Aging Medicine最新文献

Objectives: This study reviewed the factors involved in medication adherence among the elderly. By understanding these factors, we can develop targeted strategies to promote better medication adherence, ultimately improving health outcomes for this population.

Methods: This cross-sectional study was performed in 2023. In the first phase, five scientific databases were searched: PubMed, Science Direct, Springer, Wiley, and Wolters Kluwer. The review included articles published between 2001 and January 2022. The keywords used in the searches included "drug adherence," "medication adherence," "elderly," and "older adults." Two researchers independently evaluated the titles, abstracts, and texts of papers. Specific inclusion and exclusion criteria determined the selection of studies. Data were extracted using a data extraction form based on the study objectives. From all 116 articles retrieved, 68 studies were included. In the second phase, factors on medication adherence in the elderly were divided into categories and subcategories.

Results: Factors involved in medication adherence among the elderly were divided into two categories: personal and external factors. Personal factors were classified into three subcategories: reducing, increasing, and other, while external factors included cultural, social, and economic factors as well as the influence of others. The most important factor associated with medication non-adherence among the elderly is polypharmacy. Other factors such as economic and social status, cognitive impairment, health literacy, age, and depression also significantly influence medication adherence among the elderly.

Conclusions: The health system should focus on managing medications for older adults who use multiple drugs. Providing economic and social support, psychological training, and counseling can ameliorate medication adherence.

Objectives: Sarcopenia is a progressive and systemic skeletal muscle disease. Uric acid is a powerful endogenous antioxidant and an indicator reflecting the nutritional status in the human body. Serum uric acid creatinine ratio (UCR) is serum uric acid (SUA) corrected by renal function. The relationship between SUA, UCR, and sarcopenia remains underexplored. This study explored the correlation between SUA, UCR, and sarcopenia in elderly patients.

Methods: This study included 214 elderly patients (aged > 65 years) who were hospitalized in Xiangya Second Hospital from March 2022 to July 2023. T test, U test, or chi-squared test was used to compare the differences between groups. Spearman correlation analysis was used to analyze the correlation between SUA, UCR, and skeletal muscle mass index (SMI) and handgrip strength. The relationship between SUA, UCR, and sarcopenia was estimated by a multivariate logistic regression model. ROC curve was drawn to test the diagnostic efficacy of SUA and UCR for sarcopenia.

Results: The levels of SUA and UCR were significantly lower in participants with sarcopenia. Spearman correlation analysis showed that SUA and UCR were positively correlated with handgrip strength and skeletal muscle mass index. Multivariate logistic regression analysis showed that, after adjusting for relevant confounding factors, UCR remained significantly associated with sarcopenia, while SUA didn't. The AUC of SUA combined with UCR in diagnosing sarcopenia in males was 0.744. In females, the progressive significance of SUA was not statistically significant. The AUC of UCR was 0.658.

Conclusion: In the elderly, SUA and UCR are related to sarcopenia, but there are certain gender differences.

Objectives: To explore the prognostic factors affecting overall survival (OS) in patients aged ≥ 65 years with lung cancer BMs.

Methods: In this multicenter retrospective study, 293 patients aged ≥ 65 years diagnosed with lung cancer BMs between 2010 and 2023 were included. We analyzed the correlation between clinical information, treatment methods, molecular data, and OS. Univariate and multivariate Cox regression models were used to identify risk factors, and Kaplan-Meier survival curves were constructed for analysis.

Results: A total of 293 patients aged ≥ 65 years with lung cancer BMs were included (age mean [SD], 69.40 [4.04] years). Univariate analysis of 293 lung cancer patients aged ≥ 65 years with BMs showed that risk prognostic factors included pathological type (SCLC, hazard ratio [HR] = 2.221, 95% confidence interval [CI] = 1.531-3.224, p < 0.001), location of BMs (HR = 1.428, 95% CI = 1.045-1.951, p = 0.025), diagnosis KPS (HR = 0.693, 95% CI = 0.528-0.909, p = 0.008), and targeted therapy (HR = 0.610, 95% CI = 0.465-0.798, p < 0.001). Multivariate analysis showed that pathological type (SCLC, HR = 1.814, 95% CI = 1.230-2.676, p = 0.003), diagnosis KPS (HR = 0.726, 95% CI = 0.550-0.959, p = 0.024), and targeted therapy (HR = 0.008, 95% CI = 0.506-0.902, p = 0.008) were independent factors of OS in such patients.

Conclusions: Pathological type, KPS, and targeted therapy significantly impact OS in elderly lung cancer BM patients. Targeted therapy may be a promising option for improving prognosis in this patient population.

Trial registration: ClinicalTrials.gov identifier: NCT05609162.

Objectives: To examine associations between taste propensity and body mass index (BMI) in elderly individuals (≥ 60 years), compare taste propensity between obese and nonobese groups, and explore gender-related differences to inform dietary interventions.

