry is common among healthy older Australians with men more likely to have abnormal hearing thresholds than women. Hearing loss was associated with fewer years of formal education, but not with a range of chronic conditions or alcohol use. Self-reported hearing loss correlates well with higher PTA hearing threshold levels in this healthy cohort where prevalence was lower than previously reported for the age group >70 years. Hearing health education remains an important public health tool for this age. Targeting hearing in older patient health checks could be beneficial to mitigate the cognitive, social, and mental health consequences of ARHL, even if patients do not report a problem or handicap.

Introduction: This study aimed to investigate the relationship between the serum albumin to serum creatinine ratio (sACR) and readmission in elderly heart failure patients.

Methods: We conducted a retrospective cohort study using data from the PhysioNet Restricted Health Data database. The exposure variable was sACR and the outcome variable readmission. Multivariate logistic regression and subgroup analyses were performed to assess the independent association between sACR and readmission. Smooth curve fits were applied to examine the non-linear relationship. We employed multiple imputation and E-value sensitivity analyses to assess the robustness of our results.

Results: Our study included 1,725 participants, of whom 40.6% were male, 59.2% were aged 60-79 years, and 40.8% were aged 80 years and older. After adjusting for potential confounders, we found that for each unit increase in sACR, the 28-day readmission rate decreased by 48% (OR = 0.52, 95% CI: 0.29-0.95, P = 0.003). The 28-day readmission rate was significantly higher in the low sACR group (sACR<0.32) than in the high sACR group (sACR>0.51) (OR = 0.47, 95% CI: 0.3-0.76, P=0.002). Similar results were observed for 3-month and 9-month readmission. Subgroup analysis showed no significant interactions. A nonlinear relationship was observed between the sACR and readmission. Sensitivity analyses have confirmed the robustness of our results.

Conclusion: There is a negative association between sACR and readmission in Chinese heart failure patients. Our study may offer novel insights into the management of heart failure readmissions.

Introduction The aging process of the incarcerated population is a growing concern, yet there are few data on older adults in this demographic group. Hence, this study seeks to examine the health status of older adults who are incarcerated in Mexican prisons and its association with the duration of their imprisonment. Methods This is a secondary analysis of the 2021 Mexico National Prisons Survey. We analyzed 50-year-old and older prisoners, and performed a descriptive analysis of the sample's age, sex, sociodemographic variables, and chronic conditions. Multivariate analysis stratified by age was performed to assess the effect of the time spent in prison on older prisoners' health. Results The mean age was 56.95 (± 6.4 SD) and the mean duration of imprisonment was 8.93 years (± 6.94 SD). Regarding health conditions, 17.80% had diabetes, 29.62% had hypertension, 10.33% had suicidal ideation, 40.87% were visually impaired, 17.01% had hearing impairment, and 17.64% had mobility impairment. Multivariate analysis revealed that among categories of imprisonment duration, longer time imprisoned was associated with an increased risk of diabetes and hypertension for all groups but was not associated with mobility impairment or suicidal ideation except in the younger group. Conclusion Longer periods of incarceration appear to be associated with a greater occurrence of diabetes and hypertension in older prisoners. Sensory impairments and suicidal ideation are mainly identified in younger prisoners, while mobility impairments do not appear to be influenced by the time spent in prison. Further research needs to be done in prisons, where the addition of physical performance tests and cognitive tests could help further study geriatric conditions in older prisoners.

Introduction The problem of population aging is intensifying worldwide. Osteoporosis has become an important cause affecting the health status of older populations. However, the diagnosis of osteoporosis and people's understanding of it are seriously insufficient. We aim to develop a deep learning model to automatically measure bone mineral density (BMD) and improve the diagnostic rate of osteoporosis. Methods The images of 801 subjects with 2080 vertebral bodies who underwent abdominal paired computer tomography (CT) and quantitative computer tomography (QCT) scanning was retrived from June 2020 to January 2022. The BMD of T11-L4 vertebral bodies was measured by QCT. Developing a multi-stage deep learning-based model to simulate the segmentation of the vertebral body and predict BMD. The subjects were randomly divided into training dataset, validation dataset and test dataset. Analyze the fitting effect between the BMD measured by the model and the standard BMD by QCT. Accuracy, precision, recall and f1- score were used to analyze the diagnostic performance according to categorization criterion measured by QCT. Results 410 males (51.2%) and 391 females (48.8%) were included in this study. Among them, there were 154 (19.2%) males and 118 (14.7%) females aged 23-44; 182 (22.7%) males and 205 (25.6%) females aged 45-64; 74 (9.2%) males and 68 (8.5%) females aged 65-84. The number of vertebral bodies in the training dataset, the validation dataset, and the test dataset was 1433, 243, 404, respectively. In each dataset, the BMD of males and females decreases with age. There was a significant correlation between the BMD measured by the model and QCT, with the coefficient of determination (r2) 0.95-0.97. The diagnostic accuracy based on the model in the three datasets was 0.88, 0.91, and 0.91, respectively. Conclusion The proposed multi-stage deep learning-based model can achieve automatic measurement of vertebral BMD and performed well in the prediction of osteoporosis.

