Annals of Geriatric Medicine and Research最新文献

Background: Sarcopenia is a prevalent condition in patients undergoing chronic hemodialysis. Therefore, a convenient and reliable method of monitoring muscle health is required. This study identified the utility of the phase angle (PhA) to estimate muscle health, and evaluated its changes following intradialytic neuromuscular electrical stimulation (NMES) and oral nutritional supplement interventions in patients undergoing chronic hemodialysis.

Methods: This post-hoc analysis was conducted using data obtained from a 12-week multicenter randomized trial that examined the effects of NMES and protein supplementation. The participants were divided into four groups according to intradialytic NMES and protein supplementation. The PhA, muscle mass, muscle strength, and physical performance were measured every 4 weeks.

Results: Overall, 59 participants completed the study. PhA values were linearly associated with muscle mass and muscle strength. Additionally, high PhA levels indicated fast gait speed and shortened timed up-and-go (TUG) results. We further evaluated the association between the PhA slope and muscle health-related parameters. In participants with the PhA slope <0° over 12 weeks, TUG results worsened over time, relative to those with a slope ≥0° over 12 weeks, independent of age, sex, diabetes, and body mass index. NMES did not improve the PhA values over time; however, protein supplementation tended to increase the PhA values.

Conclusion: PhA is a reliable marker for estimating and monitoring muscle health in patients undergoing chronic hemodialysis, and a strong association exists between PhA and TUG results.

Activities of Daily Living (ADL) assessments are crucial for evaluating functional independence and formulating care strategies for older adults. However, the existing tools encounter challenges, including cultural bias, subjectivity, and limited sensitivity to subtle changes in functional abilities. This review examines these limitations across Basic, Instrumental, and Extended ADL categories and explores the integration of emerging technologies, such as artificial intelligence, sensor-based systems, and remote monitoring tools, to address these gaps. Technological advancements have the potential to enhance the accuracy, efficiency, and inclusivity of ADL assessment by providing objective data, supporting real-time evaluations, and enabling personalized care plans. By bridging the gap between traditional methods and innovative technologies, this review highlights a pathway for more equitable and effective assessments, ensuring that older adults across diverse contexts receive tailored support to maintain their independence and improve their quality of life.

Background: This study aimed to evaluate the long-term clinical outcomes of patients with acute myocardial infarction (AMI) who underwent successful stent implantation and were subsequently treated with angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB).

Methods: Among 13104 patients enrolled in the Korean AMI registry, 2763 elderly patients aged 70 years or older, who were prescribed either ACEI or ARB at discharge, were included in this study. Propensity score matching (PSM) was performed to adjust for baseline confounders. The primary outcome was a composite of cardiac death and recurrent myocardial infarction (MI) at the 3-year follow-up.

Results: In PSM cohort, use of ACEI at discharge was associated with a significantly lower incidence of primary outcome (hazard ratio, 1.60; 95% confidence interval, 1.20-2.14; p=0.001) compared to those of ARB at discharge. Additionally, incidences of cardiac death, recurrent MI and all-cause death were lower in use of ACEI at discharge than in those of ARB. However, there were no statistically significant differences between the two groups in hospitalization for heart failure, any revascularization, stent thrombosis, or stroke.

Conclusions: The findings of this study suggest that ACEI use at discharge, compared with ARB use, was associated with lower incidences of cardiac death, and recurrent MI in elderly patients with AMI after successful stent implantation.

Celiac disease is a chronic, immune-mediated enteropathy that is precipitated by dietary gluten in genetically predisposed individuals. Classical form of the disease is characterized by gastrointestinal symptoms and signs of malabsorption, while patients with nonclassical celiac disease lack significant gastrointestinal symptoms. We report an uncommon case of celiac disease in an 84 -year-old oligosymptomatic female with a recently treated colon tumor, diagnosed during the investigation of profound hypoproteinemia and hypoalbuminemia. In this case, two factors could have been misleading about the cause of hypoalbuminemia: malignant tumor and advanced age. Since the oncological disease was in remission, and the albumin concentration in the healthy elderly people in the community usually exceeds 38 g/L until after the age of 90, we pursued an alternative cause, leading to the diagnosis of celiac disease. Even in the absence of intestinal symptoms, advanced age, or other diagnoses, celiac disease should be considered a potential differential diagnosis in every patient presenting with hypoalbuminemia.

Background: Guidelines for heart failure (HF) management recommend high target doses for medications. These targets are based on standardized dosing regimens that rarely consider the complex challenges faced by older patients. However, little is known about such challenges perceived by older adults. We assessed older adults' perceived challenges with HF medication utilization, which may guide a more patient-centered definition of the target intensity for HF medications.

Methods: We conducted a pilot qualitative study using one-on-one, semi-structured interviews with older adults. We included patients over the age of 65 years admitted to the acute cardiac care units (cardiac intensive care unit or cardiac intermediate care unit) with a known diagnosis of HF. We conducted a deductive and inductive thematic analysis based on a prior conceptual framework for the Medication-Related Burden Quality of Life tool. Subthemes and themes were finalized with two other coders who were study investigators.

Results: Ten patients were enrolled in the study. Six major themes were identified in the perception of challenges of HF medication utilization. The most common themes were experiencing adverse drug effects (80%) and psychological distress (80%), followed by problems in logistics (70%), the burden from the number of medications (70%), impact from patient-doctor relations (70%), and burden from the cost (40%).

Conclusions: The results from this pilot study provide preliminary insight into the perceived challenges of HF medication utilization and the distinctive ways the treatment burden is experienced by patients. These results will need validation in larger studies and different patient settings.