Methods: A cross-sectional study was conducted with 231 elderly participants (aged ≥ 60 years) in Zanjan city, categorized into obese (n = 80) and nonobese (n = 151) groups. Taste propensity was assessed using a validated food frequency questionnaire (FFQ) evaluating six taste groups: sweet, salty, sour, bitter, umami, and fat. Pearson's correlation and independent samples t-tests were used to examine relationships between BMI and taste propensity.

Results: Inverse correlations were observed between BMI and sweet (r = -0.172, p = 0.009), bitter (r = -0.139, p = 0.035), and umami (r = -0.168, p = 0.010) taste propensities; whereas there were positive correlations between BMI and salty (r = 0.204, p = 0.002) and fat (r = 0.167, p = 0.011) taste scores. Moreover, obese participants showed a lower propensity for sweet and umami tastes (p = 0.049; p < 0.001), but a higher propensity for salty and fat tastes (p = 0.029; p = 0.024) compared to nonobese individuals. A gender difference was observed in umami propensity among obese participants, with women showing a stronger propensity (p = 0.033).

Conclusions: Obesity in the elderly is associated with altered taste perception, particularly an increased propensity for salty and fatty foods and a decreased propensity for sweet and umami tastes. These findings may inform tailored dietary interventions in older adults.

Objectives: Hospitalization-associated disability (HAD) is prevalent among older adults, impacting their recovery and independence post-discharge. Assessing the readiness and willingness of older adults to use mobile health (mHealth) apps can provide new opportunities to mitigate HAD by promoting physical activity during hospitalization.

Methods: We performed a cross-sectional study of patients aged 65 years and older, admitted to the general medical unit of a large academic hospital. In-person surveys assessed participants' perceptions of physical activity, mobile device familiarity, and willingness to use a hypothetical mHealth mobility app that would provide reminders to be active during hospitalization. Participants also completed a practical digital literacy assessment by setting an alarm on their personal mobile device. Demographic and clinical data were abstracted from electronic medical records.

Results: Of 80 eligible patients invited, 69 (86%) were enrolled. The median age of participants was 74 years (interquartile range, 69-77 years). The majority of participants preferred to stay physically active during hospitalization (81%), owned a mobile device (83%), and expressed willingness (55%) to use an mHealth app that provides notifications to perform physical activities. Participants willing to use such an app had a higher median Charlson comorbidity score (8 vs. 6, p = 0.005), more likely completed education beyond high school (84% vs. 57%, p = 0.016), and reported greater comfort using mobile devices in general (90% vs. 67%, p = 0.033) compared to those unwilling. Willing participants were more successful in the alarm-setting task compared to those unwilling (63% vs. 13%, p = 0.001).

Conclusions: In this single-center study, most older adults prefer to stay physically active, and a majority are willing and capable of using an mHealth app to receive mobility reminders during hospitalization. These findings support the development of targeted mHealth interventions to decrease HAD in geriatric acute care settings.

Objectives: To explore the mechanism of RNA oxidation and its inhibitor MTHI involved in cardiomyocyte hypertrophy.

Methods: The hypertrophic H9c2 cardiomyocytes were stimulated with different concentrations and times of Ang II (Ang II) to construct a model of hypertensive heart failure in vitro. Transfection of H9c2 cells with the MTH1 overexpression plasmid was performed. The mRNA expression of ANP, BNP, and β-MHC in each experimental group was detected by PCR. The expression of 8-oxoG in H9c2 cells was determined by immunofluorescence and enzyme-linked immunosorbent assay (ELISA). The activation of the ERK-MAPK pathway and the amount of MTH1 protein were detected by WB semi-quantitative method.

Results: Notably, RNA oxidation is a critical event in cellular senescence, and its accumulation is strongly linked to the aging process and the development of age-related diseases. In our model of cardiomyocyte hypertrophy, the oxidative damage of RNA was aggravated, and the expression of MTH1 was increased. At the same time, the sequence of ERK-MAPK pathway proteins was activated. It can be seen that the oxidative damage of RNA is related to the process of cardiomyocyte hypertrophy. After transfection of the MTH1 overexpression plasmid into the cardiomyocyte hypertrophy model, we found that the amount of 8-oxoG decreased, and the activation of ERK-MAPK signaling pathway proteins decreased, and H9c2 cell hypertrophy decreased. Therefore, we concluded that 8-oxoG may aggravate the hypertrophy of the cardiomyocyte hypertrophy model by activating the ERK-MAPK pathway.

Conclusion: The oxidative damage of RNA is involved in the process of cardiomyocyte hypertrophy. The mechanism may be that 8-oxoG, a product of RNA oxidation, activates the downstream ERK-MAPK signaling pathway. These findings provide new perspectives for further exploration into the role of RNA oxidation in the pathogenesis of age-related diseases, particularly heart failure.

