Gerontology最新文献

Introduction: Comprehensive geriatric assessment (CGA) is used to thoroughly assess and identify complex healthcare problems among older adults. However, administration of CGA is time-consuming and labor intensive. A simple screening tool with the mnemonic "FIND-NEEDS" was developed to quickly identify common geriatric conditions. The present study was to evaluate the clinimetric properties of the FIND-NEEDS.

Methods: The participants comprised first-visiting older adults aged 65 years and above (and who were able to communicate by themselves or with the help of a caregiver) who were assessed (October to December, 2021) using the FIND-NEEDS and CGA at geriatric outpatient clinics of a tertiary, referred medical center. The FIND-NEEDS was examined for its criterion-related validity and compared with the CGA results. Two types of scoring (summed score and binary score) of FIND-NEEDS and CGA were analyzed using Spearman correlation, sensitivity and specificity, and area under receiver operating characteristic curve (AUC).

Results: The mean age of the 114 outpatients was 78.3 ± 7.6 years, and 79 (69.3%) were female. The internal consistency was excellent when using all FIND-NEEDS items, and was acceptable when using domain scores. Exploratory factor analysis showed that most of the FIND-NEEDS domain scores had factor loadings higher than 0.3. Intercorrelations of binary scores between domains of FIND-NEEDS and CGA showed most domains were moderately correlated. The overall correlation of summed scores between FIND-NEEDS and CGA was high. The FIND-NEEDS summed score was moderately correlated with CGA score (r = 0.494; p < 0.001), and the binary score showed excellent correlation (r = 0.944; p < 0.001). When using the CGA score as the gold standard, the FIND-NEEDS showed excellent AUC (0.950), sensitivity (1.00), and specificity (0.90).

Discussion/conclusion: The present study demonstrated that the FIND-NEEDS had acceptable clinimetric properties to screen for geriatric problems among older adults. Further in-depth assessment and care plan can then be conducted afterwards.

Introduction: Our recent reports have shown that movement pattern and displacement assessed with an infrared depth sensor during a 20-s stepping-in-place test (ST) correlates with measures of balance and need for assistance in older individuals. This study investigated ST test-retest reliability in community-dwelling older adults with and without supportive care.

Methods: Two groups were included: those not participating (HO: n = 25, 74.7 ± 5.2 years) and those participating (DSU: n = 41, 78.8 ± 5.8 years) in regular senior day services (supportive care). HO completed three ST trials, separated by 1 week, while DSU completed two ST trials during the same half-day supportive care visit. Testing was conducted with eyes open. ST measures included head movement path distance (TMD), maximum movement displacement (MMD), knee movement path length (KMD), and stepping rate (STEP). TMD×KMD-1 ratio indicated upper-body sway relative to lower-body. Test-retest reliability (intra-class correlation coefficients, ICCs) and between-trial and between group differences (ANCOVA, adjusting for age) were assessed.

Results: After adjusting for age, TMD, KMD, TMD×KMD-1 were lesser and STEP was greater in HO than DUS. HO ST variables did not differ across testing days. HO ICC (1, 3) for TMD (0.911 [95% confidence interval: 0.827-0.958]), MMD (0.918 [0.814-0.961]), KMD (0.838 [0.685-0.923]), and TMD×KMD-1 (0.940 [0.884-0.872]) showed strong to very strong reliability. Similarly, DSU ST variables did not differ across same day trials and ICC (1, 2) for TMD, KMD, and TMD×KMD-1 displayed very strong reliability.

Conclusion: These ST variables exhibited excellent test-retest reliability of discriminating between community-dwelling older adults with and without supportive care.

Introduction: Research on athletic footwear familiarisation within an older population is sparse. This is problematic because unfamiliar footwear may act as a new perturbation and modify older adults' walking gait and stability. In addition, while athletic footwear has been suggested to enhance older adults' comfort and support during activities of daily living, the necessary period for familiarisation with athletic footwear is unknown. Therefore, this study aimed to identify the number of steps required for older adults to be familiarised with athletic footwear of different midsole thicknesses.

