Gerontology最新文献

Introduction: Decline in balance is a major risk factor for falls among older adults. Virtual reality (VR)-based training can enhance neural activation and sensorimotor integration, offering a promising approach for improving balance in older adults. However, the effects of immersive VR-based tennis training on balance in older adults remain unclear. This study aimed to investigate the effects of immersive VR-based tennis training on static and dynamic balance in older adults and to evaluate the retention of these effects 1 week after detraining.

Methods: Thirty-eight healthy older adults were randomly assigned to either a VR-based tennis training group (EXP, n = 20) or a VR-based documentary viewing control group (CON, n = 18). Both groups participated in three weekly sessions for 4 weeks. Static balance was assessed using the one-legged stance test (OLST) and Romberg test (RBT), while dynamic balance was evaluated through the balance beam walking test (BBWT), timed up and go test (TUG), and Fukuda stepping test (FST). Assessments were conducted at baseline (T0), after the intervention (T1), and 1 week after detraining (T2).

Results: The EXP group showed significant improvements in OLST with the dominant leg and in RBT at T1 and T2 compared to the CON group (p < 0.05). Within the EXP group, performance on OLST, RBT, and BBWT improved at T1 and T2 compared to T0 (p < 0.05), along with a significant decrease in TUG completion time at T2 compared to T0 (p = 0.011). No significant effects were observed in the FST (p > 0.05).

Conclusion: Four weeks of immersive VR-based tennis training effectively improved static balance in older adults, with benefits lasting for at least 1 week after detraining. These findings suggest that VR-based sports simulations may serve as an engaging and effective balance training method, particularly in addressing static balance impairments.

Background: Numerous factors, including some modifiable factors as well as demographic factors, are associated with risk for age-related cognitive impairment. Evaluating the complex interaction of these factors and their trajectories across the adult lifespan requires large sample sizes with diverse cohorts. Online research has the potential to overcome barriers to research participation and provide the statistical power required to examine individual differences in cognitive functions. Understanding the complexity of cognitive aging is critical for developing individualized interventions aimed at promoting brain and cognitive health across the lifespan.

Methods: Using a fully Web-based platform, MindCrowd-Expanded, we examined associations between age, sex, educational attainment, and cognitive performance in a large cohort of participants, aged 18-100. Tests were included from five cognitive domains - associative memory, information processing speed, and three components of executive function - inhibition, updating/working memory, and set shifting.

Results: Increased age was associated with poorer performance across all domains, especially in conditions that reflected increased task complexity. Age effects were not confined to the 6th decade and beyond but were evident across the entire age range in a relatively linear fashion. Considerable individual differences in performance were also observed, especially among older adults. We also report robust sex effects that depended on the task - males showed faster simple response times than females, while females outperformed males on associative memory. Increased level of educational attainment showed small but consistent benefits across all domains.

Conclusion: The study adds to a growing body of research demonstrating the feasibility and utility of online cognitive testing for reaching large cohorts of individuals across the adult lifespan. We report findings that mirror the existing literature on cognitive aging but also provide unique insights into the trajectory of cognitive functioning. We discuss the benefits, challenges, and future promise of Web-based testing.

Introduction: Resistance training is widely recognized as a valuable method to enhance physical function, reduce the risk of falls, and improve overall health, independence and well-being in older adults. The training can be performed through various modalities of which the comparative effects have not yet been thoroughly elucidated. This network meta-analysis (NMA) therefore aims to compare and rank different resistance training modalities regarding their effects on strength outcomes in older adults.

Methods: The studies included in this NMA were identified through a comprehensive search across three health-related and biomedical databases (PubMed, Web of Science, and SPORTDiscus). We included (randomized) controlled trials that assessed the effect of resistance training modes (including: free weight training, machine-based training, bodyweight training, elastic band training, and mixed training) in comparison to each other or to a control condition, focusing on traditional maximal strength outcomes in older individuals.

Results: This NMA includes 102 trials involving 4,754 community-dwelling seniors with a mean age of 70 ± 4 years (range 63-87 years of age). All of the included resistance training modalities yield moderate to large positive effects on strength when compared to a "no intervention" control condition. Machine-based training {standardized mean difference (SMD) = 1.34 (95% confidence interval [CI]: 1.16; 1.52)} elicits the largest effects, followed by free weight (SMD = 1.15 [95% CI: 0.28; 2.03]), elastic band (SMD = 0.93 [95% CI: 0.49; 1.37]), mixed (SMD = 0.88 [95% CI: 0.51; 1.25]), and bodyweight training (SMD = 0.71 [95% CI: 0.16; 1.26]).