Objectives: To evaluate the effects of anodal transcranial direct current stimulation (tDCS) over the left prefrontal cortex, combined with computerized cognitive training, on cognitive performance, anxiety, depression, motor reaction time, and neurophysiological markers in elderly women with subjective cognitive decline or preserved cognition.

Methods: This was a randomized double-blind clinical trial involving 30 elderly women allocated to three groups: active tDCS, sham tDCS, and controls. The intervention consisted of nine sessions of tDCS combined with cognitive training. Cognitive aspects (Addenbrooke's Cognitive Examination-Revised), depressive symptoms (CES-D), anxiety symptoms (GAI), motor reaction times, and neurophysiological aspects (EEG) were assessed. Statistical analyses included ANOVA and paired t-tests for between-group comparisons.

Results: The tDCS group exhibited significant improvements in global cognition, episodic memory, verbal fluency, and language. Additionally, there was a significant reduction in anxiety and depression scores compared to those in the sham and control groups. The motor reaction time was reduced in the tDCS group, indicating improved sensorimotor integration. The EEG data demonstrated increased cortical excitation and improved emotional valence in the tDCS group.

Conclusion: Anodal tDCS associated with computerized cognitive training has proven to be an effective strategy for optimizing performance in memory tasks, verbal fluency, and decision-making as well as for reducing anxiety and depression symptoms in elderly individuals with or without subjective cognitive decline. Based on these findings, tDCS is a promising and safe tool for developing cognitive interventions for the elderly. Future studies should explore the long-term effects and impact of different stimulation protocols.

Trial registration: This clinical trial is registered in the Brazilian Clinical Trials Registry (ReBEC) under the identification number RBR-16768.

Objectives: The triglyceride-to-high-density lipoprotein cholesterol (TG/HDL-C) ratio reflects atherogenic dyslipidemia and insulin resistance. Its predictive value for unplanned coronary revascularization in elderly patients with type 2 diabetes mellitus (T2DM) and coronary artery disease (CAD) is unclear.

Methods: We retrospectively analyzed 1796 patients aged ≥ 60 years with T2DM and angiographically confirmed CAD from January 2008 to November 2021. The primary endpoint was unplanned coronary revascularization, defined as revascularization performed because of angina symptoms, new ischemic changes on ECG, or signs of reversible myocardial ischemia on noninvasive imaging. TG/HDL-C ratio was evaluated by tertiles in Kaplan-Meier analysis and as a continuous variable in Cox models: Model 1 (unadjusted), Model 2 (age, gender, smoking), and Model 3 (further adjusted for lipid, metabolic, renal, and angiographic covariates). Restricted cubic spline (RCS) analysis and prespecified subgroup analyses were performed.

Results: During a median follow-up of 1175 days (interquartile range, 597-1986), unplanned revascularization occurred in 309 patients (17.2%). In the fully adjusted model, TG/HDL-C ratio remained independently associated with increased risk (per 1-unit increase: hazard ratio [HR] 1.029, 95% confidence interval [CI] 1.007-1.051, p = 0.011; per standard deviation increase: HR 1.158, 95% CI 1.039-1.290, p = 0.008). Compared with the lowest tertile, the highest tertile showed a significantly higher risk of unplanned revascularization (HR = 1.646, 95% CI = 1.133-2.393, p < 0.010). The RCS analysis demonstrated a relatively flat risk below approximately 3.427, with a progressive increase thereafter (p for overall association = 0.006; p for nonlinearity = 0.045). Subgroup analyses showed no statistically significant interactions (all p for interaction > 0.05), and the direction of association was consistent across predefined clinical strata.

Conclusion: Higher TG/HDL-C ratio independently predicted unplanned revascularization in elderly patients with T2DM and CAD. This simple, widely available lipid parameter may aid long-term risk stratification, but prospective multicenter studies are needed for validation.

In recent years, significant progress has been made in understanding the therapeutic potential of idebenone (IDE), a synthetic analogue of Coenzyme Q10, in neurodegenerative diseases (NDs). This review comprehensively examines the pharmacological properties of IDE and its emerging applications in various NDs, with particular emphasis on Alzheimer's disease, Parkinson's disease, Friedreich's ataxia, and Huntington's disease. We elucidate IDE's multifaceted neuroprotective mechanisms, including its potent antioxidant activity that reduces reactive oxygen species production, its ability to enhance mitochondrial bioenergetics, and its regulatory effects on cellular metabolism. Additionally, we critically evaluate current clinical research findings and discuss the translational potential of IDE in ND therapeutics. The accumulated evidence strongly supports IDE as a promising mitochondrial-targeted agent capable of mitigating disease symptoms and modifying disease progression in multiple neurodegenerative disorders. This review highlights both the current achievements and future directions for IDE-based interventions in ND treatment.