Methods: Twenty-six healthy and physically active community-dwelling older adults, 21 females (71.1 ± 4.5 years; 164.5 ± 5.3 cm; 68.4 ± 11.4 kg) and five males (70.6 ± 2.3 years; 175.2 ± 7.8 cm; 72.8 ± 9.7 kg), completed a walking-based protocol. Participants walked two trials of 200 steps at their habitual speed on a 10-m track of an optical measurement system in three footwear conditions: (1) New Balance® REVlite 890v6 (thick midsole); (2) New Balance® REVlite 1400v5 (moderate midsole); and (3) New Balance® Minimus 20v7 (thin midsole). Gait speed (m.s-1) and walking time (min) were analysed for each participant over the 400 steps. Number of required familiarisation steps were established over three analysis phases, consisting of steady-state gait assessment, averaging and analysis of blocks of 40 steps, and sequentially comparing these steps with a predetermined threshold. Footwear familiarisation was assumed when the mean gait speed fell within an acceptable level (±2 SD from 320 to 360 step values) and subsequently maintained.

Results: Most participants were familiarised with all three footwear conditions (thick n = 18; moderate and thin n = 20) after walking 80 steps. For all participants, the moderate midsole had the shortest familiarisation period (160 steps). The highest number of familiarisation steps was found in the thick (320 steps) and thin midsoles (240 steps) for some participants.

Conclusion: A minimum of 320 familiarisation steps is recommended to account for both individual differences and midsole thicknesses. Implementing this walking-based footwear familiarisation protocol would improve validity of future studies, ensuring they analyse footwear effects rather than familiarisation with the footwear.

Background: LncRNAs perform a crucial impact on microglia's activation in Parkinson's disease (PD). Here, our purpose was to probe the function and involved mechanism of lncRNA SOX21-AS1 on microglial activation in PD.

Methods: Mice were treated with MPTP, and BV2 cells were treated with LPS/ATP to build PD animal and cell models. Genes' expression was measured using RT-qPCR, immunoblotting, and IHC stain. ELISA was applied for testing inflammatory factors' levels. Cell viability and apoptosis were tested using kits. RIP and RNA pull-down assay were utilized for monitoring the bond of SOX21-AS1 to EZH2, and ChIP was applied for affirming the bond between EZH2 and SOCS3's promoter.

Results: The expression of SOX21-AS1 and SOCS3 was abnormal in PD cell and animal models. Inhibition of SOX21-AS1 repressed LPS/ATP-induced activation in BV2 cells and nerve damage caused by activated BV2 cells, alleviating the pathological features of PD mice. Further studies found that SOX21-AS1 epigenetically inhibited SOCS3 by recruiting EZH2 to SOCS3 promoter. SOX21-AS1 overexpression partially offset the repressive impact of SOCS3 enhancement on BV2 cell activation and the protective effect on nerve cells.

Conclusion: SOX21-AS1 enhances LPS/ATP-induced activation of BV2 cells and nerve damage caused by activated BV2 cells though recruiting EZH2 to SOCS3's promoter, thereby alleviating PD progression. Our research supplies new potential target for curing PD.

Background: Recently, the incidence of acute obstructive cholangitis caused by bile duct stones in patients aged 90 years and older (super-old) has been increasing, for which urgent endoscopic retrograde cholangiopancreatography (ERCP) treatment may be required. The aim of this study was to evaluate the efficacy and safety of urgent ERCP in super-old patients with acute cholangitis caused by bile duct stones.

Methods: A total 147 consecutive patients aged between 75 and 99 years who underwent urgent ERCP for acute cholangitis caused by bile duct stones were analyzed in a retrospective manner. They were divided into the old (age 75-89 years, control) and super-old (age 90-99 years) groups. Urgent ERCP efficacy and safety, including general status, ERCP-related findings and outcomes, cardiopulmonary monitoring during ERCP, and mortality, were compared between the groups.

Results: The physical status of the super-old group was worse than that of the old group. The success rates for biliary drainage and complete clearance of bile duct stones at the first attempt in the super-old group were lower as compared to the old group, while those after two attempts increased in the super-old group and were nearly the same as in the old group. No fatal cardiopulmonary complications during ERCP were observed in either group. Mortality rate within 2 months was higher in the super-old group, though recovered to the same level as in the old group after 2 months.

