International Journal of Geriatric Psychiatry最新文献_第9页

Changes in the Emergency Department Visits Among the Older Adults With Dementia Before, and After the Nationwide Social Distancing Measures: An Interrupted Time Series Analysis 在全国社会距离措施之前和之后，老年痴呆症患者急诊室就诊的变化：中断时间序列分析

IF 3.6 3区医学 Q2 GERIATRICS & GERONTOLOGY

International Journal of Geriatric Psychiatry

Pub Date : 2025-05-21 DOI: 10.1002/gps.70100

Jeongmin Moon, Kyung-Shin Lee, Ho Kyung Sung, Seonji Kim

Objectives

Social isolation is a well-known risk factor for dementia, particularly among the older adults. The recent global health crisis, coupled with prolonged social distancing, leading to unprecedented disruptions in social interactions and raising concerns about unforeseen impacts on vulnerable populations, particularly older individuals with dementia. This study examines the impact of extended social isolation on dementia patients receiving emergency care.

Methods

We conducted a nationwide study of emergency department (ED) visits among dementia patients aged 65+ during various phases of pandemic-related social distancing. Segmented quasi-Poisson regression models were used to determine changes in ED visits during and after social distancing compared to pre-social distancing.

Results

From 2017 to 2022, there were 203,772 ED visits by patients with dementia among older patients. The proportion of ED visits by patients with dementia decreased from 17% pre-pandemic to 15% during social isolation. Interrupted time series analysis revealed a decline in ED visits during social distancing (step change: 0.849, 95% confidence interval [CI] 0.804–0.897; slope change: 1.000, 95% CI 0.996–1.003) followed by a rebound after restrictions were lifted (step change: 1.076, 95% CI 1.024–1.131; slope change: 1.009, 95% CI 0.994–1.025). However, monthly admission and mortality rates increased during social distancing.

Conclusion

This study observed a decline in ED visits by patients with dementia among older patients during social distancing, followed by a rebound after restrictions were lifted. However, the social distancing period was associated with increased hospitalization and mortality. These findings underscore the importance of maintaining healthcare accessibility for vulnerable older adults.

众所周知，社会孤立是痴呆症的一个危险因素，尤其是在老年人中。最近的全球卫生危机，加上社交距离延长，导致社会交往前所未有的中断，并引发了对弱势群体，特别是老年痴呆症患者的不可预见影响的担忧。本研究探讨延长社会隔离对接受紧急护理的痴呆症患者的影响。方法我们在全国范围内对65岁以上痴呆症患者在大流行相关社交距离的各个阶段的急诊就诊情况进行了研究。使用分段准泊松回归模型来确定在社交距离期间和之后与社交距离前相比，急诊科就诊的变化。结果2017 - 2022年，老年痴呆患者ED就诊203772人次。痴呆症患者的急诊科就诊比例从大流行前的17%下降到社会隔离期间的15%。中断时间序列分析显示，社交距离期间急诊科就诊人数下降(阶跃变化：0.849,95%可信区间[CI] 0.804-0.897；斜率变化：1.000,95% CI 0.996-1.003)，限制解除后出现反弹(阶跃变化：1.076,95% CI 1.024-1.131；斜率变化：1.009,95% CI 0.994-1.025)。然而，在保持社交距离期间，月入院率和死亡率有所上升。本研究发现，在保持社交距离期间，老年痴呆症患者的急诊科就诊人数有所下降，而在限制解除后，就诊人数又出现反弹。然而，社交距离期与住院率和死亡率增加有关。这些发现强调了为脆弱的老年人保持医疗可及性的重要性。

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引用次数: 0

Conceptualising the Role of Dementia Champions Across Health and Social Care: A Qualitative Study Informed by Theory of Change (The DemChamp Study) 概念化痴呆症捍卫者在健康和社会护理中的作用：一项由变化理论提供信息的定性研究（DemChamp研究）

IF 3.6 3区医学 Q2 GERIATRICS & GERONTOLOGY

International Journal of Geriatric Psychiatry

Pub Date : 2025-05-21 DOI: 10.1002/gps.70101

Tiffeny James, Monica Leverton, Kritika Samsi, Christina Newton

Objectives

People who work in health and social care frequently come into contact with people living with dementia, highlighting the need for a dementia aware and competent workforce. Some health and care services have implemented ‘Dementia Champions’ (DCs) to address this, but the role is rarely seen in domiciliary homecare services. We aim to conceptualise the DC role across health and social care to learn how it is implemented in practice and consider how it can be applied to homecare.

Methods

We conducted 30 semi-structured interviews with health and social care workers who either work as DCs or have experience/knowledge of working with them. We used framework analysis to analyse the data, informed by a Theory of Change (ToC) approach which involved identifying the ‘inputs’ involved in the role (tasks and responsibilities); and the short, medium, and long-term mechanisms required to implement, embed, and maintain the role.

Results

We identified key tasks and responsibilities of a DC which varied between and within sectors and services. The was a lack of role clarity and rarely a role description, which was considered a barrier to the role's success. The DC role is typically voluntary with no remuneration and performed on top of existing roles with no protected time for specific DC tasks. DCs typically take on the role due to a passion for good dementia care and a desire to make a difference, meaning feedback and feeling valued were important. The DC role provides an opportunity for career development, which was considered essential to retaining DCs, and health and social care workers generally. We present these findings as five themes which map onto our ToC framework to explore how the DC role is implemented, embedded, and maintained in practice.

