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Clinical Efficacy of Virtual Reality Cave Automatic Virtual Environments (CAVE) for Chronic Musculoskeletal Pain in Older Adults: A Randomized Controlled Trial 虚拟现实洞穴自动虚拟环境 (CAVE) 对老年人慢性肌肉骨骼疼痛的临床疗效:随机对照试验
IF 4.2 2区 医学 Q2 GERIATRICS & GERONTOLOGY Pub Date : 2024-11-04 DOI: 10.1016/j.jamda.2024.105344
Hermione Hin Man Lo MPH, MScN , Pak Yiu Hugo Fong MBBS, MSc , Bo Wang EdD , Cheryl Lok-Chee Fung BSocSc , Samuel Yeung-Shan Wong MD, MPH, CCFP , Regina Wing Shan Sit MD, MBBS, DCH, DPD, PDip, DipMed

Objectives

To assess whether tai chi assisted by the Cave Automatic Virtual Environment (CAVE), a novel virtual reality (VR) technology, was superior to tai chi alone in managing chronic pain in older adults. CAVE may offer a promising alternative to head-mounted displays in chronic pain treatment.

Design

The study was a 12-week, 2-arm, parallel, randomized controlled trial implemented in VR and non-VR groups (N = 80, each arm = 40). The VR group underwent an 8-week tai chi program in a 3-wall VR-CAVE with projections of nature scenes and music, whereas the control group received tai chi only.

Setting and Participants

Community-dwelling older adults with chronic musculoskeletal pain were randomized (1:1) to VR and non-VR groups.

Measures

Participants were assessed at baseline, posttreatment at 8 weeks, and 12 weeks. The primary outcome was the Brief Pain Inventory severity score at 8 weeks, modeled within an intention-to-treat framework using generalized estimating equations.

Results

Participants had a mean age of 65.1 ± 5.6 years, with 78.8% female and mean BPI-pain severity score of 4.4 ± 1.5. At 8 weeks, the VR group demonstrated a statistically significant improvement in BPI severity score compared with the non-VR group (β = −0.75, 95% CI −1.48 to −0.03, P = .043), with the effect sustained to 12 weeks (β = −1.18, 95% CI −1.90 to −0.46, P = .001). No major adverse events were reported.

Conclusions and Implications

VR-CAVE tai chi was superior to non-VR tai chi for chronic musculoskeletal pain. Future trials that are longer-term, larger in scale, and include other forms of exercise will further inform VR-CAVE's role in post-acute and long-term rehabilitation.
目的评估在洞穴自动虚拟环境(CAVE)这一新型虚拟现实(VR)技术的辅助下,太极拳在控制老年人慢性疼痛方面是否优于单纯的太极拳。在慢性疼痛治疗中,CAVE可能是头戴式显示器的一种有前途的替代品:该研究是一项为期 12 周的双臂平行随机对照试验,分为 VR 组和非 VR 组(N = 80,每组 = 40)。VR组在3面墙的VR-CAVE中进行为期8周的太极拳训练,并配有自然场景投影和音乐,而对照组只进行太极拳训练:环境和参与者:患有慢性肌肉骨骼疼痛的社区老年人被随机(1:1)分为 VR 组和非 VR 组:在基线、治疗后 8 周和 12 周对参与者进行评估。主要结果是 8 周时的简明疼痛量表严重程度评分,在意向治疗框架内使用广义估计方程进行建模:参与者的平均年龄为 65.1 ± 5.6 岁,78.8% 为女性,平均 BPI 疼痛严重程度评分为 4.4 ± 1.5 分。8 周时,与非 VR 组相比,VR 组的 BPI 严重程度评分有显著改善(β = -0.75,95% CI -1.48 至 -0.03,P = .043),效果持续到 12 周(β = -1.18,95% CI -1.90 至 -0.46,P = .001)。无重大不良事件报告:VR-CAVE太极拳在治疗慢性肌肉骨骼疼痛方面优于非VR太极拳。未来更长期、更大规模和包括其他运动形式的试验将进一步说明 VR-CAVE 在急性期后和长期康复中的作用。
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引用次数: 0
Process Mining on National Health Care Data for the Discovery of Patient Journeys of Older Adults. 对全国医疗保健数据进行流程挖掘,以发现老年人的患者旅程。
IF 4.2 2区 医学 Q2 GERIATRICS & GERONTOLOGY Pub Date : 2024-11-04 DOI: 10.1016/j.jamda.2024.105333
Tim R de Boer, Rebekka J Arntzen, René Bekker, Bianca M Buurman, Hanna C Willems, Rob D van der Mei

Objective: Understanding the longitudinal patterns of health care utilization among older adults is crucial for designing effective patient journeys and enhancing care coordination across settings. This study aims to uncover the most common patient journeys of older adults.

