Gerontology最新文献

Introduction: Understanding risk factors associated with perceived and objective neighborhood environments is critical for community-level interventions to prevent falls. This is a cross-sectional design to explore how perceived and objective neighborhood environment are related to falls among community-dwelling older adults in densely populated urban areas. Building upon identified neighborhood environment risk factors, this study proposes preliminary community-level interventions tailored to each determinant.

Methods: This study analyzed data of 400 community-dwelling older adults (age = 70.9 ± 8.0 years; 49.8% female) in central urban areas of Guangzhou, China. Five categories of variable, perceived neighborhood environment, objective neighborhood environment, sociodemographics, health status, and physical activity, were incorporated. Objective neighborhood environment comprised accessibility to ten types of facilities within 500-meter residential buffers and 1 km2 grid-level population density, measured by ArcGIS using geospatial data. Univariate analyses were employed to select variables and multivariable binary logistic regression were used to establish the adjusted model.

Results: Older adults who perceived low accessibility to service facilities (OR = 2.502, 95% CI: 1.230-5.088), unsatisfying streetscapes (OR = 1.814, 95% CI: 1.001-3.286), and unsafety neighborhood (OR = 2.614, 95% CI: 1.103-6.192) had higher probabilities of reported falls. Surprisingly, having parks (OR = 0.524, 95% CI: 0.319-0.861) or subway stations (OR = 0.556, 95% CI: 0.326-0.951) within the 500-meter residential buffer, and living in neighborhoods with relatively low population density (OR = 0.842, 95% CI: 0.731-0.972) were associated with an increased risk of falls. Young age (OR = 0.927, 95% CI: 0.887-0.970), low income (OR = 2.449, 95% CI: 1.476-4.064), using walking aids (OR = 1.789, 95% CI: 0.960-3.337), and self-rated good health (OR = 0.392, 95% CI: 0.175-0.879) were risk factors of reported falls. Engaging in physical activity for over 30 min per day (OR = 2.148, 95% CI: 1.111-4.154) was identified as a protective factor.

Conclusion: Integrating multi-source perceived and objective environmental data, this study found out neighborhood environment risk factors for falls among older adults in high-density urban communities. Our findings contribute to community-level interventions regarding neighborhood environment to reduce falls in older adults in urban areas of developing countries.

Introduction: Vitamin D deficiency has previously been shown to be associated with cancer-related fatigue. If vitamin D deficiency affects fatigue in frail elderly has not been studied before. The aim of this study was to investigate associations between vitamin D, fatigue, frailty, and sarcopenia in frail elderly with cancer (FEC) and without cancer (FE) in comparison with healthy controls.

Methods: Baseline data from the "IMmunity and AGE" (IMAGE) study were used. IMAGE is an observational, prospective study originally designed to study immunity in frail elderly. In this study, data on self-assessed fatigue (0-10), vitamin D, and muscle strength at baseline were used. Four groups were included: (1) healthy elderly (HE) ≥65 years old with a score of 1-3 on Clinical Frailty Scale (CFS); (2) FE ≥65 years old (CFS 4-9); (3) with advanced cancer (FEC); and (4) healthy controls 18-64 years old (HY).

Results: A total of 273 participants were included. HE had significantly higher vitamin D levels compared to FE and FEC, median 82 nmol/L compared to 54 and 47 nmol/L (p < 0.001 for both). FE and FEC were more fatigued, median 5 (IQR 4-8) and 7 (IQR 5-8), compared to HE, median 2 (IQR 0-4) (p < 0.001 for both). Regression models showed that low vitamin D was associated with increased fatigue (p < 0.001), frailty (p < 0.001), and reduced muscle strength (p < 0.05).

Conclusion: Fatigue was common in frail elderly, with or without cancer, and was associated with low vitamin D. Vitamin D deficiency was associated with increasing frailty and reduced muscle strength.