Conclusions

Across all services, there is need for role clarity, with a DC role description at the outset to set out the tasks, responsibilities, and boundaries of the role. The DC role needs protected time for workers to implement it and undertake training. We will use these findings to develop and refine our ToC framework to reflect its applicability for the homecare sector.

从事卫生和社会护理工作的人员经常与痴呆症患者接触，这突出表明需要一支认识到痴呆症的称职工作队伍。为了解决这一问题，一些保健和护理服务机构实施了“痴呆症捍卫者”（DCs），但在居家护理服务中很少看到这一角色。我们的目标是概念化DC在健康和社会护理中的作用，了解它在实践中是如何实施的，并考虑如何将其应用于家庭护理。方法：我们对30名卫生和社会护理工作者进行了半结构化访谈，这些工作者要么是dc工作，要么是有与dc一起工作的经验/知识。我们使用框架分析来分析数据，通过变革理论（ToC）方法进行分析，该方法涉及识别角色（任务和责任）中涉及的“输入”；以及实现、嵌入和维护角色所需的短期、中期和长期机制。结果：我们确定了DC的关键任务和责任，这些任务和责任在部门和服务之间和内部有所不同。问题是角色不清晰，很少有角色描述，这被认为是角色成功的障碍。DC角色通常是自愿的，没有报酬，并且在现有角色之上执行，没有特定DC任务的保护时间。dc通常承担这一角色，是因为他们对良好的痴呆症护理充满热情，并希望有所作为，这意味着反馈和被重视的感觉很重要。DC角色提供了职业发展的机会，这被认为是留住DC以及一般保健和社会护理工作者的关键。我们将这些发现分为五个主题，并将其映射到我们的ToC框架中，以探索如何在实践中实现、嵌入和维护DC角色。在所有服务中，都需要明确角色，在开始时使用DC角色描述来设置角色的任务、职责和边界。DC角色需要保护员工的时间来实施它并进行培训。我们将利用这些发现来发展和完善我们的ToC框架，以反映其对家庭护理部门的适用性。

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引用次数: 0

Validity and Sensitivity to Change of a Self-Report Quality of Life Measure in Patients With Korsakoff's Syndrome 科萨科夫综合征患者自我报告生活质量量表变化的有效性和敏感性

IF 3.6 3区医学 Q2 GERIATRICS & GERONTOLOGY

International Journal of Geriatric Psychiatry

Pub Date : 2025-05-21 DOI: 10.1002/gps.70103

Yvonne C. M. Rensen, Corrie de Waal - Gordijn, Roy P. C. Kessels

Background

Assessing (self-reported) quality of life (QoL) in patients with Korsakoff's syndrome (KS) is important to gain insight into these patients' well-being and to optimize their care in long-term care facilities. In this study, we describe the development of the QUALIKO-Self Report (QUALIKO-SR), an instrument for objectifying self-reported QoL in patients with KS. Next, we compared the QUALIKO-SR scores with the scores on the QUALIKO-Proxy Version (QUALIKO-PV) and examined changes in QoL over time. Finally, we assessed the convergent validity and investigated whether QUALIKO-SR scores were related to the severity of the cognitive impairments.

Methods

The study took place in specialized long-term care facilities providing care for patients with KS. 116 patients with alcoholic KS participated in this study. The QUALIKO-SR was developed and validated against the QUALIKO-PV, the Manchester Short Assessment of Quality of Life (MANSA-16), and the Montreal Cognitive Assessment 8.1 (MoCA).

Results

Significant differences were found between self- and proxy reported QoL on the subscales Negative Affect, Social Isolation, and Feeling at Home. No significant differences were found on the other subscales. QUALIKO-SR scores did not significantly vary over time. However, caregivers reported significant improvements in Care Relationships, Autonomy, Restless Tense Behavior, Social Isolation, and Feeling at Home over time. A significant, positive association was found between the QUALIKO-SR and the MANSA-16. No significant correlations were found between the QUALIKO-SR and the MoCA.

Conclusions

This study describes the development and validation of a self-report instrument for objectifying QoL in patients with KS living in 24-h care facilities, the QUALIKO-SR. Measuring QoL in patients with severe cognitive impairments, such as patients with KS, is complex and we advise to include both self-report and proxy-report measures in future studies as well as in clinical practice. The availability of the QUALIKO-SR and QUALIKO-PV encourages researchers and clinicians to do so in patients with KS.

评估（自我报告的）科萨科夫综合征（KS）患者的生活质量（QoL）对于深入了解这些患者的健康状况和优化他们在长期护理机构的护理非常重要。在本研究中，我们描述了qualko - self Report （QUALIKO-SR）的发展，这是一种客观化KS患者自我报告生活质量的工具。接下来，我们将QUALIKO-SR分数与QUALIKO-Proxy Version （QUALIKO-PV）分数进行比较，并检查生活质量随时间的变化。最后，我们评估了趋同效度，并研究了QUALIKO-SR评分是否与认知障碍的严重程度相关。方法本研究在专门为KS患者提供护理的长期护理机构中进行。116例酒精性KS患者参与了本研究。根据QUALIKO-PV、曼彻斯特生活质量短期评估（MANSA-16）和蒙特利尔认知评估8.1 （MoCA）开发并验证了QUALIKO-SR。结果自我和代理报告的生活质量在消极情绪、社会孤立和家的感觉三项量表上存在显著差异。在其他量表上没有发现显著差异。QUALIKO-SR评分随时间变化不显著。然而，护理人员报告说，随着时间的推移，他们在护理关系、自主性、不安紧张行为、社会隔离和家的感觉方面有了显著的改善。在QUALIKO-SR和MANSA-16之间发现了显著的正相关。QUALIKO-SR与MoCA之间无显著相关。本研究描述了一种自我报告工具的开发和验证，用于客观化生活在24小时护理机构的KS患者的生活质量，即QUALIKO-SR。测量严重认知障碍患者（如KS患者）的生活质量是复杂的，我们建议在未来的研究和临床实践中同时采用自我报告和代理报告的测量方法。QUALIKO-SR和QUALIKO-PV的可用性鼓励研究人员和临床医生在KS患者中这样做。