Conclusions: Efficacy and safety of urgent ERCP treatment in super-old patients were comparable to those seen in old patients, though the overall trend indicated greater difficulty. Urgent ERCP treatment can be useful for acute cholangitis caused by bile duct stones in super-old patients.

Background: Approximately one-third of adults over the age of 65 experience falls annually, with half resulting in injury. Peak bodies have recommended the use of fall-risk screening tools in the emergency department (ED) to identify patients requiring in-depth assessment and potential fall-prevention intervention. This study aimed to examine the scope of published studies on fall-risk screening tools used in the ED and evidence of associations between screening and future falls.

Summary: PubMed, Embase and CINAHL were searched for peer-reviewed journal articles published since 2012 that examined one or more screening tools to identify patient-level fall risk. Eligible studies described fall-risk tools applied in the ED. Data extracted included sample information, variables measured, and statistical analysis. Sixteen studies published since 2012 were included after full-text review. Fourteen unique screening tools were found. Eight tools were fall-risk screening tools, one tool was a functional screening tool, one tool was a frailty-screening tool, two tools were rapid physical tests, one tool was a trauma triage tool, and one tool was a component of a health-related quality-of-life measure. Studies that evaluated prognostic performance (n = 11) generally reported sensitivity higher than specificity. Previous falls (n = 10) and high-risk medications (n = 6) were consistently associated with future falls. Augmentation with additional variables from the electronic medical record (EMR) improved screening tool prognostic performance in one study.

Key messages: Current evidence on the association between the use of fall-risk screening tools in the ED for future falls consistently identifies previous falls and high-risk medications as associated with future falls. Comparison between tools is difficult due to different evaluation methods and different covariates measured. Augmentation of fall-risk screening using the EMR in the ED requires further investigation.

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.

Introduction: Aging is often seen as a challenging process, prompting individuals to form emotional reactions in response to the perceived challenges associated with growing older, manifested as aging-related fears. The present study focuses on the fear of loneliness in old age, a significant concern considering the socioemotional importance of close relationships in later life. Drawing from proactive coping theory, the study explores the association between fear of loneliness and aging preparation. This research aimed to investigate whether the fear of loneliness motivates individuals to engage in activities aimed at preventing loneliness in old age. For exploratory purposes, we consider both linear and nonlinear effects at the interindividual level, as well as the intraindividual-level differences between fear levels and behavioral outcomes. In addition, we also investigate the moderating role of trait neuroticism in these associations.

Methods: Data from the "Ageing as Future (AAF)" project in Germany (N = 1,183) spanning from 2012 to 2023 were utilized. A multilevel model considered both intra- and interindividual variations, incorporating time-varying variables and covariates.

Results: Linear mixed model analysis revealed that increased fear of loneliness corresponded to heightened engagement in preventive activities linearly, while a quadratic term indicated an inverted U-shaped relationship. The inclusion of occasion-specific deviation scores showed that individuals were more inclined to engage in preventive activities when experiencing heightened fear of loneliness than usual. This impact of deviation in fear perception was particularly evident among those with high levels of trait neuroticism.

Conclusion: The study reveals that fear of loneliness in old age is associated with proactive engagement in preventive activities, with those prone to higher levels of fear or worry being particularly affected. These results emphasize the importance of a moderate level of fear in driving action without succumbing to excessive pessimism or unrealistic optimism. The findings contribute to understanding the motivational role of aging-related fears and hold implications for gerontological practices, emphasizing the need for a balanced fear perception in addressing potential negative impacts of aging. Future research could explore moderators and long-term consequences of motivational aging-related fears.

Introduction: Anxiety and depression are prevalent among older adults, and digital interactive interventions have shown promise in promoting their mental well-being. However, limited research has explored the effects of different types of digital interactive interventions across various devices on anxiety and depression in older adults with different health conditions.

