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.
Introduction: Cognitive impairment and frailty are prevalent in older persons. Physical frailty is associated with cognitive decline; however, the role of effect modifiers such as age, sex, race/ethnicity, and cognitive reserve is not well understood.
Methods: Cross-sectional data from the National Health and Nutrition Examination Survey (2011-2014) were obtained for participants aged ≥60 years. Complete availability of cognitive scores was an inclusion criterion. Physical frailty was defined by the presence of exhaustion, weakness, low body mass, and/or low physical activity, and categorized into three groups: robust (0 present), pre-frail (1-2 present), or frail (3-4 present). Four cognitive test scores were converted to z-scores, and global cognition (composite z-score) was calculated by averaging the four-individual z-scores. Multivariable linear regression models were fit to estimate the associations between frailty and cognitive function. Frailty was also evaluated as a risk factor for self-reported subjective memory complaint (SMC) using logistic regression. All models were adjusted for age, sex, race/ethnicity, education, alcohol use, income, marital status, diabetes, hypertension, and history of stroke. Effect measure modification analyses were conducted by age, sex, race/ethnicity, education, and occupational cognitive demand.
Results: The study population comprised 2,863 participants aged ≥60 years. 50.6% of the participants were categorized into robust, 43.2% pre-frail, and 6.2% frail. After adjusting for covariates, compared to robust participants, frail and prefrail participants had lower adjusted mean global cognitive z-scores,
Discussion/conclusion: Both pre-frailty and frailty were associated with lower cognitive performance and were more likely to report subjective memory complaints relative to persons without frailty. These findings provide additional evidence that physical frailty may serve as a prognostic factor for cognitive deterioration or dementia, and prevention of frailty may be an important public health strategy.
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.
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.
Introduction: Globally, there are few studies but wide variation in the epidemiology of faecal incontinence (FI) for people living with dementia in the community. Our objectives are to identify 1-year period prevalence, 5-year incidence, and risks for FI for people living with dementia.
Methods: A retrospective cohort study comprising the International Residential Assessment Instrument Home Care version (interRAI-HC) assessments in a 5-year period in New Zealand (N = 109,964). For prevalence analysis, we selected a dementia cohort for a 1-year period from August 1, 2020, to July 31, 2021 (n = 7,775). For the incidence analysis, participants in the dementia cohort were followed up from the day of the first dementia diagnosis during the period August 1, 2016, and July 31, 2021. Dementia was identified by combining diagnosis of "Alzheimer's disease" and "Dementia other than Alzheimer's disease." Participants were coded with faecal incontinence if they were continent with a stoma, seldom incontinent, occasionally incontinent, often incontinent and incontinent.
Results: One year period (1 August 2020-31 July 2021) prevalence of FI was 26.7% (2,082/7,775) of people with dementia. 5-Year incident FI rate was 19.0 per 100 person-years for people with dementia and 12.3 per 100 person-years for people without dementia. Controlling for risk factors for FI in both groups the hazard ratio for FI was 1.7 for people with dementia.
Conclusion: FI affects a significant proportion of people with dementia in New Zealand. interRAI-HC data could facilitate global epidemiological studies to estimate service or intervention needs for people with dementia to redress or manage FI.
Introduction: Hospitalization and discharge in older patients are critical and clinical pharmacists have shown to ameliorate risks. Our objective was to assess their benefit as part of the geriatric team regarding rehospitalizations and related outcomes after discharge focusing on general practitioners' decision to continue or change discharge medication (GPD).
Methods: Prospective implementation study with 6-month follow-up in an acute geriatric clinic. Patients ≥70 years with comorbidities, impairments, and a current drug therapy were consecutively assigned to three groups: control group (CG), implementation group (IG), and wash-out group (WG). CG only received medication reconciliation (MR) at admission; IG and their hospital physicians received a pharmaceutical counseling and medication management; during WG, pharmaceutical counseling except for MR was discontinued. We used a negative-binomial model to calculate rehospitalizations and days spent at home as well as a recurrent events survival model to investigate recurrent rehospitalizations.
Results: One hundred thirty-two patients (mean age 82 years, 76 women [57.6%]) finished the project. In most of the models for rehospitalizations, a positive GPD led to fewer events. We also found an effect of pharmaceutical counseling on rehospitalizations and recurrent rehospitalizations in the CG versus WG but not in the CG versus IG models. 95.3% of medication recommendations by the pharmacist in the clinic setting were accepted. While the number of positive GPDs in CG was low (38%), pharmaceutical counseling directly to the GP in IG led to a higher number of positive GPDs (60%).
Discussion: Although rehospitalizations were not directly reduced by our intervention in the CG versus IG, the pharmacist's acceptance rate in the hospital was very high and a positive GPD led to fewer rehospitalization in most models.
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.
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.
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.
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