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引用次数: 0

Clozapine Treatment in Patients With a Neurocognitive Disorder 氯氮平治疗神经认知障碍

IF 3.6 3区医学 Q2 GERIATRICS & GERONTOLOGY

International Journal of Geriatric Psychiatry

Pub Date : 2025-05-19 DOI: 10.1002/gps.70099

A. Triest, Rob M. Kok

Objectives

Behavioural and Psychological Symptoms of Dementia (BPSD) are usually managed with a combination of pharmacological and nonpharmacological interventions, but efficacy is often moderate, and many patients are treatment-resistant. We aimed to evaluate the indication for treatment with clozapine, response, side effects, frequency of clozapine discontinuation, reasons for discontinuation and time to discontinue clozapine in patients with a neurocognitive disorder.

Methods

A retrospective cohort study including all patients with a neurocognitive disorder who started with clozapine between 2011 and 2020, admitted to old age departments of a psychiatric hospital in The Netherlands. The Clinical Global Impression of Improvement-scale (CGI-I) was used to evaluate treatment response, based on clinical notes in the electronical patients' files. Side effects and variables concerning discontinuation of clozapine treatment were also extracted from patients' files.

Results

We included 81 inpatients who started with clozapine and had a major neurocognitive disorder. A clinically relevant positive treatment response (CGI-I score 1-2) was found in 27 patients. Patients without a delirium have a statistically significantly better outcome compared to patients with a delirium superposed on a neurocognitive disorder (Chi² = 14.47, df = 2, p < 0.0001). Only 79 side effects were reported in these 81 patients, and severe side effects in only 2 patients. Side effects were the primary reason to discontinue clozapine in 11 patients, lack of efficacy in 7 patients and side effects combined with lack of efficacy in 5 patients. The median clozapine dose was only 50 mg/day, and a higher dose was a significant predictor of a shorter treatment duration.

Conclusion

Clozapine may be an effective and safe intervention for patients with a neurocognitive disorder and BPSD without a superposed delirium. Clozapine at a low dose may be a treatment option for severe, treatment resistant BPSD.

目的：痴呆症的行为和心理症状通常通过药物和非药物干预相结合来治疗，但效果通常是中等的，而且许多患者对治疗有抵抗性。我们的目的是评估神经认知障碍患者使用氯氮平治疗的适应症、反应、副作用、氯氮平停药的频率、停药的原因和停药的时间。方法回顾性队列研究，纳入荷兰一家精神病院老年科2011年至2020年间接受氯氮平治疗的所有神经认知障碍患者。临床总体印象改善量表（CGI-I）用于评估治疗反应，基于患者电子档案中的临床记录。还从患者档案中提取了有关氯氮平停药的副作用和变量。结果我们纳入了81例住院患者，他们开始使用氯氮平并有严重的神经认知障碍。27例患者出现临床相关阳性治疗反应（CGI-I评分1-2）。与伴有神经认知障碍的谵妄患者相比，无谵妄患者的预后有统计学意义上的显著改善(Chi2 = 14.47, df = 2, p <；0.0001)。81例患者中仅有79例出现不良反应，2例出现严重不良反应。11例患者因副反应主要停药，7例患者无疗效，5例患者副反应合并无疗效。氯氮平的中位剂量仅为50mg /天，较高的剂量是较短治疗时间的显著预测因子。结论氯氮平对无谵妄叠加的神经认知障碍合并BPSD患者可能是一种安全有效的干预手段。低剂量氯氮平可能是重度难治性BPSD的一种治疗选择。

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引用次数: 0

Prevalence of Dementia in European, Chinese and Indian/Fijian-Indian Populations in Aotearoa New Zealand: A Protocol 新西兰奥特罗阿地区欧洲人、中国人和印度人/斐济-印度人痴呆症患病率：一项议定书

IF 3.6 3区医学 Q2 GERIATRICS & GERONTOLOGY

International Journal of Geriatric Psychiatry

Pub Date : 2025-05-19 DOI: 10.1002/gps.70089

Sarah Cullum, Xiaojing Wu, Claudia Rivera-Rodriguez, Rita Krishnamurthi, Jackie Broadbent, Susan Yates, Adrian Martinez-Ruiz, Lynette Tippett, Nick Garrett, Oliver Menzies, Braden Te Ao, Joanna Hikaka, Fuafiva Fa'alau, Etuini Ma'u, Emme Chacko, Amy Chan, Makarena Dudley, Richard Faull, Mathew Croucher, Ngaire Kerse, Gary Cheung

Objectives

Aotearoa New Zealand (NZ) is a bicultural nation (Māori and European) with a growing population of Asian and Pacific peoples. Recent analysis of national routinely collected data suggests dementia prevalence is higher in Māori and Pacific peoples when compared with European and Asian, and that inequities in dementia care for Māori, Asian, and Pacific people with dementia exist. A population-based dementia prevalence study is needed to confirm these findings. The aim of this protocol is to describe a dementia prevalence study focussing on the European, Chinese and Indian populations in NZ. The findings will be compared to a separate study on Māori populations using a similar study design.

