Pub Date : 2024-01-01Epub Date: 2024-04-27DOI: 10.1159/000538598
Laura Schmidt, Tania Zieschang, Jessica Koschate, Tim Stuckenschneider
Introduction: Fall-related sequelae as well as balance and gait impairments are more pronounced in older adults who are cognitively impaired (OACI) compared to older adults who are cognitively healthy (OACH). Evidence is scarce about differences in standing balance and gait in OACH and OACI after a fall, even though these are major risks for recurrent falls. Thus, the aim of this study was to investigate early impairments in gait and balance, by adding inertial measurement units (IMUs) to a functional performance test in OACH and OACI after a severe fall with a presentation to the emergency department (ED) and immediate discharge.
Methods: The study sample was stratified into participants with and without probable cognitive impairment using the result of the Montreal Cognitive Assessment total score (maximum of 30 points). The cutoff for probable cognitive impairment was set at ≤ 24. Standing balance and gait parameters were measured using three IMUs in n = 69 OACH (72.0 ± 8.2 years) and n = 76 OACI (78.7 ± 8.1 years). Data were collected at participants' homes as part of a comprehensive geriatric assessment in the "SeFallED" study within 4 weeks after presentation to the ED after a severe fall (German Clinical Trials Register ID: 00025949). ANCOVA was used for statistical analysis, adjusted for age.
Results: The data indicated significantly more sway for OACI compared to OACH during balance tasks, whereas no differences in gait behavior were found. In detail, differences in standing balance were revealed for mean velocity (m/s) during parallel stance with eyes open (ηp2 = 0.190, p < 0.001) and eyes closed on a balance cushion (ηp2 = 0.059, p = 0.029), as well as during tandem stance (ηp2 = 0.034, p = 0.044) between OACI and OACH. Further differences between the two groups were detected for path length (m/s2) during parallel stance with eyes open (ηp2 = 0.144, p < 0.001) and eyes closed (ηp2
{"title":"Impaired Standing Balance in Older Adults with Cognitive Impairment after a Severe Fall.","authors":"Laura Schmidt, Tania Zieschang, Jessica Koschate, Tim Stuckenschneider","doi":"10.1159/000538598","DOIUrl":"10.1159/000538598","url":null,"abstract":"<p><strong>Introduction: </strong>Fall-related sequelae as well as balance and gait impairments are more pronounced in older adults who are cognitively impaired (OACI) compared to older adults who are cognitively healthy (OACH). Evidence is scarce about differences in standing balance and gait in OACH and OACI after a fall, even though these are major risks for recurrent falls. Thus, the aim of this study was to investigate early impairments in gait and balance, by adding inertial measurement units (IMUs) to a functional performance test in OACH and OACI after a severe fall with a presentation to the emergency department (ED) and immediate discharge.</p><p><strong>Methods: </strong>The study sample was stratified into participants with and without probable cognitive impairment using the result of the Montreal Cognitive Assessment total score (maximum of 30 points). The cutoff for probable cognitive impairment was set at ≤ 24. Standing balance and gait parameters were measured using three IMUs in n = 69 OACH (72.0 ± 8.2 years) and n = 76 OACI (78.7 ± 8.1 years). Data were collected at participants' homes as part of a comprehensive geriatric assessment in the \"SeFallED\" study within 4 weeks after presentation to the ED after a severe fall (German Clinical Trials Register ID: 00025949). ANCOVA was used for statistical analysis, adjusted for age.</p><p><strong>Results: </strong>The data indicated significantly more sway for OACI compared to OACH during balance tasks, whereas no differences in gait behavior were found. In detail, differences in standing balance were revealed for mean velocity (m/s) during parallel stance with eyes open (<inline-formula><mml:math id=\"m1\" xmlns:mml=\"http://www.w3.org/1998/Math/MathML\"><mml:mrow><mml:msubsup><mml:mi>η</mml:mi><mml:mi>p</mml:mi><mml:mn>2</mml:mn></mml:msubsup></mml:mrow></mml:math></inline-formula> = 0.190, p < 0.001) and eyes closed on a balance cushion (<inline-formula><mml:math id=\"m2\" xmlns:mml=\"http://www.w3.org/1998/Math/MathML\"><mml:mrow><mml:msubsup><mml:mi>η</mml:mi><mml:mi>p</mml:mi><mml:mn>2</mml:mn></mml:msubsup></mml:mrow></mml:math></inline-formula> = 0.059, p = 0.029), as well as during tandem stance (<inline-formula><mml:math id=\"m3\" xmlns:mml=\"http://www.w3.org/1998/Math/MathML\"><mml:mrow><mml:msubsup><mml:mi>η</mml:mi><mml:mi>p</mml:mi><mml:mn>2</mml:mn></mml:msubsup></mml:mrow></mml:math></inline-formula> = 0.034, p = 0.044) between OACI and OACH. Further differences between the two groups were detected for path length (m/s2) during parallel stance with eyes open (<inline-formula><mml:math id=\"m4\" xmlns:mml=\"http://www.w3.org/1998/Math/MathML\"><mml:mrow><mml:msubsup><mml:mi>η</mml:mi><mml:mi>p</mml:mi><mml:mn>2</mml:mn></mml:msubsup></mml:mrow></mml:math></inline-formula> = 0.144, p < 0.001) and eyes closed (<inline-formula><mml:math id=\"m5\" xmlns:mml=\"http://www.w3.org/1998/Math/MathML\"><mml:mrow><mml:msubsup><mml:mi>η</mml:mi><mml:mi>p</mml:mi><mml:mn>2</mml:mn></mml:msubsup></m","PeriodicalId":12662,"journal":{"name":"Gerontology","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140851125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01Epub Date: 2024-05-02DOI: 10.1159/000538314
Cheng Huang, Bei Wu, Chen Zhang, Zhuqin Wei, Liming Su, Junwei Zhang, Lina Wang
Introduction: Motoric cognitive risk syndrome (MCR) is a newly proposed pre-dementia syndrome characterized by subjective cognitive complaints (SCCs) and slow gait (SG). Increasing evidence links MCR to several adverse health outcomes, but the specific relationship between MCR and the risk of frailty, Alzheimer's disease (AD), and vascular dementia (VaD) remains unclear. Additionally, literature lacks analysis of MCR's components and associated health outcomes, complicating risk identification. This systematic review and meta-analysis aimed to provide a comprehensive overview of MCR's predictive value for adverse health outcomes.