Introduction: In ageing societies, older adults may increasingly take on informal caregiving responsibilities for others. Although some previous studies indicate that informal caregiving among adults is associated with an increased risk of loneliness and social isolation, studies have not focused specifically on informal caregivers who are older adults themselves and therefore may be at increased risk of adverse psychosocial outcomes. In this study, we aimed to assess if informal caregiving at older ages adversely impacts loneliness and social networks.

Methods: We used data pertaining to 2,577 participants in a nationally representative longitudinal study of community-dwelling older adults in Singapore, a rapidly ageing Asian country. To address selection bias into caregiving, we estimated the relationship between caregiving status with loneliness and social networks using inverse probability-weighted regression adjustment, controlling for multiple demographic and health characteristics.

Results: Informal caregiving among older adults impacted loneliness and was related to a 28.9% higher loneliness score. However, informal caregiving at older ages was not related to either social networks overall or family- and friends-focused social networks.

Conclusion: Older adult informal caregivers are a vulnerable subgroup at a higher risk of loneliness. Although informal caregiving does not impact social networks, older adult informal caregivers experience higher loneliness, i.e., a perceived discrepancy between their actual and desired social relationships compared to non-caregivers. Our study suggests the need for further examination of the underlying mechanisms between informal caregiving at older ages and loneliness, as well as a special focus on older adult caregivers in efforts and interventions to address loneliness at older ages.

Introduction: Loneliness among the elderly population has been well established as a risk factor for poor health outcomes, including increased morbidity and mortality. The study objective was to evaluate the feasibility of assessing and implementing patient-tailored interventions to reduce loneliness among elderly patients in the cardiac intensive care unit (CICU).

Methods: This randomized control trial conducted at the CICU included 58 patients; 28 patients were in control and 30 in the intervention groups. The University of California Los Angeles Loneliness Scale and the De Jong Gierveld Loneliness Scale were administered at the time of admission to the CICU and immediately before discharge. The intervention group was given an individualized questionnaire to determine their needs and preferences, which were used to create patient-tailored interventions provided by CICU staff. The control group received standard care.

Results: The results of the study revealed that while there was no significant reduction in overall loneliness scores between the intervention and control groups, there was a significant difference in the reduction of loneliness scores for the item "I miss having people around me" (p = 0.02) in the intervention group compared to the control group. Additionally, a near significant difference in loneliness score reductions was observed for the item "I feel left out" (p = 0.05) in the intervention group. These results suggest that patient-tailored interventions focused on addressing patient-specific needs may lead to a reduction in certain aspects of loneliness.

Conclusion: This study demonstrates the feasibility of identifying loneliness in a critical care setting, as well as developing an intervention strategy tailored to the individual patient's needs. These findings highlight the importance of addressing loneliness in the setting of an intensive care unit and provide support for the need to further explore and implement strategies to reduce loneliness in this population.

Introduction: Healthy Longevity Medicine (HLM) offers a strategy to reduce the healthspan-lifespan gap, yet public perspectives remain unclear. This study refines the Healthy Longevity (HELO) framework through a qualitative exploration of public views towards lifespan, healthspan, and HLM.

Methods: Individuals living in Singapore participated in semi-structured group or individual discussions to explore (a) their understanding of lifespan and healthspan, (b) motivational factors for health behaviours, and (c) their awareness of HLM. Sampling maximised variation across age, sex, and ethnicity. Data obtained through 13 discussions were analysed with a mixed, inductive-deductive approach employing the HELO framework.

Results: Thirty-six participants (mean age = 49.4 years, SD = 15.9, 19 males, 15 ethnic Chinese) were generally familiar with the definitions of lifespan and healthspan, emphasising the importance of quality of life. Health was defined comprehensively, and autonomy over behaviours was highly valued during ageing and in adopting health behaviours. Community resources and government health initiatives were deemed useful, recognising the potential to enhance social, mental, and physical health. Singapore's busy, achievement-oriented culture was identified as a barrier to healthy behaviours. Participants expressed enthusiasm for HLM's potential to extend the healthspan yet voiced concerns about lifestyle changes and potentially losing autonomy.