Introduction Physical function and cognition seem to be interrelated, especially in the oldest-old. However, the temporal order in which they are related and the role of brain health remain uncertain. Methods We included 338 participants (mean age 93.1 years) from two longitudinal cohorts: The UCI 90+ Study and EMIF-AD 90+ Study. We tested the association between physical function (Short Physical Performance Battery, gait speed and handgrip strength) at baseline with cognitive decline (MMSE, memory tests, Animal fluency, Trail Making Test (TMT) A and Digit Span Backward), and the association between cognition at baseline with physical decline (mean follow-up 3.3 years). We also tested whether measures for brain health (hippocampal, white matter lesion and gray matter volume) were related to physical function and cognition, and whether brain health was a common driver of the association between physical function and cognition by adding it as confounder (if applicable). Results Better performance on all physical tests at baseline was associated with less decline on MMSE, memory and TMT A. Conversely, fewer associations were significant but better scores on memory, TMT A and Digit Span Backward were associated with less physical decline. When adding measures for brain health as confounder, all associations stayed significant except for memory with gait speed decline. Discussion In the oldest-old, physical function and cognition are strongly related, independently of brain health. Also, the association between physical function and cognitive decline is more pronounced than the other way around, suggesting a potential for slowing cognitive decline by optimizing physical function.

Introduction: Thrombolysis and endovascular thrombectomy (EVT) are standard treatments after stroke. We previously reported that these therapies benefit stroke patients over 80 years old. Now, we aimed to study reperfusion therapies specifically in nonagenarians, hypothesizing a poorer prognosis in this group.

Methods: Nonagenarian stroke patients were identified from our prospective monocentric cohort, which included consecutive patients ≥80 years old treated with thrombolysis and/or EVT from 2015 to 2019. Baseline characteristics, treatments, and outcomes, as well as complications and mortality were analyzed.

Results: Ninety-six nonagenarians were treated with thrombolysis (69.8%) and/or EVT (81.1%). A total of 51% had a pre-stroke modified Rankin score (mRS) ≤2. Cardioembolism was the most common etiology (67.7%). Age was associated with a higher mRS after stroke with a turning point at 90 years old: (90-99 years old: odds ratio [OR] = 0.33, 95% confidence interval [95% CI]: 0.13-0.83, p = 0.02) versus (85-89 years old: OR = 0.72, 95% CI: 0.34-1.50, p = 0.38), with 80- to 84-year-old patients as the reference. In nonagenarians, previous coronary artery disease (OR = 8.02, 95% CI: 1.66-38.68, p = 0.01), initial National Institute of Health Stroke Score (NIHSS) (OR = 1.11, 95% CI: 1.03-1.19, p = 0.01), pre stroke independence (OR = 0.25, 95% CI: 0.08-0.71, p = 0.01), and "drip-and-ship" status (OR = 3.35, 95% CI: 1.22-9.16, p = 0.02) were associated with 3-month mortality. Nonagenarians had more baseline comorbidities (p = 0.003) and lower levels of pre-stroke independence (p = 0.002) than octogenarians (n = 261). Despite no difference in the use of acute treatments, timelines, and rates of successful reperfusion, a good functional status at 3 months was less common in nonagenarians than octogenarians (14.3% vs. 34.0%, p < 0.001) with a higher mortality (60.2% vs. 16.4%, p < 0.001). A total of 9.5% of nonagenarians experienced a symptomatic intracranial hemorrhage.

Conclusions: Age is a crucial factor affecting prognosis after stroke with a turning point at 90 years old. However, age alone should not be a limiting factor for treatment decision. Despite higher mortality and poorer functional prognosis overall, some nonagenarians may benefit from reperfusion therapies.

Introduction: Nocturnal lower urinary tract symptoms are common in geriatric rehabilitation inpatients but have not been well described. The aim of this study was to compare patient characteristics stratified by self-reported nocturia severity in geriatric rehabilitation inpatients.

Methods: The REStORing health of acutely unwell adulTs (RESORT) is an observational, longitudinal, prospective inception cohort of geriatric rehabilitation inpatients who underwent a Comprehensive Geriatric Assessment (CGA) at admission and discharge. Nocturia was captured by item 7 of the American Urology Association Symptom Score (AUASS) and dichotomised as ≤1 void and >1 void at night as per the International Continence Society definition. Differences in demographic, functional, and medical characteristics of the inpatients with and without nocturia >1 were compared.

Results: Overall, 641 inpatients completed the nocturia item (mean age 82.6 [SD 7.7] years, 59.9% female). Nocturia occurred >once per night in 57.4%; mean number of episodes was 1.96 (SD 1.38), ranging from 0 to 5. There was no change in nocturia severity between admission and discharge. Daily urinary incontinence, urinary urgency, and comorbid illness were independently associated with multiple nocturia episodes. A history of falls within the last year, difficulty climbing stairs pre-admission, higher faecal incontinence score, impaired quality of life domains, higher levels of anxiety and depression were significantly more common in inpatients with multiple episodes of nocturia compared to no or only one episode of nocturia.

Conclusion: Lower urinary tract symptoms, poor functional status and frailty markers were associated with repeated episodes of nocturia. Targeted intervention may reduce the severity of nocturia, with potential to improve sleep quality, impact therapeutic gains and influence discharge destination.