Methods: Relevant cross-sectional, cohort, and longitudinal studies examining the association between MCR and adverse health outcomes were extracted from ten electronic databases. The Newcastle-Ottawa Scale (NOS) and modified NOS were used to assess the risk of bias in studies included in the analysis. Relative ratios (RRs) and 95% confidence intervals (CIs) were pooled for outcomes associated with MCR.
Results: Twenty-eight longitudinal or cohort studies and four cross-sectional studies with 1,224,569 participants were included in the final analysis. The risk of bias in all included studies was rated as low or moderate. Pooled analysis of RR indicated that MCR had a greater probability of increased the risk of dementia (adjusted RR = 2.02; 95% CI = 1.94-2.11), cognitive impairment (adjusted RR = 1.72; 95% CI = 1.49-1.99), falls (adjusted RR = 1.32; 95% CI = 1.17-1.50), mortality (adjusted RR = 1.66; 95% CI = 1.32-2.10), and hospitalization (adjusted RR = 1.46; 95% CI = 1.16-1.84); MCR had more prominent predictive efficacy for AD (adjusted RR = 2.23; 95% CI = 1.81-2.76) compared to VaD (adjusted RR = 3.78; 95% CI = 0.49-28.95), while excluding analyses from the study that utilized the timed-up-and-go test and one-leg-standing to evaluate gait speed. One study examined the association between MCR and disability (hazard ratios [HR] = 1.69; 95% CI = 1.08-2.02) and frailty (OR = 5.53; 95% CI = 1.46-20.89). SG was a stronger predictor of the risk for dementia and falls than SCC (adjusted RR = 1.22; 95% CI = 1.11-1.34 vs. adjusted RR = 1.19; 95% CI = 1.03-1.38).
Conclusion: MCR increases the risk of developing any discussed adverse health outcomes, and the predictive value for AD is superior to VaD. Additionally, SG is a stronger predictor of dementia and falls than SCC. Therefore, MCR should be routinely assessed among adults to prevent poor prognosis and provide evidence to support future targeted interventions.
{"title":"Motoric Cognitive Risk Syndrome as a Predictor of Adverse Health Outcomes: A Systematic Review and Meta-Analysis.","authors":"Cheng Huang, Bei Wu, Chen Zhang, Zhuqin Wei, Liming Su, Junwei Zhang, Lina Wang","doi":"10.1159/000538314","DOIUrl":"10.1159/000538314","url":null,"abstract":"<p><strong>Introduction: </strong>Motoric cognitive risk syndrome (MCR) is a newly proposed pre-dementia syndrome characterized by subjective cognitive complaints (SCCs) and slow gait (SG). Increasing evidence links MCR to several adverse health outcomes, but the specific relationship between MCR and the risk of frailty, Alzheimer's disease (AD), and vascular dementia (VaD) remains unclear. Additionally, literature lacks analysis of MCR's components and associated health outcomes, complicating risk identification. This systematic review and meta-analysis aimed to provide a comprehensive overview of MCR's predictive value for adverse health outcomes.</p><p><strong>Methods: </strong>Relevant cross-sectional, cohort, and longitudinal studies examining the association between MCR and adverse health outcomes were extracted from ten electronic databases. The Newcastle-Ottawa Scale (NOS) and modified NOS were used to assess the risk of bias in studies included in the analysis. Relative ratios (RRs) and 95% confidence intervals (CIs) were pooled for outcomes associated with MCR.</p><p><strong>Results: </strong>Twenty-eight longitudinal or cohort studies and four cross-sectional studies with 1,224,569 participants were included in the final analysis. The risk of bias in all included studies was rated as low or moderate. Pooled analysis of RR indicated that MCR had a greater probability of increased the risk of dementia (adjusted RR = 2.02; 95% CI = 1.94-2.11), cognitive impairment (adjusted RR = 1.72; 95% CI = 1.49-1.99), falls (adjusted RR = 1.32; 95% CI = 1.17-1.50), mortality (adjusted RR = 1.66; 95% CI = 1.32-2.10), and hospitalization (adjusted RR = 1.46; 95% CI = 1.16-1.84); MCR had more prominent predictive efficacy for AD (adjusted RR = 2.23; 95% CI = 1.81-2.76) compared to VaD (adjusted RR = 3.78; 95% CI = 0.49-28.95), while excluding analyses from the study that utilized the timed-up-and-go test and one-leg-standing to evaluate gait speed. One study examined the association between MCR and disability (hazard ratios [HR] = 1.69; 95% CI = 1.08-2.02) and frailty (OR = 5.53; 95% CI = 1.46-20.89). SG was a stronger predictor of the risk for dementia and falls than SCC (adjusted RR = 1.22; 95% CI = 1.11-1.34 vs. adjusted RR = 1.19; 95% CI = 1.03-1.38).