Conclusion: Machine-based training elicits the largest effects with the smallest variance. However, our findings demonstrate that various resistance-training modalities can have large positive effects on strength development in older adults. We suggest that, with adequately chosen load criteria such as training intensity, volume and duration of the training period, the selection of the appropriate resistance training type might depend on individual preference, enjoyability, and practicability.

Introduction: Perturbation-based balance training reduces fall rates dramatically by triggering and improving balance recovery skills. We aimed to investigate whether multidirectional surface perturbation treadmill training, which explicitly challenges age-related impairments in reactive responses, can improve balance recovery responses in standing and reduce annual falls.

Methods: This was a two-arm parallel-group randomized controlled trial with concealed allocation, blinded assessors, data analyzers, and intention-to-treat analysis. Fifty-three older adults aged 80.1 ± 5.2 years, living in retirement housing, were randomized into two groups: (1) surface perturbation-based hands-free treadmill training (SPTT, n = 27) and (2) control group, hands-free treadmill walking training without perturbations (TT, n = 26). Both received a 12-week, 24-session training program. For primary outcomes, we evaluated balance recovery, pre- and post-intervention, by stepping thresholds, percentage of stepping responses, total probability of stepping, and kinematics of reactive stepping to lateral-surface perturbations in standing. Fall incidents were monitored prospectively 1 year after training for a secondary outcome.

Results: Both groups showed a significant decrease in the percentage of multiple-step responses (p = 0.013) and a shorter total recovery time to recover balance (p = 0.006). Compared with the TT, the SPTT led to a more significant reduction in single-step and multiple-step thresholds (p = 0.003 and p = 0.002, respectively), total probability of stepping (p = 0.008), shorter first-step length (p = 0.003), total steps path length (p = 0.007), and decreased total center-of-mass (CoM) displacement (p = 0.040) during recovery stepping. One-year prospective fall monitoring revealed nine fall events in the SPTT group compared to 17 in the TT group. Although these numbers are insignificant, they imply a potential generalization that SPTT can reduce annual falls.

Conclusion: A 12-week SPTT reduces the risk of falls by improving reactive balance responses in retirement-housing older adults. Findings suggest that the primary benefit of SPTT was better control in the CoM following perturbations. This study addressed the generalizability of PBT benefits from walking to standing and the personalization of perturbation training to enhance effectiveness and real-life applicability.

Introduction: In this qualitative study, care providers from long-term care homes were interviewed to explore how they experienced, coped with, and adapted to care shifts during the COVID-19 pandemic.

Methods: Thirteen multidisciplinary care providers and 24 supervisory and administrative staff participated in either a focus group or individual interview between July 2021 and February 2022. Participants were front-line care providers in 5 urban long-term care homes in western Canada.

Results: Care providers described negative impacts on residents and family members related to service delivery, restricted visiting, and quarantining protocols. They also identified negative impacts they experienced as care providers including fear and uncertainty, exhaustion, concerns about care provision, lower morale, and job self-efficacy. Buffers to stress comprised working as an integrated team and organizational support. Opportunities for growth and development and being adaptive were also described. Recommendations focused on organizational pandemic readiness and the importance of holistic care.

Conclusion: These findings highlight the need to proactively ensure a supportive infrastructure, wellness-promoting work culture, and a sustainable resource plan to help care providers pivot and adapt in a pandemic.

Introduction: There is limited information on elderly patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron variant infections. We aimed to describe the characteristics and outcomes of elderly patients with Omicron variant infections admitted to the intensive care unit (ICU) on the Chinese mainland and to evaluate the risk factors associated with mortality in these patients.

Methods: We conducted a multicenter retrospective study including elderly patients with SARS-CoV-2 infection who were admitted to the ICU from November 1, 2022, to February 11, 2023, on the Chinese mainland. The primary objective of the study was to describe the characteristics and outcomes of elderly ICU patients with Omicron variant infections. The secondary objective was to evaluate the risk factors for mortality of these patients.

Results: We included 1,605 patients aged 65 years or older diagnosed with severe or critical COVID-19 and admitted to ICUs in 59 hospitals across different areas of the Chinese mainland. The median age was 78 years (P25-P75, 72-84), with male patients accounting for 1,164/1,605 (72.5%) and 1,459/1,605 (90.9%) of patients having at least one comorbidity. The median APACHE II scores and SOFA scores were 16 (P25-P75, 11-23) and 5 (P25-P75, 3-8), respectively. Among these patients, 553 (34.5%) were recovery discharged, 557 (34.7%) died in the ICUs, and 495 (30.8%) discharged voluntarily during therapy and were later confirmed dead after discharge. Multivariable logistics analysis indicated that older age, coinfection, high levels of white blood cell count, blood urea nitrogen, D-dimer, and lactate at admission were against for recovery discharged.