Design: This explorative study used process mining techniques to analyze national health care data from 2017 to 2019, focusing on patient care journeys of older adults (aged ≥65 years) in the Netherlands.

Setting and participants: Data were sourced from Statistics Netherlands, encompassing all residents aged ≥65 years as of January 1, 2017. Health care usage declarations from various care settings during 2017-2019 were included. Patient journeys were exclusively selected if their initiation points were certain.

Methods: Data underwent rigorous preprocessing, merging, and filtering to create a single event log file suitable for process mining. Patients were categorized by age and medication use, and differences in patient journeys were analyzed. Process mining techniques generated visualizations illustrating the connections between care forms and the impact of changes in one form on others.

Results: The study included 3,177,203 individuals aged 65 years and older, with 44% experiencing 1 or more patient journeys totaling 2,469,663 journeys in 2017-2019. Most care journeys for older adults were simple and short. The top 10 most frequent journeys had 4 or fewer care forms, with 95% of journeys for the 65+ population and 90% for the 85+ population having 4 or fewer care transitions. Long-term care forms, such as home care, personal care, and long-term care, accounted for the majority of time spent in the system.

Conclusions and implications: This pioneering study used process mining to show that most older adults tend to have a straightforward health care need, often involving the emergency department and hospitalizations. However, a smaller group among the population requires more complex and prolonged care, especially in the 85+ population. Reducing the number of transitions for this population, although impacting fewer people, might result in a larger effect on the overall system.

目的:了解老年人使用医疗保健服务的纵向模式对于设计有效的患者旅程和加强不同医疗机构之间的医疗协调至关重要。本研究旨在揭示老年人最常见的患者旅程:这项探索性研究使用流程挖掘技术分析了2017年至2019年的全国医疗保健数据,重点关注荷兰老年人(年龄≥65岁)的患者护理历程:数据来源于荷兰统计局,涵盖截至 2017 年 1 月 1 日年龄≥65 岁的所有居民。数据包括 2017-2019 年期间各种医疗机构的医疗使用申报。如果患者旅程的起始点是确定的,则只选择患者旅程:对数据进行严格的预处理、合并和过滤,以创建适合流程挖掘的单一事件日志文件。根据年龄和用药情况对患者进行分类,并分析患者旅程的差异。流程挖掘技术生成的可视化图表说明了护理形式之间的联系以及一种形式的变化对其他形式的影响:该研究包括 3,177,203 名 65 岁及以上的患者,其中 44% 的患者在 2017-2019 年期间经历了一次或多次患者旅程,共计 2,469,663 次旅程。大多数老年人的护理旅程简单而短暂。最频繁的前 10 个旅程有 4 个或更少的护理形式,65 岁以上人群 95% 的旅程和 85 岁以上人群 90% 的旅程有 4 个或更少的护理转换。长期护理形式,如家庭护理、个人护理和长期护理,占据了在系统中花费的大部分时间:这项开创性的研究利用过程挖掘表明,大多数老年人往往有直接的医疗保健需求,通常涉及急诊科和住院治疗。然而,人口中还有一小部分人需要更复杂、更长时间的医疗服务,尤其是 85 岁以上的老年人。减少这部分人群的转院次数,虽然影响的人数较少,但可能会对整个系统产生较大的影响。
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引用次数: 0
Spirituality and Religion as a Pillar in Multimodal Dementia Prevention. 精神与宗教是多模式痴呆症预防的支柱。
IF 5.4 2区 医学 Q2 GERIATRICS & GERONTOLOGY Pub Date : 2024-11-04 DOI: 10.1016/j.jamda.2024.105343
Shi Ying Tan, Shyh Poh Teo
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引用次数: 0
Higher Magnesium Intake Is Associated with a Lower Risk of Frailty in Older Adults 镁摄入量越高,老年人体弱的风险越低。
IF 4.2 2区 医学 Q2 GERIATRICS & GERONTOLOGY Pub Date : 2024-11-02 DOI: 10.1016/j.jamda.2024.105335
Ligia J. Dominguez MD , Diana M. Mérida MD , Carolina Donat-Vargas PhD , José R. Banegas MD , Nicola Veronese MD , Mario Barbagallo MD , Fernando Rodríguez-Artalejo MD , Pilar Guallar-Castillón MD, PhD

Objectives

Magnesium deficiency is common in older adults and has been associated with reduced muscle functionality and several age-related diseases. Evidence of its relationship with frailty is scarce. We aimed to explore the association of magnesium intake with incident frailty in the Seniors-ENRICA-1 cohort.

Design

Prospective longitudinal cohort study.