</p><p><strong>Conclusion: </strong>MCR increases the risk of developing any discussed adverse health outcomes, and the predictive value for AD is superior to VaD. Additionally, SG is a stronger predictor of dementia and falls than SCC. Therefore, MCR should be routinely assessed among adults to prevent poor prognosis and provide evidence to support future targeted interventions.</p>","PeriodicalId":12662,"journal":{"name":"Gerontology","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140853408","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01Epub Date: 2024-05-24DOI: 10.1159/000539450
Minna Stolt, Noora Narsakka, Jouko Katajisto, Riitta Suhonen
Introduction: Foot health and lower extremity function are important in older people with rheumatoid arthritis (RA), as they maintain and promote these individuals' independent living and functional health. RA is a long-term inflammatory health condition that alters foot structure and function. Relatively little is known about the association between foot health and lower extremity function in older people with RA. Therefore, the aim of the study was to analyse the levels of foot health and lower extremity function in older people with RA and to explore the associations between these factors.
Methods: A cross-sectional survey design study was conducted. The data were collected online in April 2023 from a national association of patients with rheumatic conditions in Finland using two instruments: the Self-administered Foot Health Assessment Instrument (S-FHAI) and the Lower Extremity Function Scale (LEFS). The data were analysed using descriptive and inferential statistics.
Results: Older people with RA (n = 270) reported many foot health problems, the most common of which were foot pain, dry skin, and oedema. Lower extremity function in older people with RA was at the mild-to-moderate functional limitation level and respondents reported major difficulties running or hopping, squatting, carrying out their usual hobbies, performing strenuous activities outside their homes or putting on shoes/socks. Poor levels of foot health were correlated with decreased lower extremity function.
Conclusion: Foot health is associated with lower extremity function in older people with RA. Therefore, it is essential that older people with RA be provided with systematic foot health assessments, care and rehabilitation to promote their lower extremity health and improve their functional health. Multiprofessional collaboration and seamless care chains at different levels of health care could benefit older people with RA looking to maintain their functional ability and - above all - promote their active ageing.
导言:足部健康和下肢功能对患有类风湿性关节炎(RA)的老年人非常重要,因为它们能维持和促进这些人的独立生活和功能健康。类风湿关节炎是一种长期的炎症性健康问题,会改变足部结构和功能。人们对患有 RA 的老年人足部健康与下肢功能之间的关系知之甚少。因此,本研究旨在分析患有 RA 的老年人的足部健康水平和下肢功能,并探讨这些因素之间的关联:研究采用横断面调查设计。数据于2023年4月从芬兰全国风湿病患者协会在线收集,使用了两种工具:自制足部健康评估工具(S-FHAI)和下肢功能量表(LEFS)。数据采用描述性和推论性统计方法进行分析:患有 RA 的老年人(n = 270)报告了许多足部健康问题,其中最常见的是足部疼痛、皮肤干燥和水肿。患有 RA 的老年人的下肢功能处于轻度至中度功能受限水平,受访者称在跑步或跳跃、下蹲、进行日常爱好、在户外进行剧烈活动或穿鞋/袜子时遇到很大困难。足部健康状况差与下肢功能下降相关:结论:足部健康与患有 RA 的老年人的下肢功能有关。因此,必须为患有 RA 的老年人提供系统的足部健康评估、护理和康复服务,以促进他们的下肢健康,改善他们的功能健康。不同级别医疗保健机构的多专业合作和无缝护理链可使患有 RA 的老年人受益,从而保持他们的功能能力,最重要的是促进他们老有所为。
{"title":"Association of Foot Health and Lower Extremity Function in Older People with Rheumatoid Arthritis: A Cross-Sectional Study.","authors":"Minna Stolt, Noora Narsakka, Jouko Katajisto, Riitta Suhonen","doi":"10.1159/000539450","DOIUrl":"10.1159/000539450","url":null,"abstract":"<p><strong>Introduction: </strong>Foot health and lower extremity function are important in older people with rheumatoid arthritis (RA), as they maintain and promote these individuals' independent living and functional health. RA is a long-term inflammatory health condition that alters foot structure and function. Relatively little is known about the association between foot health and lower extremity function in older people with RA. Therefore, the aim of the study was to analyse the levels of foot health and lower extremity function in older people with RA and to explore the associations between these factors.