Methods

This is a cross-sectional screen-interview survey of people aged ≥ 65 from European, Chinese and Indian/Fijian-Indian backgrounds in sampled meshblocks within two regions of NZ. Stage 1 involves screening eligible participants at the door using the brief cognitive scale of the Community Screening Instrument for Dementia (CSI-D). Stage 2 involves interviewing random samples of screen positive and negative participants using the 10/66 dementia protocol. With a margin of error of approximately 3%, and a confidence level of 5%, a total of 485 European, 410 Chinese and 425 Indian/Fijian-Indian people will be interviewed with the 10/66 protocol. Age-standardised prevalence estimates of 10/66 dementia will be back-weighted for study design.

Conclusion

This study will provide evidence for suspected ethnic inequalities in dementia, inform new culturally appropriate dementia management strategies, and contribute to improved outcomes for people with dementia in NZ.

新西兰（NZ）是一个双文化国家（Māori和欧洲），亚洲和太平洋人民的人口不断增长。最近对国家常规收集数据的分析表明，与欧洲和亚洲相比，Māori和太平洋地区的痴呆症患病率更高，并且Māori、亚洲和太平洋地区的痴呆症患者在痴呆症护理方面存在不公平现象。需要一项基于人群的痴呆患病率研究来证实这些发现。本方案的目的是描述一项以新西兰的欧洲人、中国人和印度人为重点的痴呆症患病率研究。研究结果将与使用类似研究设计的Māori人群的单独研究进行比较。方法采用横断面屏幕访谈法，在新西兰两个地区的抽样网格块中对年龄≥65岁的欧洲人、中国人和印度/斐济-印度人进行调查。第一阶段包括使用社区痴呆症筛查工具（CSI-D）的简短认知量表在门口筛查符合条件的参与者。第二阶段包括使用10/66痴呆方案随机采访筛查阳性和阴性参与者的样本。在误差约为3%，置信水平为5%的情况下，根据10/66协议将对485名欧洲人、410名中国人和425名印度人/斐济-印度人进行采访。10/66痴呆的年龄标准化患病率估计将被反向加权用于研究设计。本研究将为痴呆症的种族不平等提供证据，为新的文化上合适的痴呆症管理策略提供信息，并有助于改善新西兰痴呆症患者的预后。

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引用次数: 0

How Disease-Modifying Therapies Challenge Dementia Care Continuity in Japan: From Promise to Paradox 疾病修饰疗法如何挑战日本痴呆症护理的连续性：从承诺到悖论

IF 3.6 3区医学 Q2 GERIATRICS & GERONTOLOGY

International Journal of Geriatric Psychiatry

Pub Date : 2025-05-14 DOI: 10.1002/gps.70098

Kae Ito, Akira Hatakeyama, Tsuyoshi Okamura

Management of Alzheimer's disease has entered a new phase with the advent of disease-modifying therapies (DMTs). Anti-amyloid beta antibodies used in DMTs—such as aducanumab, lecanemab, and donanemab—differ from earlier medications in that they slow cognitive decline by reducing amyloid plaque accumulation in the brain [1]. As Belder noted, the introduction of DMTs is expected to increase the demand for clinical services, necessitating systems that ensure timely and equitable access to these therapies [2].

Despite the demonstrated efficacy of DMTs, there are concerns remain regarding their cost-effectiveness. Their adoption has been limited in the United States, and they have not yet been approved in the European Union. In contrast, the Japanese government has taken a proactive stance toward promoting the use of DMTs. Japan's universal health insurance system allows patients to access treatment with minimal out-of-pocket costs if they meet specified criteria [3]. However, implementing DMTs within this system requires careful planning to avoid disruptions and ensure equitable delivery.

Our institution was tasked with advising the Tokyo Metropolitan Government to establish a delivery system for DMTs. We initially anticipated that expanding therapeutic options would lead to earlier diagnoses, thereby increasing the number of patients requiring post-diagnostic support. However, we have encountered an unintended consequence: the implementation of DMTs is, in some cases, impeding the provision of post-diagnostic support. We share this experience with the global scientific community.

The philosophy underlying Tokyo's DMT delivery system is based on the following principles [4]: diagnosis and treatment require confirmation of amyloid pathology and the capacity to monitor and manage amyloid-related imaging abnormalities (ARIA) throughout an 18-month treatment course. Therefore, only hospitals equipped with PET and MRI scanners and staffed by certified neurologists were designated as DMT-initiating hospitals. When primary care physicians (typically based in clinics) suspect that a patient is eligible for DMT, they refer the patient to an initiating hospital. In Tokyo, medical centers for dementia (MCDs), government-certified hubs for dementia care, serves as either DMT-initiating hospitals or as collaborating hospitals that support DMT-initiating institutions.