Methods: A systematic literature review and meta-analysis were conducted using seven selected databases to identify relevant studies up to July 19, 2023. Two reviewers independently conducted study selection, data extraction, and quality appraisals. The risk of bias in the included studies was assessed using the Cochrane risk-of-bias tool. For the meta-analysis, the effect size was calculated as the standardized mean difference (SMD) using a random-effects model.

Results: A total of 20 randomized control trails involving 1,309 older adults fulfilled inclusion criteria. The meta-analysis results demonstrates that the digital interactive intervention technologies had a significance on depression (SMD = -0.656 s, 95% confidence interval [CI] = -0.992 to -0.380, p < 0.001) and anxiety (SMD = -0.381 s, 95% CI = -0.517 to -0.245, p < 0.001). Physical interactive interventions demonstrated a significant effect on depression and anxiety (SMD = -0.711 s, 95% CI = -1.102 to -0.319, p < 0.001) and (SMD = -0.573 s, 95% CI = -0.910 to -0.236, p = 0.001). Similarly, immersive interactive interventions also showed a significant effect on depression and anxiety (SMD = -0.699 s, 95% CI = -1.026 to -0.373, p < 0.001) and (SMD = -0.343 s, 95% CI = -0.493 to -0.194, p < 0.001). Additionally, in the internal medicine group, significant intervention effects were observed for depression (SMD = -0.388, 95% CI = -0.630 to -0.145, p = 0.002) and anxiety (SMD = -0.325, 95% CI = -0.481 to -0.169, p < 0.001). Similarly, in the neurocognitive disorders group, significant intervention effects were found for depression (SMD = -0.702, 95% CI = -0.991 to -0.413, p < 0.001) and anxiety (SMD = -0.790, 95% CI = -1.237 to -0.342, p = 0.001).

Conclusion: The results indicated that various digital interactive devices, including physical and immersive interactive devices, have a positive impact on depression and anxiety among older adults. However, mobile games were not effective in addressing depression. Digital interactive technologies did not significantly influence anxiety intervention, except for elderly individuals undergoing surgical procedures. Nevertheless, these interventions effectively addressed depression and anxiety in older individuals with neurocognitive disorders, internal medical issues, and those without health issues.

Introduction: We analyzed the effect of dexmedetomidine (DEX) as a local anesthetic adjuvant on postoperative delirium (POD) in elderly patients undergoing elective hip surgery.

Methods: In this study, 120 patients undergoing hip surgery were enrolled and randomly assigned to two groups: fascia iliaca compartment block with DEX + ropivacaine (the Y group, n = 60) and fascia iliaca compartment block with ropivacaine (the R group, n = 60). The primary outcomes: presence of delirium during the postanesthesia care unit (PACU) period and on the first day (D1), the second day (D2), and the third day (D3) after surgery. The secondary outcomes: preoperative and postoperative C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), occurrence of insomnia on the preoperative day, day of operation, D1 and D2; HR values of patients in both groups before iliac fascia block (T1), 30 min after iliac fascia block (T2), at surgical incision (T3), 20 min after incision (T4), when they were transferred out of the operating room (T5) and after leaving the recovery room (T6) at each time point; VAS for T1, PACU, D1, D2; the number of patients requiring remedial analgesics within 24 h after blockade and related complications between the two groups.

Results: A total of 97 patients were included in the final analysis, with 11 and 12 patients withdrawing from the R and Y groups, respectively. The overall incidence of POD and its incidence in the PACU and ward were all lesser in the Y group than in the R group (p < 0.05). Additionally, fewer cases required remedial analgesia during the PACU period, and more vasoactive drugs were used for maintaining circulatory system stability in the Y group as compared to the R group (p < 0.05). At the same time, the incidence of intraoperative and postoperative bradycardia in the Y group was higher than that in the R group, accompanied by lower postoperative CRP and ESR (all p < 0.05).

Conclusion: Ultrasound-guided high fascia iliaca compartment block with a combination of ropivacaine and DEX can reduce the incidence of POD, the use of intraoperative opioids and postoperative remedial analgesics, and postoperative inflammation in elderly patients who have undergone hip surgery, indicating that this method could be beneficial in the prevention and treatment of POD.