</p><p><strong>Methods: </strong>A cross-sectional survey design study was conducted. The data were collected online in April 2023 from a national association of patients with rheumatic conditions in Finland using two instruments: the Self-administered Foot Health Assessment Instrument (S-FHAI) and the Lower Extremity Function Scale (LEFS). The data were analysed using descriptive and inferential statistics.</p><p><strong>Results: </strong>Older people with RA (n = 270) reported many foot health problems, the most common of which were foot pain, dry skin, and oedema. Lower extremity function in older people with RA was at the mild-to-moderate functional limitation level and respondents reported major difficulties running or hopping, squatting, carrying out their usual hobbies, performing strenuous activities outside their homes or putting on shoes/socks. Poor levels of foot health were correlated with decreased lower extremity function.</p><p><strong>Conclusion: </strong>Foot health is associated with lower extremity function in older people with RA. Therefore, it is essential that older people with RA be provided with systematic foot health assessments, care and rehabilitation to promote their lower extremity health and improve their functional health. Multiprofessional collaboration and seamless care chains at different levels of health care could benefit older people with RA looking to maintain their functional ability and - above all - promote their active ageing.</p>","PeriodicalId":12662,"journal":{"name":"Gerontology","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141155127","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01Epub Date: 2024-06-05DOI: 10.1159/000539591
Ameer Nor Azhar, Shan M Bergin, Shannon E Munteanu, Hylton B Menz
Background: Footwear, orthoses, and insoles have been shown to influence balance in older adults; however, it remains unclear which features, singular or in combination, are considered optimal. The aim of this scoping review was to identify and synthesise the current evidence regarding how footwear, orthoses, and insoles influence balance in older adults. Four electronic databases (MEDLINE, CINAHL, Embase, and AMED) were searched from inception to October 2023. Key terms such as "shoe*," "orthoses," "postural balance" and "older people" were employed in the search strategy. Studies meeting the following criteria were included: (i) participants had a minimum age ≥60 years, and were free of any neurological, musculoskeletal, and cardiovascular diseases; (ii) an active intervention consisting of footwear, foot orthoses, or insoles was evaluated; and (iii) at least one objective outcome measure of balance was reported.
Summary: A total of 56 studies from 17 different countries were included. Three study designs were utilised (cross-sectional study, n = 44; randomised parallel group, n = 6; cohort study n = 6). The duration of studies varied considerably, with 41 studies evaluating immediate effects, 14 evaluating effects from 3 days to 12 weeks, and 1 study having a duration of 6 months. Seventeen different interventions were evaluated, including/consisting of textured insoles (n = 12), heel elevation (n = 8), non-specific standardised footwear and changes in sole thickness or hardness (n = 7 each), sole geometry or rocker soles, contoured or custom insoles and high collar height (n = 6 each), insole thickness or hardness and vibrating insoles (n = 5 each), outsole tread (n = 4), minimalist footwear and slippers (n = 3 each), balance-enhancing shoes, footwear fit, socks, and ankle-foot orthoses (n = 2 each), and eversion insoles, heel cups, and unstable footwear (n = 1 each). Twenty-three different outcomes were assessed, and postural sway was the most common (n = 20), followed by temporo-spatial gait parameters (n = 17). There was uncertainty regarding intervention effectiveness. Overall, features such as secure fixation, a textured insole, a medium-to-hard density midsole and a higher ankle collar, in isolation, were able to positively impact balance. Conversely, footwear with an elevated heel height and the use of socks and slippers impaired balance.
Key messages: There is a substantial body of literature exploring the effects of footwear, orthoses, and insoles on balance in older adults. However, considerable uncertainty exists regarding the efficacy of these interventions due to variability in methodological approaches. Further high-quality research is necessary to determine whether a singular intervention or a combination of interventions is most effective for enhancing balance in older adults.