With the increasing number of patients starting DMTs, hospitals have exceeded their capacity. Consequently, patients are transferred after 6 months to less-equipped “DMT-continuing clinics,” usually smaller institutions or clinics. These continuing clinics take over day-to-day care while DMT-initiating hospitals remain responsible for periodic MRIs, cognitive assessments, and managing serious side effects, such as ARIA. Thus, a two-tiered system (Figure 1) was established to balance the need for specialized care with unive

随着疾病修饰疗法（dmt）的出现，阿尔茨海默病的治疗进入了一个新的阶段。用于dmts的抗淀粉样抗体，如aducanumab、lecanemab和donanemab，不同于早期的药物，它们通过减少大脑中淀粉样斑块的积累来减缓认知能力下降。正如Belder所指出的那样，dmt的引入预计将增加对临床服务的需求，因此需要确保及时和公平获得这些疗法的系统。尽管证明了dmt的有效性，但仍然存在对其成本效益的担忧。它们在美国的应用受到限制，在欧盟也尚未获得批准。与此相反，日本政府对推广dmt的使用采取了积极的态度。日本的全民健康保险制度允许患者以最低的自付费用获得治疗，只要他们符合特定的标准。然而，在该系统内实施dmt需要仔细规划，以避免中断并确保公平交付。我们机构的任务是为东京都政府提供建议，建立一个dmt的交付系统。我们最初预计，扩大治疗选择将导致早期诊断，从而增加需要诊断后支持的患者数量。然而，我们遇到了一个意想不到的后果：在某些情况下，dmt的实施阻碍了诊断后支持的提供。我们与全球科学界分享这一经验。东京DMT给药系统的基本理念是基于以下原则：诊断和治疗需要在整个18个月的治疗过程中确认淀粉样蛋白病理和监测和管理淀粉样蛋白相关成像异常（ARIA）的能力。因此，只有配备PET和MRI扫描仪并配备有认证神经科医生的医院才被指定为dmt启动医院。当初级保健医生（通常在诊所）怀疑患者有资格接受DMT时，他们会将患者转介到初始医院。在东京，痴呆症医疗中心（mcd），政府认证的痴呆症护理中心，要么作为dmt启动医院，要么作为支持dmt启动机构的合作医院。随着接受dmt治疗的患者越来越多，医院已经超出了能力范围。因此，患者在6个月后被转移到设备较差的“dmt继续诊所”，通常是较小的机构或诊所。这些持续的诊所接管日常护理，而启动dmt的医院仍然负责定期核磁共振成像、认知评估和管理严重的副作用，如ARIA。因此，建立了一个双层系统（图1），以平衡对专业护理的需求和普遍可及性。虽然初级保健医生不直接参与DMT的管理，但他们与患者及其家属保持着长期的关系。这些医生能够很好地通过考虑患者的生活史、家庭动态和合并症来支持共同决策，这些因素对整体生活质量至关重要。这种以患者为中心，以康复为导向的支持是有效的诊断后护理的核心。然而，一旦患者开始DMT，他们的痴呆症护理往往会转移到实施DMT的医疗机构，常常打断初级保健医生参与诊断后支持。此外，由于发起dmt的医院也是负责诊断后支持的mcd，因此患者在初始治疗阶段就得到了这种支持。然而，我们对一些继续使用dmt的诊所的工作人员的采访显示，他们有意避免提供诊断后的支持。这种不情愿源于担心破坏现有的医患关系。在缺乏全科医生制度的日本，病人可以自由地向任何医疗机构咨询。在关系紧密的地方医疗社区，更换初级保健提供者有时被视为“偷走病人”，导致一些临床医生避免提供支持性护理，因为这可能会吸引病人离开原来的医生。因此，诊断后支持的不连续性经常发生在患者转移到dmt继续诊所后。目前尚不清楚这种情况是普遍存在还是仅限于某些地区。然而，必须强调这一矛盾：旨在确保安全、公平使用dmt的提供系统可能在不经意间造成诊断后支持方面的差距。这一发现值得在痴呆症护理系统改革的背景下进行更广泛的讨论。该研究得到了东京都老年学研究所研究伦理委员会的批准（R24-121）。作者声明无利益冲突。

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引用次数: 0

Incidence and Risk Factors of Postoperative Delirium in Elderly Patients Following Hip Fracture Surgery: A Nationwide Retrospective Cohort Study in Taiwan 老年髋部骨折术后谵妄的发生率及危险因素：台湾一项全国性的回顾性队列研究

IF 3.6 3区医学 Q2 GERIATRICS & GERONTOLOGY

International Journal of Geriatric Psychiatry

Pub Date : 2025-05-12 DOI: 10.1002/gps.70094

Chien-An Shih, Deng-Chi Yang, Wei-Ming Wang, Yi-Lin Wu, Yi-Ching Yang, Han-Chang Ku

Background

Delirium is an acute cognitive change characterized by behavioral and psychological features, such as visual and auditory hallucinations, sleep disturbances, and emotional confusion. It can lead to extended hospital stays, increased mortality risk, and higher nursing costs. In postoperative hip fracture patients, delirium results in a higher complication rate, poorer functional recovery, increased readmission rates, repeat surgeries, and elevated mortality. Despite these serious consequences, the literature provides limited information on the incidence of postoperative delirium following hip fracture surgeries in Asians. Additionally, there is a lack of long-term, comprehensive nationwide population-based studies, highlighting an important area for future research. This study aims to understand the incidence and risk factors of postoperative delirium in hip fracture patients using representative population data.

Methods

We conducted a retrospective cohort study using the Taiwan National Health Insurance Research Database (NHIRD) from 2009 to 2020. The cohort consisted of 118,682 patients aged 65 years or older who were diagnosed with hip fractures. The delirium incidence was observed per 1000 person-years. The Cox proportional hazards model was used to investigate the incidence of delirium among hip fracture patients.