Setting and Participants

The ENRICA study is a population-based study (N = 13,105) that includes a representative sample of the noninstitutionalized Spanish population aged 18 years and older. For the present analyses, we used data from the community-dwelling participants aged 60 years and older at baseline (n = 2519). After exclusions, we included data from 1900 participants of the Seniors-ENRICA-1 cohort (mean age 68.7 ± 6.4 years; 51.7% women).

Methods

Food consumption was assessed at baseline with a validated, computer-based, face-to-face dietary history (DH-ENRICA), from which magnesium intake was estimated. Frailty was defined as having 3 or more of Fried criteria: exhaustion, low physical activity, slow gait speed, weakness, and weight loss. Analyses were performed with logistic regression adjusted for potential confounders.

Results

During a mean follow-up of 3.5 years, 136 new cases (7.2%) of frailty occurred. Compared with the lowest sex-specific quartile of magnesium intake, the fully adjusted odds ratio (95% CI) for incident frailty across increasing quartiles of intake was 0.62 (0.36, 1.07), 0.53 (0.28, 0.98), and 0.43 (0.21, 0.86), respectively (P-trend = .016). Corresponding results for slow gait speed were 0.68 (0.47, 1.01), 0.58 (0.37, 0.89), and 0.52 (0.32-0.84), respectively (P-trend = .008). Other Fried criteria showed a similar tendency to reduced frailty incidence with increasing magnesium intake, without achieving statistical significance in the fully adjusted model.

Conclusions and Implications

Higher magnesium intake was inversely and independently associated with lower frailty risk, especially of slow gait speed, in community-dwelling older adults, suggesting that adequate intake of this vital ion could help prevent unhealthy aging.
目的:镁缺乏症在老年人中很常见,与肌肉功能减退和多种老年相关疾病有关。有关镁与虚弱关系的证据却很少。我们的目的是在 Seniors-ENRICA-1 队列中探讨镁摄入量与体弱事件的关系:设计:前瞻性纵向队列研究:ENRICA研究是一项基于人口的研究(N = 13,105),包括西班牙18岁及以上非住院人口的代表性样本。在本次分析中,我们使用了基线年龄在 60 岁及以上的社区居民参与者的数据(n = 2519)。在排除其他数据后,我们纳入了 1900 名老年人-ENRICA-1 队列参与者(平均年龄为 68.7 ± 6.4 岁;51.7% 为女性)的数据:在基线时,我们使用经过验证的、基于计算机的面对面膳食史(DH-ENRICA)对食物摄入量进行了评估,并从中估算出镁摄入量。在弗里德标准(疲惫、体力活动少、步态缓慢、虚弱和体重减轻)中,有 3 项或 3 项以上的标准即为体弱。分析采用逻辑回归法,并对潜在的混杂因素进行了调整:在平均 3.5 年的随访期间,新增了 136 例虚弱病例(7.2%)。与镁摄入量最低的性别特异性四分位数相比,在镁摄入量不断增加的四分位数中,发生虚弱的完全调整几率比(95% CI)分别为 0.62(0.36,1.07)、0.53(0.28,0.98)和 0.43(0.21,0.86)(P-趋势 = .016)。慢步速度的相应结果分别为 0.68(0.47,1.01)、0.58(0.37,0.89)和 0.52(0.32-0.84)(P-趋势 = .008)。其他弗里德标准也显示出类似的趋势,即随着镁摄入量的增加,虚弱发生率会降低,但在完全调整模型中未达到统计学意义:在社区居住的老年人中,较高的镁摄入量与较低的虚弱风险(尤其是步速缓慢)呈独立的反比关系,这表明摄入充足的这种重要离子有助于预防不健康的衰老。
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引用次数: 0
PALTmed Events and Products PALTmed 活动和产品
IF 4.2 2区 医学 Q2 GERIATRICS & GERONTOLOGY Pub Date : 2024-11-01 DOI: 10.1016/S1525-8610(24)00795-3
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引用次数: 0
Enhancing the Effectiveness of Public Health Policies on the Health of Older Adults: The Crucial Role of Social Work 提高公共卫生政策对老年人健康的影响:社会工作的关键作用。
IF 4.2 2区 医学 Q2 GERIATRICS & GERONTOLOGY Pub Date : 2024-11-01 DOI: 10.1016/j.jamda.2024.105226
Afei Qin, Lingzhong Xu
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引用次数: 0
Emerging Digital Technologies Used for Fall Detection in Older Adults in Aged Care: A Scoping Review 用于老年护理中老年人跌倒检测的新兴数字技术:范围审查。
IF 4.2 2区 医学 Q2 GERIATRICS & GERONTOLOGY Pub Date : 2024-11-01 DOI: 10.1016/j.jamda.2024.105330
Sriyani Padmalatha Konara Mudiyanselage RN, PhD , Ching Teng Yao PhD , Sujeewa Dilhani Maithreepala RN, MSc , Bih O. Lee RN, PhD

Objective

To explore a comprehensive overview of digital technologies used for fall detection in older adults, categorizing the types, functions, and usability of these systems.