{"title":"Footwear, Orthoses, and Insoles and Their Effects on Balance in Older Adults: A Scoping Review.","authors":"Ameer Nor Azhar, Shan M Bergin, Shannon E Munteanu, Hylton B Menz","doi":"10.1159/000539591","DOIUrl":"10.1159/000539591","url":null,"abstract":"<p><strong>Background: </strong>Footwear, orthoses, and insoles have been shown to influence balance in older adults; however, it remains unclear which features, singular or in combination, are considered optimal. The aim of this scoping review was to identify and synthesise the current evidence regarding how footwear, orthoses, and insoles influence balance in older adults. Four electronic databases (MEDLINE, CINAHL, Embase, and AMED) were searched from inception to October 2023. Key terms such as \"shoe*,\" \"orthoses,\" \"postural balance\" and \"older people\" were employed in the search strategy. Studies meeting the following criteria were included: (i) participants had a minimum age ≥60 years, and were free of any neurological, musculoskeletal, and cardiovascular diseases; (ii) an active intervention consisting of footwear, foot orthoses, or insoles was evaluated; and (iii) at least one objective outcome measure of balance was reported.</p><p><strong>Summary: </strong>A total of 56 studies from 17 different countries were included. Three study designs were utilised (cross-sectional study, n = 44; randomised parallel group, n = 6; cohort study n = 6). The duration of studies varied considerably, with 41 studies evaluating immediate effects, 14 evaluating effects from 3 days to 12 weeks, and 1 study having a duration of 6 months. Seventeen different interventions were evaluated, including/consisting of textured insoles (n = 12), heel elevation (n = 8), non-specific standardised footwear and changes in sole thickness or hardness (n = 7 each), sole geometry or rocker soles, contoured or custom insoles and high collar height (n = 6 each), insole thickness or hardness and vibrating insoles (n = 5 each), outsole tread (n = 4), minimalist footwear and slippers (n = 3 each), balance-enhancing shoes, footwear fit, socks, and ankle-foot orthoses (n = 2 each), and eversion insoles, heel cups, and unstable footwear (n = 1 each). Twenty-three different outcomes were assessed, and postural sway was the most common (n = 20), followed by temporo-spatial gait parameters (n = 17). There was uncertainty regarding intervention effectiveness. Overall, features such as secure fixation, a textured insole, a medium-to-hard density midsole and a higher ankle collar, in isolation, were able to positively impact balance. Conversely, footwear with an elevated heel height and the use of socks and slippers impaired balance.</p><p><strong>Key messages: </strong>There is a substantial body of literature exploring the effects of footwear, orthoses, and insoles on balance in older adults. However, considerable uncertainty exists regarding the efficacy of these interventions due to variability in methodological approaches. Further high-quality research is necessary to determine whether a singular intervention or a combination of interventions is most effective for enhancing balance in older adults.</p>","PeriodicalId":12662,"journal":{"name":"Gerontology","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141261614","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01Epub Date: 2023-12-13DOI: 10.1159/000534998
Emilia Frangos, Jane Barratt, Jean-Pierre Michel, Fiona Ecarnot
Background: Older people living in long-term care facilities represent a particularly vulnerable segment of the population, who disproportionately bear the burden of infectious diseases, as recently highlighted by the COVID-19 pandemic.
Summary: Older long-term care residents typically cumulate several risk factors for infection and experience serious life-threatening outcomes once infected. These common infections are often compounded by the collective living environment, where it is more difficult to contain the spread of infection. Moreover, the staff may represent an additional reservoir of potential infection and mode of transmission. In this paper, we review the burden of infectious respiratory diseases in residents in long-term care and discuss the potential gains from higher vaccine coverage in this older and most vulnerable population but also from higher vaccine coverage among the facility staff. We highlight the compelling need to integrate specific vaccine recommendations for residents of long-term care into national vaccination schedules, as well as the need to include vaccination campaigns in routine protocols for infection control. Surveillance, reporting, hygiene, and individual protective measures remain key aspects in basic infection control, both in ordinary times and during epidemics.
Key message: Vaccination of residents in long-term care facilities against respiratory diseases including influenza, pneumococcal disease, pertussis, and COVID is a simple, inexpensive, and effective means to reduce the burden of infection in this segment of the population.
{"title":"Vaccines in Long-Term Care Settings: A Narrative Review.","authors":"Emilia Frangos, Jane Barratt, Jean-Pierre Michel, Fiona Ecarnot","doi":"10.1159/000534998","DOIUrl":"10.1159/000534998","url":null,"abstract":"<p><strong>Background: </strong>Older people living in long-term care facilities represent a particularly vulnerable segment of the population, who disproportionately bear the burden of infectious diseases, as recently highlighted by the COVID-19 pandemic.</p><p><strong>Summary: </strong>Older long-term care residents typically cumulate several risk factors for infection and experience serious life-threatening outcomes once infected. These common infections are often compounded by the collective living environment, where it is more difficult to contain the spread of infection. Moreover, the staff may represent an additional reservoir of potential infection and mode of transmission. In this paper, we review the burden of infectious respiratory diseases in residents in long-term care and discuss the potential gains from higher vaccine coverage in this older and most vulnerable population but also from higher vaccine coverage among the facility staff. We highlight the compelling need to integrate specific vaccine recommendations for residents of long-term care into national vaccination schedules, as well as the need to include vaccination campaigns in routine protocols for infection control. Surveillance, reporting, hygiene, and individual protective measures remain key aspects in basic infection control, both in ordinary times and during epidemics.</p><p><strong>Key message: </strong>Vaccination of residents in long-term care facilities against respiratory diseases including influenza, pneumococcal disease, pertussis, and COVID is a simple, inexpensive, and effective means to reduce the burden of infection in this segment of the population.</p>","PeriodicalId":12662,"journal":{"name":"Gerontology","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138800677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01Epub Date: 2024-01-16DOI: 10.1159/000536227
Yu Liang, Yiming Zhou, Can Zhou, Xinqi Cai, Li Liu, Fang Wei, Guolin Li
Introduction: While several antidepressants have been identified as potential geroprotectors, the effect and mechanism of sertraline on healthspan remain to be elucidated. Here, we explored the role of sertraline in the lifespan and healthspan of Caenorhabditis elegans.