Results

The incidence of the first episode of delirium after hip surgery in the elderly was 1.87 events per 1000 PYs. Factors associated with delirium included being female (adjusted hazard ratio [aHR]: 0.59; 95% confidence interval [CI]: 0.53–0.64), age ≥ 95 years (aHR: 3.52; 95% CI: 2.74–4.51), comorbid dementia (aHR: 2.63; 95% CI: 2.38–2.92), and ICU stay 2–3 days (aHR: 2.85; 95% CI: 1.28–6.37). The occurrence of delirium was significantly associated with an ICU stay of ≥ 4 days, dementia, as well as 30-day, 90-day, and 1-year mortality (p < 0.001).

Conclusions

This study highlights the relatively low incidence of postoperative delirium in elderly hip fracture patients in Taiwan. Key risk factors identified include advanced age, female gender, comorbid dementia, and prolonged ICU stays. These findings underscore the need for targeted prevention and early intervention strategies to improve patient outcomes.

谵妄是一种以行为和心理特征为特征的急性认知变化，如视觉和听觉幻觉、睡眠障碍和情绪混乱。它可能导致住院时间延长，死亡风险增加，护理费用增加。在髋部骨折术后患者中，谵妄导致较高的并发症发生率、较差的功能恢复、再入院率增加、重复手术和死亡率升高。尽管有这些严重的后果，文献提供的关于亚洲人髋部骨折术后谵妄发生率的信息有限。此外，缺乏长期的、全面的、基于全国人口的研究，这突出了未来研究的一个重要领域。本研究旨在通过具有代表性的人群数据了解髋部骨折患者术后谵妄的发生率及危险因素。方法采用2009年至2020年台湾全民健康保险研究数据库（NHIRD）进行回顾性队列研究。该队列包括118,682名年龄在65岁或以上的诊断为髋部骨折的患者。谵妄发生率为每1000人年。采用Cox比例风险模型调查髋部骨折患者谵妄的发生率。结果老年髋关节术后首次谵妄的发生率为1.87例/ 1000年。谵妄的相关因素包括女性(校正风险比[aHR]: 0.59；95%可信区间[CI]: 0.53-0.64)，年龄≥95岁(aHR: 3.52；95% CI: 2.74-4.51)，共病性痴呆(aHR: 2.63；95% CI: 2.38-2.92)， ICU住院2-3天(aHR: 2.85；95% ci: 1.28-6.37)。谵妄的发生与ICU住院≥4天、痴呆以及30天、90天和1年死亡率显著相关(p <；0.001)。结论台湾老年髋部骨折患者术后谵妄发生率较低。确定的主要危险因素包括高龄、女性、共病性痴呆和延长ICU住院时间。这些发现强调需要有针对性的预防和早期干预策略来改善患者的预后。

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引用次数: 0

The Association of Apathy With Incident Dementia: A Multiple Mediation Analysis of Cardiovascular Risk Factors 冷漠与痴呆的关联：心血管危险因素的多重中介分析

IF 3.6 3区医学 Q2 GERIATRICS & GERONTOLOGY

International Journal of Geriatric Psychiatry

Pub Date : 2025-05-10 DOI: 10.1002/gps.70092

Josephine E. Lindhout, Jan Willem van Dalen, Willem A. van Gool, Edo Richard, Marieke P. Hoevenaar-Blom

Objectives

Despite established links between apathy, cardiovascular disease, and dementia, it remains unclear if cardiovascular risk factors (CVRF) play a mediating role in the association between apathy and dementia. If apathy increases dementia risk via lifestyle-related dementia risk factors, targeted lifestyle interventions could help high-risk individuals.

Methods

We used data from the preDIVA study including 3303 individuals aged 70–78 years. Apathy was assessed using the geriatric depression scale, and CVRF (cardiovascular risk factors) (systolic blood pressure, cholesterol, diabetes, body mass index (BMI), smoking, and physical activity) were considered as potential mediators. Outcome was incident dementia during 12 years of follow-up. We assessed mediation using Multiple Mediation Analysis (MMA).

Results

Of the association between apathy and dementia (HR 1.49 [95% CI 0.99–2.41]), 27% was mediated by physical inactivity, BMI and diabetes combined. Of this total, physical inactivity mediated 28% of the effect (HR 1.12, 95% CI 1.03–1.29), diabetes 9% of the effect (HR 1.04, 95% CI 1.02–1.10), and BMI counteracted these effects by −12% (HR 0.95, 95% CI 0.88–0.98).

Conclusion

The relationship between apathy and dementia is partly mediated by physical inactivity, BMI and diabetes. Apathy is an important clinical marker that signals the existence of potentially modifiable pathways, providing an opportunity for lifestyle interventions. To potentially reduce dementia risk via lifestyle modification in patients with apathy, a tailored approach should be taken to overcome the characterizing symptom of diminished motivation.