Background: Appetite loss in older adults raises the risk of malnutrition and frailty. The recent emphasis on psychological and social support for appetite loss reveals the importance of robust social networks. Depression is linked to a decline in appetite and social networks. Social networks may influence appetite directly and indirectly through depression. This exploratory cross-sectional study categorizes social networks into family and friend networks to elucidate their direct and indirect effects.

Methods: The study analyzed 193 community-dwelling older adults (women 78.2%; mean age 77.1±5.3 years) who participated in health-checkup events in two cities in Japan. Appetite was assessed using the Japanese version of the Simplified Nutritional Appetite Questionnaire, and family and friend networks were assessed using the Lubben Social Network Scale-6. Depression was assessed using the Geriatric Depression Scale-15. Based on previous research, we constructed a causal model examining the impacts of family and friend social networks and depression on appetite and calculated the direct and indirect effects through structural equation modeling.

Results: The family network had a direct effect on appetite (path coefficient=0.18) and an indirect effect via depression (path coefficient=0.0608). Conversely, the friend network was not directly associated with appetite but had an indirect effect through depression (path coefficient=0.0905). The model exhibited a good fit. The mechanism of influence on appetite varied between the networks.

Conclusion: To prevent appetite loss, social networks with family and friends should be assessed separately, and tailored support should be provided for each.

Background: A nationwide Rehabilitation at Home Care Pilot Program for patients undergoing lower extremity orthopedic surgeries has been ongoing since 2020. The program was designed to improve clinical outcomes through early mobilization and rehabilitation after discharge. This study aimed to analyze the interim data to assess its effectiveness and suggest improvements, particularly for older patients who are more vulnerable compared to younger patients.

Methods: We analyzed the data of 872 patients from seven hospitals. Patients were divided into an older-age group (OG) (≥ 60 years) and younger-age group (YG) (< 60 years). The Berg Balance Scale (BBS) and numeric rating scale (NRS) scores for pain were the main outcomes.

Results: Participants were categorized into OG (n=801) and YG (n=71). The most common surgeries were knee joint replacement (63.7%) in OG and hip joint replacement in YG (77.5%). It took more days to enroll in the pilot program in OG (4.4 days) than YG (3.2 days). OG showed less improvement in BBS than YG for all surgeries (23.3 vs. 31.9) and hip joint surgery (19.8 vs. 33.5). In patients with hip joint replacement in OG, those with a higher number of comorbidities (≥3) showed less BBS improvement than those with fewer comorbidities (<3). In the pain domain, NRS scores decreased in both groups.

Conclusion: The postoperative rehabilitation education program appeared to be effective in improving physical function and reducing pain severity, though the improvement was less obvious in older patients who may require a more comprehensive approach compared to younger patients.

Background: Home-visit care should prioritize patient safety and promote positive safety awareness to maintain caregivers' commitment to providing safe care. This descriptive study aims to examine the relationship between home-visit caregivers' knowledge, attitudes, awareness of patient safety, and safety-related activities.

Methods: The participants were 210 adult home-visit caregivers, aged 20 years or older, with more than six months of experience working at six long-term care centers in D Metropolitan City. Data were collected using a structured self-report questionnaire to measure participants' general characteristics and their patient safety knowledge, attitudes, awareness, and activities and analyzed using SPSS/WIN 28.0.

Results: This study demonstrated that patient safety activities were significantly positively correlated with patient safety knowledge (r=.63, p˂.001), patient safety attitude (r=.49, p ˂.001), and patient safety awareness (r=.69, p˂.001). The factors affecting patient safety activities were patient safety awareness and patient safety knowledge, with an explanatory power of 55%.

Conclusion: To practice patient safety activities and maintain a desirable attitude, an educational strategy that promotes cognitive change, such as a systematic and continuous practice-oriented campaign, is needed. Furthermore, efforts to improve the working environment to extend the tenure of experienced caregivers are required.

Background: The co-occurrence of frailty, sarcopenia and malnutrition has been well studied in inpatient and nursing home settings, which are associated with a higher risk of all-cause mortality. However, multicentre data from community-dwelling outpatient settings are lacking. Therefore, we aimed to find the prevalence of frailty, possible sarcopenia and malnutrition, their overlap, and the associated factors in community-dwelling older outpatients.

Methods: We collected data from community-dwelling outpatients aged 60 years in Indonesian geriatric care centres to conduct this cross-sectional study with bivariate and multivariable analyses. Frailty, possible sarcopenia and malnutrition diagnoses were based on the FRAIL scale, AWGS 2019 consensus and MNA-SF, respectively.

Results: The prevalence of frailty, possible sarcopenia and malnutrition in community-dwelling older outpatients was 13.6%, 45.5% and 5.3%, respectively, while the prevalence of their co-occurrence was 3.3%. The prevalence was associated with transient ischaemic attack (TIA) and cerebrovascular accident (OR, 5.53; 95% CI: 1.48-20.61), cognitive impairment (OR, 3.70; 95% CI: 1.21-11.31), and dependent functional capacity (OR, 11.62; 95% CI: 3.38-39.99). The three evaluated syndromes were found to overlap in 24.1%, 7.2% and 61.3% of subjects with frailty, possible sarcopenia and malnutrition, respectively. Of these subjects, a substantial proportion were female or had low educational attainment, diabetes mellitus, hypertension, cognitive impairment, multimorbidity or dependent functional status.

Conclusion: Approximately 1 in 30 community-dwelling older outpatients had overlapping frailty, possible sarcopenia and malnutrition. The condition is associated with TIA and cerebrovascular accident, cognitive impairment and dependent functional capacity. Standardized screening in community-dwelling older population is necessary.