Methods: The optimal effect concentration of sertraline was first screened in wild-type N2 worms under heat stress conditions. Then, we examined the effects of sertraline on lifespan, reproduction, lipofuscin accumulation, mobility, and stress resistance. Finally, the expression of serotonin signaling and aging-related genes was investigated to explore the underlying mechanism, and the lifespan assays were performed in ser-7 RNAi strain, daf-2, daf-16, and aak-2 mutants.
Results: Sertraline extended the lifespan in C. elegans with concomitant extension of healthspan as indicated by increasing mobility and reducing fertility and lipofuscin accumulation, as well as enhanced resistance to different abiotic stresses. Mechanistically, ser-7 orchestrated sertraline-induced longevity via the regulation of insulin and AMPK pathways, and sertraline-induced lifespan extension in nematodes was abolished in ser-7 RNAi strain, daf-2, daf-16, and aak-2 mutants.
Conclusion: Sertraline promotes health and longevity in C. elegans through ser-7-insulin/AMPK pathways.
{"title":"Sertraline Promotes Health and Longevity in Caenorhabditis elegans.","authors":"Yu Liang, Yiming Zhou, Can Zhou, Xinqi Cai, Li Liu, Fang Wei, Guolin Li","doi":"10.1159/000536227","DOIUrl":"10.1159/000536227","url":null,"abstract":"<p><strong>Introduction: </strong>While several antidepressants have been identified as potential geroprotectors, the effect and mechanism of sertraline on healthspan remain to be elucidated. Here, we explored the role of sertraline in the lifespan and healthspan of Caenorhabditis elegans.</p><p><strong>Methods: </strong>The optimal effect concentration of sertraline was first screened in wild-type N2 worms under heat stress conditions. Then, we examined the effects of sertraline on lifespan, reproduction, lipofuscin accumulation, mobility, and stress resistance. Finally, the expression of serotonin signaling and aging-related genes was investigated to explore the underlying mechanism, and the lifespan assays were performed in ser-7 RNAi strain, daf-2, daf-16, and aak-2 mutants.</p><p><strong>Results: </strong>Sertraline extended the lifespan in C. elegans with concomitant extension of healthspan as indicated by increasing mobility and reducing fertility and lipofuscin accumulation, as well as enhanced resistance to different abiotic stresses. Mechanistically, ser-7 orchestrated sertraline-induced longevity via the regulation of insulin and AMPK pathways, and sertraline-induced lifespan extension in nematodes was abolished in ser-7 RNAi strain, daf-2, daf-16, and aak-2 mutants.</p><p><strong>Conclusion: </strong>Sertraline promotes health and longevity in C. elegans through ser-7-insulin/AMPK pathways.</p>","PeriodicalId":12662,"journal":{"name":"Gerontology","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139478076","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01Epub Date: 2024-02-01DOI: 10.1159/000536050
Fei Gao, Ru-San Tan, Louis L Y Teo, See Hooi Ewe, Woon-Puay Koh, Kelvin B Tan, Angela S Koh
Introduction: Despite growing calls to tackle aging-related cardiovascular disease (CVD), the role of detecting early diastolic dysfunction such as those observed in aging, prior to clinical disease, is of unclear clinical benefit.
Methods: Myocardial function determined by echocardiography was examined in association with incident cardiovascular outcomes or all-cause death by Cox proportional hazards model. Sex-based differences in outcomes were included.
Results: A total of 956 participants (mean age 63 ± 12.9 years, n = 424 males [44%]) were categorized based on mitral peak early-to-late diastolic filling velocity (E/A) ratios: E/A <0.8 (28%), E/A 0.8-1.2 (39%), E/A (29%), E/A >2.0 (4%). Incidence rate (IR) for non-fatal cardiovascular outcomes was 2.83 per 100 person-years (95% CI: 2.24-3.56) and 0.45 per 100 person-years (95% CI: 0.26-0.80) for all-cause death. Event-free survival from non-fatal cardiovascular outcomes was significantly different among E/A categories (log-rank p = 0.0269). E/A <0.8 (HR 1.80, 95% CI: 1.031, 3.14, p = 0.039) was associated with non-fatal cardiovascular outcomes. Among men, IR for cardiovascular outcomes was 3.56 per 100 person-years (95% CI: 2.62-4.84) and 0.75 per 100 person-years (95% CI: 0.39-1.44) for all-cause death. Among women, IR for cardiovascular outcomes was 2.22 per 100 person-years (95% CI: 1.56-3.16) and 0.21 per 100 person-years (95% CI: 0.067-0.64) for all-cause death. For E/A <0.8 category, women had significantly higher risks of non-fatal cardiovascular outcomes, compared to E/A 0.8-1.2 category (HR 2.49, 95% CI: 1.18, 5.23, p = 0.017).
Conclusion: Myocardial aging was an independent predictor of cardiovascular outcomes in community-dwelling older adults prior to clinical CVD. Impaired myocardial relaxation was prevalent in both sexes but associated with worse outcomes in women, suggestive of sex differences in age-related biology.