尽管在冷漠、心血管疾病和痴呆之间建立了联系，但尚不清楚心血管危险因素（CVRF）是否在冷漠和痴呆之间的关联中起中介作用。如果冷漠通过与生活方式相关的痴呆症风险因素增加痴呆症风险，那么有针对性的生活方式干预可以帮助高危人群。方法我们使用preDIVA研究的数据，包括3303名70-78岁的个体。使用老年抑郁量表评估冷漠，CVRF（心血管危险因素）（收缩压、胆固醇、糖尿病、体重指数（BMI）、吸烟和体育活动）被认为是潜在的中介因素。结果是在12年的随访中发生痴呆。我们使用多重中介分析（MMA）评估中介作用。结果在冷漠与痴呆之间的相关性（HR 1.49 [95% CI 0.99-2.41]）中，27%是由缺乏运动、BMI和糖尿病共同介导的。其中，缺乏运动介导了28%的影响（HR 1.12, 95% CI 1.03-1.29），糖尿病介导了9%的影响（HR 1.04, 95% CI 1.02-1.10）， BMI抵消了- 12%的影响（HR 0.95, 95% CI 0.88-0.98）。结论冷漠与痴呆的关系与缺乏运动、BMI和糖尿病有一定关系。冷漠是一个重要的临床标志，表明存在潜在的可改变的途径，为生活方式干预提供了机会。为了通过改变冷漠患者的生活方式来潜在地降低痴呆风险，应该采取一种量身定制的方法来克服动机减弱的特征症状。

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引用次数: 0

Age Trajectories of Mental and Cognitive Health From Midlife to Older Adulthood: Examination of Cohort and Gender Roles in Taiwan 从中年到老年心理与认知健康的年龄轨迹：台湾群体与性别角色的检验

IF 3.6 3区医学 Q2 GERIATRICS & GERONTOLOGY

International Journal of Geriatric Psychiatry

Pub Date : 2025-05-10 DOI: 10.1002/gps.70095

Ching-Ju Chiu, Linda A. Wray, Jou-Yin Chen, Szu-Yu Hou

Objectives

This study examined the age trajectories of mental and cognitive health from midlife to older adulthood, and how age and gender impacted mental and cognitive health change across age cohorts.

Methods

Multilevel modeling was used to analyze the panel data on cognitive function, life satisfaction, and depressive symptoms from the 1996-2011 Taiwan Longitudinal Study on Aging (N = 5131).

Results

Cognitive function gradually declined with chronological age (β_age = −0.041, p < 0.001), and declined faster in earlier-born cohorts (β_{age*cohort 7} = −0.168, p < 0.001). Life satisfaction showed the opposite effect with age and cohort: while earlier-born cohorts reported lower life satisfaction (β_{cohort 7} = −0.498, p < 0.05), life satisfaction increased with chronological age (β_age = 0.015, p < 0.05). Older adults reported more depressive symptoms, but this phenomenon was only significantly associated with age cohort (β_{cohort 7} = 3.530, p < 0.001). Widened differences between men and women in life satisfaction and depressive symptoms were associated with age cohort but not chronological age per se.

Conclusions

Men and later-born cohorts experienced significantly better mental and cognitive health than women and earlier-born cohorts. Age- and gender-related changes in mental and cognitive health in later life should be considered within the socio-culturally contextualized birth cohort.

目的本研究考察了从中年到老年心理和认知健康的年龄轨迹，以及年龄和性别如何影响各年龄段人群的心理和认知健康变化。方法采用多水平模型分析1996-2011年台湾老龄化纵向研究（N = 5131）的认知功能、生活满意度和抑郁症状的面板数据。结果认知功能随年龄增长逐渐下降(βage = - 0.041, p <；0.001)，在较早出生的队列中下降更快(β年龄*队列7 = - 0.168,p <；0.001)。生活满意度与年龄和队列相反：较早出生的队列报告的生活满意度较低(β队列7 = - 0.498,p <；0.05)，生活满意度随年龄增长而增加(βage = 0.015, p <；0.05)。老年人报告的抑郁症状更多，但这一现象仅与年龄队列显著相关(β队列7 = 3.530,p <；0.001)。男女在生活满意度和抑郁症状方面的差异扩大与年龄群有关，但与实际年龄本身无关。结论：男性和晚出生人群的心理和认知健康状况明显好于女性和早出生人群。在社会文化背景下的出生队列中，应考虑到老年生活中与年龄和性别相关的心理和认知健康变化。

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引用次数: 0

The Role of Social Media in Mitigating the Long-Term Impact of Social Isolation on Mental and Cognitive Health in Older Adults During the COVID-19 Pandemic: The HUNT Study 在COVID-19大流行期间，社交媒体在减轻社会隔离对老年人心理和认知健康的长期影响方面的作用：HUNT研究

IF 3.6 3区医学 Q2 GERIATRICS & GERONTOLOGY

International Journal of Geriatric Psychiatry

Pub Date : 2025-05-07 DOI: 10.1002/gps.70097

Tanja Louise Ibsen, Ekaterina Zotcheva, Sverre Bergh, Debby Gerritsen, Gill Livingston, Hilde Lurås, Svenn-Erik Mamelund, Anne Marie Mork Rokstad, Bjørn Heine Strand, Pernille Thingstad, Richard C. Oude Voshaar, Geir Selbæk

Background

The COVID-19 pandemic increased social isolation in older adults, promoting mental and cognitive decline. The impact of social media on these effects remains unclear.

Aim

To investigate the long-term association of social isolation with mental and cognitive health in older adults and whether social media use mitigated this association.

Method

Data from the Norwegian Trøndelag Health Study before (2017–2019), during (January 2021), and after the pandemic (2021–2023) were analysed (N = 4844, 53% women, mean age 80 years). Multi-adjusted mixed-effects linear regression estimated differences in changes in mental (CONOR-MHI) and cognitive (MoCA) health related to self-reported social isolation and social media use. Beta (β) represents differences in change in z-score of CONOR-MHI or MoCA.