Conclusions: Elderly patients infected with the Omicron variant of SARS-CoV-2 and admitted to the ICU had a considerable mortality rate. Better understanding of risk factors for mortality may improve clinical management and more rational allocation of limited medical resources during a COVID-19 surge.

Background: Reductions in oxygen availability at altitude reduce oxygen supply to the myocardium. This reduction in oxygen supply may be problematic for patients with cardiovascular disease and/or associated comorbidities such as hypertension, diabetes, or heart failure.

Summary: The risk of adverse cardiovascular events may be increased at altitude as a result of the interaction between hypoxia and exercise, which further increases myocardial demand for oxygen. When an acute coronary syndrome occurs, outcomes may be suboptimal given limited access to medical centers with cardiac catheterization laboratories and sudden cardiac death may occur. Pretravel planning should prioritize optimizing cardiovascular health and mitigating associated risk factors to reduce risk.

Key messages: Patients should have a realistic expectation of the types of activities that can be undertaken at altitude based on their underlying cardiovascular risk profile. Travel itineraries should include a period of acclimatization to hypoxia before initiating planned activities. In this review, we provide an overview of the relevant physiology related to hypoxia, its impact on cardiovascular function and clinical considerations and management strategies for patients and providers to reduce risk of adverse events from occurring in austere environments.

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 COVID-19 pandemic lockdowns have reduced physical activity (PA) among home-dwelling older adults. The main aim of this study was to investigate how real-life PA in home-dwelling older adults changed over a year with gradual eases in COVID-19 restrictions.

Methods: Community-dwelling older adults (≥65 years) were recruited from local exercise groups aimed at preventing functional decline and falls. All participants had been involved in the exercise groups before the pandemic but had been without the offer for 6 months prior to inclusion because of COVID-19 restrictions. Sensor-based PA was measured using Axivity accelerometers worn on the lower back and right thigh for seven consecutive days at baseline (autumn 2020), 6 (spring 2021) and 12 (autumn 2021) months. PA activities were classified using the HAR70+ machine learning model, validated on older adults.

Results: Ninety-one older adults (78 ± 6.4 years, 88% female) were included. At baseline, 9% used walking aids and 26.5% reported a fall in the previous year. Daily time spent upright did not change, while time spent walking decreased by 8.19 min from baseline to 12 months (p < 0.048). Walking bouts of >10 min decreased with 0.5 bouts per day (p < 0.001), and the longest walking bout showed a nonsignificant decrease of 17.7 min (p = 0.056). This shows a change toward a more sedentary activity pattern over the year despite a gradual ease of the restrictions.

Conclusion: In a relatively well functioning group of older adults, PA did not increase with gradual ease in COVID-19 restrictions.

Introduction: Falls among older adults are frequent and will remain a health concern. We describe fall characteristics among older adults living independently in the community based on location, severity, and sex.

Methods: As part of the SCOPE study, fall occurrence, location, causes, circumstances, and consequences were reported by 1,754 community-dwelling older adults across Europe at baseline (F0), 12-month follow-up (FU12), and 24-month follow-up (FU24). A geriatric assessment that included demographics, clinical and medication assessment, depression, Cumulative Illness Rating Scale, blood and urine examination, hand grip strength, and fear of falling was performed. Falls characteristics were described, and a multivariate logistic regression analysis was performed to examine the probability of being severely injured because of a fall, inside or outdoors.

Results: Data on falls revealed 938 falls at baseline, 773 falls at FU12, and 797 falls at FU24. Approximately 70% of these falls resulted in no injury or untreated injuries, while 8.5% led to bone fractures. Most falls (54.8%) occurred outdoors, primarily during ambulation (64.6%). About 50% of the falls were due to trips, slips, or bumping into objects, while 20.3% were due to balance and gait impairments. Women experienced falls about 30% more frequently than men.

Conclusions: Our findings offer new insights into the patterns of falls by location, sex, and injury type. This may help suggest ways of preventing falls. It is reasonable to recommend that older adults train their balance and specifically balance reactive responses to a situation whenever balance is lost accidently and unexpectedly.