引言 尽管应对与衰老相关的心血管疾病(CVD)的呼声越来越高,但在临床疾病发生之前检测早期舒张功能障碍(如在衰老过程中观察到的舒张功能障碍)的作用尚不明确。方法 通过 Cox 比例危险模型研究了超声心动图测定的心肌功能与心血管事件或全因死亡的关系。结果还包括性别差异。结果 956 名参与者[平均年龄(63±12.9)岁,男性 424 人(44%)]根据二尖瓣峰值舒张早期与舒张晚期充盈速度(E/A)比值进行分类:E/A 2.0(4%)。非致死性心血管疾病的发病率(IR)为每100人年2.83例(95% CI 2.24-3.56),全因死亡的发病率(IR)为每100人年0.45例(95% CI 0.26-0.80)。非致死性心血管结局的无事件生存率在 E/A 类别中存在显著差异(对数秩 P=0.0269)。E/A
{"title":"Myocardial Aging among a Population-Based Cohort Is Associated with Adverse Cardiovascular Outcomes and Sex-Specific Differences among Older Adults.","authors":"Fei Gao, Ru-San Tan, Louis L Y Teo, See Hooi Ewe, Woon-Puay Koh, Kelvin B Tan, Angela S Koh","doi":"10.1159/000536050","DOIUrl":"10.1159/000536050","url":null,"abstract":"<p><strong>Introduction: </strong>Despite growing calls to tackle aging-related cardiovascular disease (CVD), the role of detecting early diastolic dysfunction such as those observed in aging, prior to clinical disease, is of unclear clinical benefit.</p><p><strong>Methods: </strong>Myocardial function determined by echocardiography was examined in association with incident cardiovascular outcomes or all-cause death by Cox proportional hazards model. Sex-based differences in outcomes were included.</p><p><strong>Results: </strong>A total of 956 participants (mean age 63 ± 12.9 years, n = 424 males [44%]) were categorized based on mitral peak early-to-late diastolic filling velocity (E/A) ratios: E/A <0.8 (28%), E/A 0.8-1.2 (39%), E/A (29%), E/A >2.0 (4%). Incidence rate (IR) for non-fatal cardiovascular outcomes was 2.83 per 100 person-years (95% CI: 2.24-3.56) and 0.45 per 100 person-years (95% CI: 0.26-0.80) for all-cause death. Event-free survival from non-fatal cardiovascular outcomes was significantly different among E/A categories (log-rank p = 0.0269). E/A <0.8 (HR 1.80, 95% CI: 1.031, 3.14, p = 0.039) was associated with non-fatal cardiovascular outcomes. Among men, IR for cardiovascular outcomes was 3.56 per 100 person-years (95% CI: 2.62-4.84) and 0.75 per 100 person-years (95% CI: 0.39-1.44) for all-cause death. Among women, IR for cardiovascular outcomes was 2.22 per 100 person-years (95% CI: 1.56-3.16) and 0.21 per 100 person-years (95% CI: 0.067-0.64) for all-cause death. For E/A <0.8 category, women had significantly higher risks of non-fatal cardiovascular outcomes, compared to E/A 0.8-1.2 category (HR 2.49, 95% CI: 1.18, 5.23, p = 0.017).</p><p><strong>Conclusion: </strong>Myocardial aging was an independent predictor of cardiovascular outcomes in community-dwelling older adults prior to clinical CVD. Impaired myocardial relaxation was prevalent in both sexes but associated with worse outcomes in women, suggestive of sex differences in age-related biology.</p>","PeriodicalId":12662,"journal":{"name":"Gerontology","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139671553","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01Epub Date: 2024-03-08DOI: 10.1159/000535082
Weihao Xu, Anying Bai, Yuanfeng Liang, Zhanyi Lin
Background: Epidemiologic studies have indicated an association of motoric cognitive risk syndrome (MCR), a pre-dementia stage characterized by the presence of cognitive complaints and a slow gait, with increased risk of incident dementia.
Objectives: We aimed to clarify this association using meta-analysis.
Methods: We systematically searched the PubMed, Embase, and Web of Science databases up to December 2022 for relevant studies that investigated the association between MCR and incident all-cause dementia and Alzheimer's disease (AD). The random-effects model was used to determine a pooled-effect estimate of the association.
Results: We identified seven articles that corresponded with nine cohort studies investigating the association between MCR and the risk of dementia. Pooled analysis showed that MCR was associated with a significantly increased risk of incident all-cause dementia (HR = 2.28; 95% CI: 1.90-2.73) and AD (HR = 2.05; 95% CI: 1.61-2.61). Sensitivity analysis showed that there was no evidence that individual studies influenced the pooled-effect estimate, verifying the robustness of the results.
Conclusions: Our results confirm that MCR is an independent risk factor of incident all-cause dementia and AD. Future studies are needed to better understand the mechanisms underlying this association.