Results

Social isolation was associated with a steeper decline in mental health than no social isolation (β = 0.07, 95% CI 0.01, 0.13) but was not associated with change in cognitive health. Daily social media use was not related to change in mental health, whereas it was associated with a less steep cognitive decline than no social media use (< 1 h: β = 0.13, 95% CI 0.05, 0.20; ≥ 1 h: β = 0.10, 95% CI 0.01, 0.15). Stratified by social isolation, daily social media use < 1 h was related to a less steep cognitive decline than no social media use in both isolated (β = 0.15, 95% CI 0.02, 0.28) and non-isolated individuals (β = 0.13, 95% CI 0.03, 0.22).

Conclusion

Individuals experiencing social isolation during the pandemic had a steeper decline in mental, but not cognitive health, compared to those not isolated. Social media use did not buffer the decline in mental health but was associated with less steep cognitive decline. The pandemic showed limits of relying solely on digital solutions for social contact.

Trial Registration

The study is registered in ClinicalTrials.gov 18.02.2021, with the identification number NCT 04792086

背景2019冠状病毒病大流行加剧了老年人的社会孤立，促进了智力和认知能力的下降。社交媒体对这些影响的影响尚不清楚。目的研究社会孤立与老年人心理和认知健康的长期关系，以及社交媒体的使用是否减轻了这种关系。方法分析挪威Trøndelag健康研究在疫情前（2017-2019年）、期间（2021年1月）和之后（2021 - 2023年）的数据（N = 4844，女性53%，平均年龄80岁）。多调整混合效应线性回归估计了与自我报告的社会孤立和社交媒体使用相关的心理（CONOR-MHI）和认知（MoCA）健康变化的差异。β (β)表示CONOR-MHI或MoCA的z-score变化的差异。结果与无社会隔离相比，社会隔离与心理健康下降的相关性更大（β = 0.07, 95% CI 0.01, 0.13），但与认知健康的变化无关。每天使用社交媒体与心理健康的变化无关，而与不使用社交媒体相比，使用社交媒体与认知能力下降的关系较小(<；1 h: β = 0.13, 95% CI 0.05, 0.20；≥1 h: β = 0.10, 95% CI 0.01, 0.15)。社会隔离分层，每天使用社交媒体<；在孤立的个体（β = 0.15, 95% CI 0.02, 0.28）和非孤立的个体（β = 0.13, 95% CI 0.03, 0.22）中，1小时与不使用社交媒体相比，认知能力下降的幅度较小。结论：与未被隔离的人相比，在大流行期间经历社会隔离的人在精神健康（而非认知健康）方面的下降幅度更大。社交媒体的使用并不能缓冲心理健康的下降，但与认知能力下降的幅度较小有关。这场大流行显示了仅仅依靠数字解决方案进行社交接触的局限性。该研究已在ClinicalTrials.gov 18.02.2021注册，识别号为NCT 04792086

{"title":"The Role of Social Media in Mitigating the Long-Term Impact of Social Isolation on Mental and Cognitive Health in Older Adults During the COVID-19 Pandemic: The HUNT Study","authors":"Tanja Louise Ibsen, Ekaterina Zotcheva, Sverre Bergh, Debby Gerritsen, Gill Livingston, Hilde Lurås, Svenn-Erik Mamelund, Anne Marie Mork Rokstad, Bjørn Heine Strand, Pernille Thingstad, Richard C. Oude Voshaar, Geir Selbæk","doi":"10.1002/gps.70097","DOIUrl":"https://doi.org/10.1002/gps.70097","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The COVID-19 pandemic increased social isolation in older adults, promoting mental and cognitive decline. The impact of social media on these effects remains unclear.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To investigate the long-term association of social isolation with mental and cognitive health in older adults and whether social media use mitigated this association.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>Data from the Norwegian Trøndelag Health Study before (2017–2019), during (January 2021), and after the pandemic (2021–2023) were analysed (<i>N</i> = 4844, 53% women, mean age 80 years). Multi-adjusted mixed-effects linear regression estimated differences in changes in mental (CONOR-MHI) and cognitive (MoCA) health related to self-reported social isolation and social media use. Beta (<i>β</i>) represents differences in change in z-score of CONOR-MHI or MoCA.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Social isolation was associated with a steeper decline in mental health than no social isolation (<i>β</i> = 0.07, 95% CI 0.01, 0.13) but was not associated with change in cognitive health. Daily social media use was not related to change in mental health, whereas it was associated with a less steep cognitive decline than no social media use (< 1 h: <i>β</i> = 0.13, 95% CI 0.05, 0.20; ≥ 1 h: <i>β</i> = 0.10, 95% CI 0.01, 0.15). Stratified by social isolation, daily social media use < 1 h was related to a less steep cognitive decline than no social media use in both isolated (<i>β</i> = 0.15, 95% CI 0.02, 0.28) and non-isolated individuals (<i>β</i> = 0.13, 95% CI 0.03, 0.22).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Individuals experiencing social isolation during the pandemic had a steeper decline in mental, but not cognitive health, compared to those not isolated. Social media use did not buffer the decline in mental health but was associated with less steep cognitive decline. The pandemic showed limits of relying solely on digital solutions for social contact.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Trial Registration</h3>\u0000 \u0000 <p>The study is registered in ClinicalTrials.gov 18.02.2021, with the identification number NCT 04792086</p>\u0000 </section>\u0000 </div>","PeriodicalId":14060,"journal":{"name":"International Journal of Geriatric Psychiatry","volume":"40 5","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/gps.70097","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143919380","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}

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