Conclusion: Personal values and priorities were central to motivations towards healthy longevity. HLM should assess and align diagnostic and treatment plans with individual preferences to support sustainable health behaviours. The Singapore public's alignment with government policies presents an opportunity to promote HLM adoption.

Introduction: Cognitive frailty, the concurrent presence of mild cognitive impairment and physical frailty, poses a significant risk for adverse outcomes in older adults. Traditional assessments that rely on extensive walking tests or specialized equipment are impractical for routine or remote evaluations. This study evaluated a 20-s video-based Upper Frailty Meter (vFM) test, incorporating dual-task conditions, as a feasible tool for identifying cognitive frailty.

Methods: Data from 413 participants aged 50-79 years in the Healthy Minds for Life cohort were analyzed across four sites: the University of Arizona, Johns Hopkins University, Emory University, and the University of Miami. Cognitive function was measured using the Montreal Cognitive Assessment (MoCA), whereas frailty indices were derived from the vFM test. Participants performed repetitive elbow flexion extension under single-task (physical task only) and dual-task (physical task with concurrent cognitive exercise) conditions. Frailty phenotypes, including slowness, weakness, and exhaustion, were quantified using AI-based video kinematic analysis. Logistic regression and receiver operating characteristic (ROC) analyses evaluated the model's predictive accuracy for cognitive frailty.

Results: Participants classified as cognitive frailty group (n = 53, 12.8%) demonstrated significantly higher frailty index scores compared to robust individuals (p < 0.001). Among all vFM-derived parameters, the dual-task slowness phenotype demonstrated the strongest correlation with MoCA scores (r = -0.282, p < 0.001) and emerged as the most predictive single marker for distinguishing the cognitive frailty group, demonstrating high clinical applicability (area under the curve [AUC] = 0.87). Combining single-task and dual-task metrics further enhanced predictive accuracy (AUC = 0.91), achieving sensitivity and specificity rates exceeding 85%. This combined approach significantly differentiated cognitive frailty from robust status, outperforming models based on age alone or single-task metrics.

Conclusion: The 20-s vFM test offers a practical, noninvasive, easy-to-implement, and accessible solution for objectively evaluating cognitive frailty, demonstrating high predictive accuracy in distinguishing at-risk individuals. Its integration into telehealth platforms could enhance early detection and enable timely interventions, promoting healthier aging trajectories. Further longitudinal studies are recommended to validate its utility in tracking cognitive and physical decline over time.

Background: Osteoporosis increases the risk of fractures and mortality, particularly in the elderly population. However, prescribing antiresorptive medication to elderly patients with osteoporosis is complex. The benefit-risk ratio should be considered for all patients but can be particularly challenging in older individuals due to factors like comorbidities, polypharmacy, fall risk, and potential rare side effects of long-term treatment.

Summary: We reviewed the efficacy and safety of antiresorptive treatments, including calcium and vitamin D supplementation, in elderly patients by evaluating published trials, reviews, and meta-analyses. Our findings confirm that antiresorptive treatment for osteoporosis is both effective and safe in the elderly population.

Key messages: One key challenge is ensuring compliance, which can be difficult for some elderly patients. In such cases, intravenously or subcutaneously administered antiresorptive treatment should be considered to improve adherence and overall treatment compliance.

Introduction: Tumor necrosis factor-alpha inhibitors (TNFi), commonly prescribed for rheumatoid arthritis (RA), have been studied for their potential association with dementia risk. However, previous findings are inconclusive. This study aimed to evaluate the impact of TNFi use on dementia in patients with RA.

Methods: A systematical search of MEDLINE, Embase, and CENTRAL databases from inception to October 1, 2023, was conducted. Longitudinal comparative studies investigating the association between TNFi use and risk of dementia in patients with RA were included. Pooled adjusted risks of dementia and meta-analysis were conducted to synthesize relative estimates with 95% confidence intervals (CIs).

