Annals of Geriatric Medicine and Research最新文献

Background: The World Health Organization published the 2019 Integrated Care for Older People (ICOPE) framework to guide, assess, and promote the intrinsic capacity of older adults, referring to their physical and mental health. This study aims to investigate the relationship between intrinsic capacity (IC) and frailty among older adults.

Methods: This cross-sectional study was conducted in a medical center in Taiwan in 2021. Two hundred ten patients over 65 admitted to the geriatric ward were invited to participate. The questionnaire included an IC measure, Fried's frailty scale, and demographic items. The IC measure was ascertained using the six domains of ICOPE (cognition, mobility, nutrition, visual, hearing, and depressive symptoms). The Fried's frailty scale was used to categorize participants as robust (Fried's frailty scale=0), prefrail (Fried's frailty scale=1-2), or frail (Fried's frailty scale ≥3). Multinomial logistic regression was used to analyze the association between individual ICOPE domains and frailty stages, while adjusting for confounders.

Results: 39.0% were prefrail, and 28.6% were frail. Mobility loss and depressive symptoms were significantly associated with prefrail (adjusted odds ratio (aOR): 4.44, 95% CI: 1.82-10.82; aOR: 8.41, 95% CI: 1.75-40.37) and frail (aOR: 11.57, 95% CI: 3.63-36.93; aOR: 13.77, 95% CI: 2.62-72.49) individuals, respectively. Malnutrition (aOR: 4.01, 95% CI: 1.18-13.62) and hearing loss (aOR: 4.37, 95% CI: 1.09-19.66) were significantly associated with frail older adults.

Conclusions: Mobility loss and depressive symptoms occurring at the prefrail stage could be used as assessment items for early detection of prefrail.

Many frail older patients with multiple comorbidities are hospitalized in long-term care hospitals and nursing facilities. Due to pre-existing conditions and immunosuppressive states, there are significant individual differences, such as weakness, sluggishness, and asymptomatic status. These differences make it challenging to find a patient's exacerbation using a conventional threshold of vital signs. We developed a circadian rhythm anomaly-detection system designed for each patient, which compares each patient's past 2 weeks average respiratory rate circadian rhythm with that of the last 24 hours. Respiratory rate was measured using a piezoelectric sensor located under the mattress. Prior to the doctor's diagnosis of acute exacerbation of lobar pneumonia and heart failure, a bedridden 88-year-old female patient with multiple chronic diseases showed abnormal circadian rhythm status. However, there were no significant changes in vital signs. A circadian rhythm anomaly-detection system appears promising as a future tool to promote medical checkups for the older person.

Background: This study aimed to reveal demographic data for care-dependent older adults receiving home medical care and to evaluate whether potentially inappropriate medication (PIM) prescriptions were associated with hospitalization and death.

Methods: Data of healthcare and long-term care (LTC) insurance claims of older adults aged ≥65 years receiving home medical care in Kure city, Japan, in April 2017 were obtained. They included age, sex, recorded diagnosis on medical claims, level of LTC needs, and medication profile. Hospital admissions and deaths were identified between April 2017 and April 2019. Factors associated with hospitalization/death and PIM (≥1 PIM) defined by the Screening Tool of Older Persons' potentially inappropriate Prescriptions for Japanese were analyzed statistically.

Results: A total of 2,052 participants (mean age 86.5±7.4 years, female 71.7%) were included. The mean number of prescribed medications was 6.6±4.3. PIM increased as LTC level became severe (8.7% for support level 1&2; 22.6% for care level 1&2; 26.0% for care level 3-5). Among PIM, H2 receptor antagonists were the most common medication (29.0%), followed by antiplatelet agents (22.6%), magnesium oxide (19.4%), non-benzodiazepine sedatives (17.7%), and benzodiazepines (16.8%). On logistic regression analysis, the number of medications, PIM, and care level 1&2 were associated with a higher likelihood of hospital admission. There was no significant correlation between each PIM and hospital admissions. Regarding death, while age was associated with a higher likelihood, female sex and severe level of disability were associated with a lower likelihood.