{"title":"Motoric Cognitive Risk Syndrome and the Risk of Incident Dementia: A Systematic Review and Meta-Analysis of Cohort Studies.","authors":"Weihao Xu, Anying Bai, Yuanfeng Liang, Zhanyi Lin","doi":"10.1159/000535082","DOIUrl":"10.1159/000535082","url":null,"abstract":"<p><strong>Background: </strong>Epidemiologic studies have indicated an association of motoric cognitive risk syndrome (MCR), a pre-dementia stage characterized by the presence of cognitive complaints and a slow gait, with increased risk of incident dementia.</p><p><strong>Objectives: </strong>We aimed to clarify this association using meta-analysis.</p><p><strong>Methods: </strong>We systematically searched the PubMed, Embase, and Web of Science databases up to December 2022 for relevant studies that investigated the association between MCR and incident all-cause dementia and Alzheimer's disease (AD). The random-effects model was used to determine a pooled-effect estimate of the association.</p><p><strong>Results: </strong>We identified seven articles that corresponded with nine cohort studies investigating the association between MCR and the risk of dementia. Pooled analysis showed that MCR was associated with a significantly increased risk of incident all-cause dementia (HR = 2.28; 95% CI: 1.90-2.73) and AD (HR = 2.05; 95% CI: 1.61-2.61). Sensitivity analysis showed that there was no evidence that individual studies influenced the pooled-effect estimate, verifying the robustness of the results.</p><p><strong>Conclusions: </strong>Our results confirm that MCR is an independent risk factor of incident all-cause dementia and AD. Future studies are needed to better understand the mechanisms underlying this association.</p>","PeriodicalId":12662,"journal":{"name":"Gerontology","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11098020/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140093734","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: Aging leads to vascular endothelial dysfunction and muscle impairment. While resistance exercise improves muscular function, its acute effects on vascular function vary in the literature, with some studies reporting detrimental effects. These findings indicate the need for exercises that optimize muscle function without compromising vascular function. Reformer Pilates (RP) is a low-impact exercise involving an adjustable sliding platform. However, the acute effects of RP on vascular function among older adults remain unknown. Therefore, this study aimed to investigate the acute effects of RP on vascular function in older adults.
Methods: Overall, 17 participants (age: 65 ± 2.76 years, body mass index: 23.42 ± 3.68 kg/m2) were examined and assigned to control and RP conditions under a randomized crossover design. The RP condition involved a 3.5-5 omnibus perceived exertion scale with 19 exercise postures for 60 min. Brachial artery flow-mediated dilation (FMD), brachial-ankle pulse wave velocity (baPWV), and blood pressure were measured at baseline and 0, 10, 30, and 60 min after exercise.
Results: RP significantly improved FMD at all time points compared with that at baseline (p < 0.05). baPWV increased at 0 min post-RP but returned to baseline levels at other time points. Additionally, RP showed improved FMD at 0, 10, and 30 min compared with that in the control condition (p < 0.05). However, no significant differences were observed in blood pressure or mean arterial pressure in either condition.
Conclusion: RP enhanced FMD and regulated blood pressure for approximately 60 min post-exercise, suggesting its suitability for older adults to enhance vascular function and control blood pressure during exercise. Nonetheless, longitudinal resistance training intervention studies are needed to validate these findings.
{"title":"Effect of 60-Min Single Bout of Resistance Exercise, Reformer Pilates, on Vascular Function Parameters in Older Adults: A Randomized Crossover Study.","authors":"Yupawan Rangabprai, Witid Mitranun, Witoon Mitarnun","doi":"10.1159/000539144","DOIUrl":"10.1159/000539144","url":null,"abstract":"<p><strong>Introduction: </strong>Aging leads to vascular endothelial dysfunction and muscle impairment. While resistance exercise improves muscular function, its acute effects on vascular function vary in the literature, with some studies reporting detrimental effects. These findings indicate the need for exercises that optimize muscle function without compromising vascular function. Reformer Pilates (RP) is a low-impact exercise involving an adjustable sliding platform. However, the acute effects of RP on vascular function among older adults remain unknown. Therefore, this study aimed to investigate the acute effects of RP on vascular function in older adults.</p><p><strong>Methods: </strong>Overall, 17 participants (age: 65 ± 2.76 years, body mass index: 23.42 ± 3.68 kg/m2) were examined and assigned to control and RP conditions under a randomized crossover design. The RP condition involved a 3.5-5 omnibus perceived exertion scale with 19 exercise postures for 60 min. Brachial artery flow-mediated dilation (FMD), brachial-ankle pulse wave velocity (baPWV), and blood pressure were measured at baseline and 0, 10, 30, and 60 min after exercise.</p><p><strong>Results: </strong>RP significantly improved FMD at all time points compared with that at baseline (p < 0.05). baPWV increased at 0 min post-RP but returned to baseline levels at other time points. Additionally, RP showed improved FMD at 0, 10, and 30 min compared with that in the control condition (p < 0.05). However, no significant differences were observed in blood pressure or mean arterial pressure in either condition.</p><p><strong>Conclusion: </strong>RP enhanced FMD and regulated blood pressure for approximately 60 min post-exercise, suggesting its suitability for older adults to enhance vascular function and control blood pressure during exercise. Nonetheless, longitudinal resistance training intervention studies are needed to validate these findings.</p>","PeriodicalId":12662,"journal":{"name":"Gerontology","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140876254","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}