Results: Seven observational studies involving 633,089 patients with RA were included, of which 6 were included in the meta-analysis. The pooled meta-analysis comparing the risk of dementia (hazard ratio [HR] = 0.77, 95% CI: 0.64-0.93) and Alzheimer's disease (AD) (odds ratio = 0.31, 95% CI: 0.23-0.43) between TNFi users and non-users showed a significant association. However, the pooled HR for AD risk was inconsistent. Also, the subgroup analyses indicated that TNFi use was associated with a decreased dementia risk in older adult patients with a mean age of ≥65 years at enrollment (HR = 0.86, 95% CI: 0.80-0.92) and TNFi new users (HR = 0.86, 95% CI: 0.80-0.92).

Conclusions: Systematic review and meta-analysis suggest that lowering the level of systemic TNF-alpha by using TNFi could lower the risk of dementia. However, given the retrospective nature of the included studies, further prospective studies are needed to evaluate the role of TNFi in dementia onset.

Background: Presently, diagnosing delirium in older people is a challenge. Diagnostic support tools such as the Confusion Assessment Method and 4AT provide structure but require specialist training, resources, and implementation support, while some subjectivity persists in diagnosis. This is particularly the case in people who live with dementia who often experience rapid fluctuation in cognitive abilities and behaviours. This leads to variation in diagnosis between settings and care providers, with consequent harmful impact on those experiencing delirium. These challenges become greater in care homes where dementia is prevalent, daily fluctuation is the norm, and the majority of staff are not trained healthcare professionals.

Summary: Here, we outline the potential for AI-based human activity recognition (HAR) approaches to identify and flag deviations from normal behaviour that may be precursors of a delirium state, enabling earlier detection and management, and better outcomes. We outline how statistical process control approaches could form the basis of diagnostic algorithms and the steps required to test the feasibility of this approach in the care home setting.

Key messages: Delirium detection and diagnosis, difficult in any setting, are more difficult in care homes because of resident, staff, and organisational factors. Artificial intelligence, machine learning, and HAR have potential to make diagnosis more reliable because of their ability to recognise changes from normal patterns of behaviour at an individual level.

Introduction: Falls can have serious health consequences, especially in the oldest old (individuals 90+ years), for whom falls often result in injury or even death. Few studies have examined falls in the oldest old. We aim to assess fall prevalence, fall rate, and rate change over time according to gender, living situation, and assistive device use.

Methods: Participants are from the 90+ Study, a longitudinal study of individuals 90 years and older with evaluations every 6 months. Participants, or their informants, were asked how many times they have fallen in the past year (first visit) or since their last visit (follow-up visits). We calculated unadjusted baseline fall prevalence. Using generalized linear mixed regression models, we estimated adjusted baseline fall rate and adjusted change in rate over time by gender, living situation, and assistive device.

Results: In 1,672 participants (mean age 93 years, range 90-110 years), unadjusted baseline prevalence of 1+ falls was 47.8% in women and 47.9% in men. Estimated adjusted baseline fall rate was 0.66 falls per person-year in women and 0.71 falls per person-year in men. In women, fall rate did not change significantly over time, whereas in men, fall rate increased by an average of 6% per year. Both men and women in nursing homes had a higher fall rate compared with those in the community. In nursing homes, fall rate remained stable over time in men and decreased over time in women. Fall rate was higher in both men and women using assistive devices. However, walkers were associated with a decrease in fall rate over time in women and in participants in nursing homes. Canes were unexpectedly associated with an increase in fall rate over time.

Conclusion: Individuals 90 years and older had a high prevalence of falls overall. The higher and increasing rate of falls over time in men compared to women suggests that efforts should be made to increase the uptake of fall prevention strategies specifically in men in the oldest age categories. The increasing fall rate in participants using canes suggests that referral to a health care provider trained in gait analysis prior to assistive device prescription could assist with fall prevention efforts in the oldest old.