Conclusion: PIM was prevalent among homebound older adults, suggesting that careful medication review should be conducted, especially in those with disability.

Background: Physical activity (PA) has long been considered a key strategy in the management of sarcopenia. To our knowledge, this is the first study to examine domain-specific physical activity, including leisure-time and occupational activities, in relation to possible sarcopenia (PS) among middle-aged and older adults.

Methods: We analyzed a total of 15,819 adults aged ≥40 years. PS was defined on the basis of handgrip strength (males <28 kg and females <18 kg) according to the Asian Working Group for Sarcopenia. The Global Physical Activity Questionnaire was used to evaluate domain-specific PA, including weekly leisure-time or occupational moderate-to-vigorous PA (MVPA). MVPA was classified into three categories: no activity, 1-149 min/week, and ≥150 min/week. Parameters potentially related to PS or PA were included as covariates: age, sex, household income, education, medication, alcohol and smoking habits, nutritional status, and body weight.

Results: Compared with participants with no leisure-time MVPA, those with 1-149 min/week and ≥150 min/week of leisure-time MVPA had odds ratios (95% confidence intervals) of 0.64 (0.54, 0.74) and 0.60 (0.52, 0.68) for PS, respectively (p<0.001 for both). However, occupational MVPA was not significantly related to PS. Subgroup analyses stratified by sex, age, and sedentary time revealed no significant heterogeneity (all p-values for interactions >0.05).

Conclusion: These findings demonstrate that PS is inversely related to leisure-time PA but not to occupational PA among middle-aged and older adults, suggesting that PA programs that focus specifically on leisure-time activities may be necessary to prevent and manage possible sarcopenia.

Background: Trauma remains a leading cause of death and disability. With the rapidly growing aging population, geriatric patients face heightened trauma risks due to physiological decline and comorbidities. Despite the growing burden, data on the clinical characteristics, injury mechanisms, patterns, and healthcare utilization in this group remain limited. This study analyzed trauma outcomes and associated factors in geriatric patients.

Methods: We conducted a retrospective cohort study using data from a Level I trauma center. Patients aged ≥65 years were compared with younger adults (<65 years). Variables included demographics, injury mechanism, Glasgow Coma Scale (GCS), Revised Trauma Score (RTS), Abbreviated Injury Scale (AIS), Injury Severity Score, clinical outcomes, and medical costs. Multivariate logistic regression identified mortality predictors.

Results: Among 10,358 trauma patients with mean age of 54.2 years, 61.9% of younger patients were male, compared to 37.7% in the geriatric group (p<0.001). Geriatric patients exhibited lower male predominance, higher costs, and greater mortality (p<0.001). Multivariable analysis revealed that, among geriatric groups, male sex, older age, lower GCS, lower RTS, burns injuries, and severe injuries (AIS ≥3) to head, thoracic, extremity, and appearance were significant mortality predictors. Undergoing orthopedic and thoracic surgeries was associated with lower mortality in geriatric patients.

Conclusion: Geriatric trauma patients experience higher mortality risks and demands. Timely interventions, critical care management, appropriate triage, and age-adapted assessment tools are essential for improving clinical outcomes. These findings underscore the importance of interdisciplinary care strategies to optimize geriatric trauma management and resource utilization.

Background: Mental health disorders among older adults are an increasing global concern, with depression affecting up to 30% globally and even higher in developing countries. In Indonesia, despite high prevalence, little is known about how mental health services are utilized by older adults under the National Health Insurance (JKN) program. This study aims to examine patterns of mental health service utilization among older adults (aged ≥60 years) enrolled in the JKN program.

