Lancet Healthy Longevity最新文献

Background: Clostridioides difficile infection causes diarrhoea and colitis. Older patients with C difficile infection are often frail and have comorbidities, leading to high mortality rates. The frailty burden in older people might restrict access to treatments, such as C difficile infection-specific antibiotics and faecal microbiota transplantation. We aimed to investigate the clinical effects of early comprehensive geriatric assessment (CGA) and frailty evaluation, including home visits and assessment for faecal microbiota transplantation, in older patients with C difficile infection.

Methods: In this randomised, quality improvement trial with a pragmatic design, patients from the Central Denmark Region aged 70 years or older with a positive PCR test for C difficile toxin were randomly assigned (1:1) to CGA or standard care, both with equal access to faecal microbiota transplantation. Patients and investigators were unmasked to treatment. The primary outcome was 90-day mortality, and was compared in the study groups according to the intention-to-treat principle. The study is registered with ClinicalTrials.gov, NCT05447533.

Findings: Between Sept 1, 2022, and May 3, 2023, we randomly assigned 217 patients to CGA (n=109) or standard care (n=108). The median patient age was 78 years (IQR 74-84). 116 (53%) of 217 patients were female and 101 (47%) were male. 16 (15%; 95% CI 9-23) of 109 patients in the CGA group and 22 (20%; 14-29) of 108 patients in the standard-care group died within 90 days (odds ratio 0·66, 95% CI 0·32-1·38. No serious adverse events or deaths related to patient assessment or faecal microbiota transplantation were recorded in either group. Deaths directly attributable to C difficile infection were lower in the CGA group (seven [44%] of 16 deaths vs 18 [82%] of 22 deaths in the standard-care group; p=0·020).

Interpretation: Older patients who received CGA had a 90-day mortality rate similar to that of patients who received standard care, but with fewer deaths directly attributable to C difficile infection.

Funding: Innovation Fund Denmark, Novo Nordisk Foundation, and Helsefonden.

This systematic review aimed to synthesise qualitative evidence on the views and experiences of older adults in using digital mental health interventions (DMHIs) for the prevention or self-management of mental disorders. We searched PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, Web of Science, PsycINFO, and the first 100 results of Google Scholar for eligible studies and we included 37 papers reporting 35 studies in this Review. Most DMHIs were delivered using mobile apps (n=11), websites (n=6), and video-conferencing tools (n=6). The use of DMHIs in older adults was affected by negative perceptions about ageing and mental health, the digital divide (eg, insufficient digital literacy), personal factors (eg, motivation) and health status, interpersonal influences (eg, guidance and encouragement), intervention features (eg, pace and content), technology-related factors (eg, accessibility), and the perceived benefits and risks of using DMHIs. Future DMHIs for older adults should involve other stakeholders such as health-care professionals, provide content relevant to the needs of older people, be more accessible, and address concerns about privacy and confidentiality.

Background: Oral health has previously shown associations with functional disability and mortality. We aimed to explore the associations of various aspects of oral health status with functional disability and mortality using survival analysis, as well as the relative magnitudes of the impact of these aspects on outcomes.

Methods: We obtained data for individuals aged 75 years and older in Shimane, Japan, who had at least one oral health check-up between April 1, 2016, and March 31, 2022 under Japan's long-life medical care system insurance system. Those with missing data or with functional disability at baseline were excluded. 13 aspects of oral health status were assessed by dentists or dental hygienists as part of the check-up (using protocols provided by the Japan Dental Association and the Japanese Ministry of Health, Labour and Welfare): number of remaining teeth, subjective masticatory performance, objective masticatory performance, periodontal tissue status, functional dysphagia, tongue mobility, articulation, oral hygiene, number of decayed teeth, inadaptation of dentures of the upper jaw and lower jaw (considered separately), oral mucosal disease, and dry mouth. Multivariate Cox proportional hazards models were used to analyse the associations between each aspect of oral health and functional disability and mortality, with fully adjusted models adjusting for sex, age, BMI, medical history, or a propensity score derived from these covariates. Population-attributable fractions (PAFs) were calculated to assess the differential impacts of these oral health status aspects on outcome occurrence.

Findings: Of the 24 619 individuals who had an oral health check-up during the study period, 21 881 individuals were included in the analysis of functional disability (9175 [41·93%] men, 12 706 [58·07%] women, mean age 78·31 years [SD 2·88], mean follow-up 41·43 months [20·80]), and 22 747 individuals in the analysis of mortality (9722 [42·74%] men, 13 025 [57·26%] women, mean age 78·34 years [2·89], mean follow-up 42·63 months [20·58]). All 13 aspects of oral health status showed significant associations with the occurrence of mortality, while functional disability was associated with 11 aspects (excluding oral mucosal disease and dry mouth) in the fully adjusted model. Based on PAFs, of all oral health aspects assessed, objective masticatory performance had the greatest impact on both functional disability (PAF 23·10% [95% CI 20·42-25·69] for the lowest and 10·62% [8·18-12·99] for the second-lowest quartile of performance) and mortality (16·47% [13·44-19·40] and 8·90% [5·87-11·82]).

Interpretation: Various aspects of oral health are associated with mortality and functional disability. Maintaining good oral health in older adults might help to reduce these outcomes.

Funding: None.

Population ageing is a global occurrence. Unfortunately, the shortage of health professionals with geriatric competencies is a major factor restricting high-quality care for older people worldwide. Strengthening the knowledge and skills of the health workforce to better respond to the needs of older people is a major global priority. Geriatricians can play a pivotal role in reorienting care for older people towards an integrated and person-centred care system focused on functional ability, preventive strategies, and age-friendly services. The current scenario requires efforts to be directed towards establishing a standardised competency-based definition of a geriatrician to allow for an accurate estimation of the existing workforce with adequate training in geriatrics as crucial resources to facilitate the paradigm shift. This Personal View, supported by the International Association of Gerontology and Geriatrics and the European Geriatric Medicine Society, proposes a standardised definition of a geriatrician based on expected competencies and roles and a precise description of the essential features of geriatric medicine. By reducing ambiguities and offering a competency-based framework, the current standardisation approach is expected to facilitate better support, monitoring, and allocation of resources for improving care for older people worldwide.

The Decade of Healthy Ageing (2021-30; the Decade), proclaimed by the UN in 2020, is a global initiative aimed at fostering collaborations to transform the world into a better place to live and grow older in. The Decade presents a positive vision of ageing, discarding the stereotypes of diseases and disabilities and promoting focus on capacities and abilities. This approach will help to foster a more inclusive world and, consequently, care systems, which value the dignity of each individual. Although the initiative represents a resource for the global population, the Decade also provides a unique opportunity for the large community of people living with HIV in terms of increased visibility and long-term solutions for their specific ageing-related health issues. This Personal View focuses on the relevance of the Decade in improving the lives of people in the HIV community, the rationale for a stronger engagement of people living with HIV in this initiative, and the potential to reduce global disparities between the HIV community and the general population and among different global regions.