Design

A scoping review was conducted to search across 5 databases [Embase, Medline (OVID), CINAHL, Coherence and IEEE Explore] from January 2013 to September 2023.

Setting and Participants

Studies in older adults living in nursing homes, care homes, residential homes, respite care homes, and all skilled and ambulatory care facilities (without context restrictions).

Methods

This review followed the 6 methodological stages: (1) identification of research question; (2) identification of relevant studies; (3) study selection; (4) charting the data; (5) collating, summarizing, and reporting the results; and an optional stage, (6) consulting with stakeholders regarding findings to explore pivotal concepts in emerging technology usage in long-term care for falls detection among older people. Data were extracted and categorized based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines.

Results

A total of 73 studies met the inclusion criteria. Four main categories of fall detection technologies were identified: motion and sensor technologies, imaging and visual systems, environmental sensors, and robotic and autonomous systems. Commonly used devices: wearable accelerometers, gyroscopes, infrared array sensors, and smart carpet pressure sensors. Data storage methods were wearable devices, cameras, and floor-mounted sensors. Communication technologies included Bluetooth, Wi-Fi, and GPS, and notification methods ranged from alarms and SMS to cloud communications. Various health care response teams, including caregivers, health care providers, and emergency services, were integral to the fall detection systems.

Conclusions and Implications

Most studies primarily focus on fall detection; however, we recommend further clinical research to emphasize both fall detection and, more importantly, fall prevention (both primary and secondary). Investigating the effectiveness of fall prevention technologies in real-world settings will be crucial for enhancing the safety and quality of life of the aging population.
目的探讨用于老年人跌倒检测的数字技术的综合概况,对这些系统的类型、功能和可用性进行分类:设计:从 2013 年 1 月到 2023 年 9 月,在 5 个数据库(Embase、Medline [OVID]、CINAHL、Coherence 和 IEEE Explore)中进行了范围综述:研究对象:居住在疗养院、护理院、养老院、临时护理院以及所有专业和非卧床护理机构的老年人(不受环境限制):本综述遵循 6 个方法阶段:(1)确定研究问题;(2)确定相关研究;(3)选择研究;(4)绘制数据图表;(5)整理、总结和报告结果;以及一个可选阶段,即(6)就研究结果咨询利益相关者,以探索在长期护理中使用新兴技术检测老年人跌倒的关键概念。数据的提取和分类依据的是《系统综述和荟萃分析的首选报告项目》(Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews,PRISMA-ScR)指南:共有 73 项研究符合纳入标准。共确定了四大类跌倒检测技术:运动和传感器技术、成像和视觉系统、环境传感器以及机器人和自主系统。常用设备:可穿戴加速度计、陀螺仪、红外阵列传感器和智能地毯压力传感器。数据存储方法包括可穿戴设备、摄像头和安装在地板上的传感器。通信技术包括蓝牙、Wi-Fi 和 GPS,通知方法包括警报、短信和云通信。各种医疗响应团队,包括护理人员、医疗服务提供者和急救服务,都是跌倒检测系统不可或缺的组成部分:大多数研究主要侧重于跌倒检测;但是,我们建议进一步开展临床研究,既要重视跌倒检测,更重要的是要重视跌倒预防(包括初级和二级)。调查防跌倒技术在实际环境中的有效性对于提高老龄人口的安全和生活质量至关重要。
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引用次数: 0
A New Look at Diabetes Through the Revised 2024 Diabetes Clinical Practice Guideline 通过修订后的 2024 年糖尿病临床实践指南重新审视糖尿病。
IF 4.2 2区 医学 Q2 GERIATRICS & GERONTOLOGY Pub Date : 2024-11-01 DOI: 10.1016/j.jamda.2024.105325
Barbara Resnick PhD, CRNP
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引用次数: 0
General Information 一般信息
IF 4.2 2区 医学 Q2 GERIATRICS & GERONTOLOGY Pub Date : 2024-11-01 DOI: 10.1016/S1525-8610(24)00793-X
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引用次数: 0
Directions & Connections 路线与连接
IF 4.2 2区 医学 Q2 GERIATRICS & GERONTOLOGY Pub Date : 2024-11-01 DOI: 10.1016/S1525-8610(24)00794-1
{"title":"Directions & Connections","authors":"","doi":"10.1016/S1525-8610(24)00794-1","DOIUrl":"10.1016/S1525-8610(24)00794-1","url":null,"abstract":"","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"25 11","pages":"Article 105372"},"PeriodicalIF":4.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142652662","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
Journal of the American Medical Directors Association
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