Methods: We conducted a retrospective cohort study using the 2024 BPJS Kesehatan Mental Health Contextual Sample, which was based on stratified random sampling. The sample included 5,966 older adults who were alive by December 31, 2023, and had at least one mental health diagnosis (International Classification of Diseases 10th revision [ICD-10] F00-F99). JKN membership categories include formal workers (PPU), informal workers (PBPU), government-subsidized groups (PBI), and non-workers. Data analysis included descriptive statistics and generalized linear modeling to assess factors associated with service utilization.

Results: Anxiety and neurotic disorders were the most common diagnoses (36.0%), followed by psychotic disorders (28.3%) and mood disorders (19.0%). The mean number of visits per person per year was 4.94±5.18. The PPU group had higher utilization than other participant groups, while those never married and those in higher ward classes had significantly lower utilization. Age was inversely associated with service use. No significant differences were observed by gender or divorce status.

Conclusion: These findings highlight the value of administrative claims data to monitor mental health service use in later life. Efforts to address disparities across sociodemographic groups could enhance equitable access to mental healthcare for older adults.

Background: With increasing life expectancy, the number of older adults with multiple chronic conditions requiring complex medication regimens is growing, raising concerns about polypharmacy and potentially inappropriate medication (PIM) use. This study investigated trends in polypharmacy and PIM use among 66-year-olds in South Korea from 2012 to 2021, considering participant characteristics, to inform interventions and policies.

Methods: A repeated cross-sectional study was conducted using the National Health Insurance Services database covering approximately 97% of Koreans. We included 3,397,044 individuals aged 66 who underwent the National Screening Program for Transitional Ages between 2012 and 2021. Polypharmacy was defined as the use of ≥5 medications for ≥90 days annually, hyper-polypharmacy as ≥10 medications, and PIM use as ≥1 PIM for ≥28 days. Trends were analyzed by sex, frailty, comorbidity, income, insurance type, and residence.

Results: Polypharmacy prevalence increased from 32.0% in 2012 to 35.4% in 2021, and hyper-polypharmacy also rose. PIM use slightly decreased from 55.7% to 53.7%. Higher rates of polypharmacy and PIM use were observed among rural residents, medical aid beneficiaries, and those with lower income. Despite improvements in comorbidity and frailty, socioeconomic disparities widened, particularly among medical aid beneficiaries. Frequently prescribed PIMs included NSAIDs, PPIs, muscle relaxants, and anxiolytics/hypnotics.

Conclusion: While PIM use slightly decreased over the study period, it remained above 50%, and polypharmacy prevalence increased among older adults in Korea. Socioeconomic disparities in medication use persist, highlighting the need for targeted interventions and policies to promote safe medication use among vulnerable groups.

Background: While adiposity has been found to be protective against adverse outcomes in older adults, the role of muscle in this association remains underexplored. This study sought to evaluate sex-specific mortality associated with available adiposity indices in older adults and the potential role of muscle strength in this relationship.

Methods: Individuals aged ≥55 years were recruited from 2013 to 2015. Adiposity indices obtained were body mass index (BMI), percentage body fat (%BF), waist-to-hip ratio (WHR), and waist circumference (WC). Vital status up to June 2022 was determined through the National Registry Department.

Results: Of the 1,347 included participants, mean age of 68.45±7.21 years, 57.1% female, and 11.2% deaths were recorded. Male who were underweight had increased mortality compared to male with normal BMI (hazard ratio [HR]=3.17, 95% confidence interval [CI] 1.35-7.47). Mortality was greater in male with %BF within the highest quartile (Q4) compared to the lowest quartile (Q1) (HR=4.72, 95% CI 2.07-10.78). Increased mortality in both male and female in Q4 for WHR compared to Q1 was influenced by age, as was increased mortality in female in Q4 for %BF. WC did not predict mortality in male or female. Increased mortality risk was present in male with normal muscle strength and increased %BF, and reduced muscle strength in male with low BMI.

Conclusions: Adiposity measured with BMI, WHR and WC had limited value in determining mortality risk at 9-year follow-up among individuals aged ≥55 years. Increased mortality was, however, observed in male with higher %BF but this could not be attributed to muscle strength.