Annals of Geriatric Medicine and Research最新文献

Video capsule endoscopy (VCE) provides endoluminal visualisation of the small bowel. It is often regarded as well-tolerated, non-invasive, and safe across all age groups, with the main, albeit rare, complication of retention of the capsule - normally in the small bowel or lower gastrointestinal (GI) tract. Retention in the upper GI tract is extremely rare; here, we present a case of a 94-year-old who experienced capsule retention in a previously undiagnosed pharyngeal pouch. This appears to be the first case report detailing video capsule retention in a pharyngeal pouch involving a patient of such an advanced age, and in which endoscopic retrieval was not necessitated. The learning here is that patients should be evaluated for prior medical history or the possibility of a pharyngeal pouch before performing VCE.

Background: Evidence on the effectiveness of exercise for cognitive recovery in patients with sarcopenia is limited. This study examined the association between group-based chair-stand exercise and cognitive improvement during convalescent rehabilitation.

Methods: This retrospective cohort study included stroke patients with sarcopenia and impaired cognitive level, defined as a Functional Independence Measure (FIM)-cognitive score ≤23, admitted between 2016 and 2023. All patients received standard rehabilitation and participated in group-based chair-stand exercise twice daily. The frequency of exercise during hospitalization was recorded. The primary outcome was FIM-cognitive score at discharge. Secondary outcomes were handgrip strength (HG) and FIM-motor score. Multivariate linear regression analysis was used to examine associations between exercise frequency and outcomes, adjusting for potential confounders.

Results: Of the 1,220 patients admitted, 273 sarcopenic stroke patients with reduced cognitive level (mean age 80 years; 48% male) were included in the final analysis dataset; the median frequency of performing chair-stand exercise per day was 43 (interquartile range, 20-71). Higher exercise frequency was independently associated with better FIM-cognitive score at discharge (β=0.217, p<0.001), greater HG (β=0.146, p=0.008), and improved FIM-motor score (β=0.295, p<0.001).

Conclusion: Frequent participation in group-based chair-stand exercise was associated with improvements in cognitive and physical function in sarcopenic stroke patients. Incorporating simple, repetitive resistance exercises into rehabilitation programs may enhance recovery outcomes in this vulnerable population.

Background: Respiratory infections significantly impact older adults in Latin America, highlighting the need for regionally adapted consensus-based vaccination recommendations to guide preventive strategies. This study aimed to develop a consensus among Latin American experts on vaccination against respiratory diseases in older adults in the region, including influenza, Streptococcus pneumoniae pneumonia, coronavirus disease 2019 (COVID-19), respiratory syncytial virus (RSV), and pertussis.

Methods: A two-round Delphi methodology was employed, involving 35 specialists from various medical fields. A rapid evidence review was conducted using scientific databases and clinical practice guideline repositories. Participants evaluated each recommendation on a 1-to-5 scale; recommendations with 80% acceptance (score of 4 or higher) were approved.

Results: The consensus resulted in recommendations for administering Tdap (tetanus, diphtheria, and pertussis) boosters every 10 years for pertussis and annual influenza vaccination in adults aged 65 years or older, using high-dose or adjuvanted formulations. Additionally, primary and annual booster COVID-19 vaccinations were recommended, along with a single dose of RSV vaccine for individuals aged 75 years and older, providing protection for at least two winter seasons. Routine administration of pneumococcal conjugate vaccine 15 (PCV15) or PCV20 was also recommended for adults aged 65 years or older who had not previously received a PCV.

Conclusions: The consensus provides a vaccination guide tailored to the Latin American context, aiming to bridge gaps in vaccination coverage among older adults in the region. This effort seeks to reduce the burden of respiratory diseases on frail healthcare systems and promote healthy aging in Latin America.

Background: Poor hand dexterity may increase the risk of functional disability; however, few studies have examined the relationship between hand dexterity and incident functional disability. The aim of this study was to prospectively investigate the dose-response association of hand dexterity with incident functional disability in community-dwelling older adults.

Methods: This study included 1,069 older adults aged ≥65 years in Kasama City, Japan. Peg-moving and circle-drawing tasks were used to evaluate hand dexterity. Functional disability was identified using the Japanese Long-Term Care Insurance System database. Restricted cubic spline analysis was performed to investigate the dose-response association between hand dexterity and incident functional disability.

Results: During a mean follow-up of 8.5 years (maximum 14.0 years), 248 participants (23.2%) developed functional disability. The lowest performance group in each hand dexterity test had a significantly higher risk of functional disability than the highest performance group-peg-moving (hazard ratio [HR]=1.92, 95% confidence interval [CI] 1.29-2.87) and circle drawing (HR=1.66, 95% CI 1.15-2.41). Spline analysis confirmed curvilinear dose-response associations between hand dexterity and incident functional disability. Increased risk was observed when participants performed worse than the cut points (peg-moving, 37.9/38.0 seconds; circle drawing, 21/20 points), and no decreased risk was observed for those who performed better than these cut points.

Conclusion: Easily evaluated hand dexterity tests may be valuable for predicting functional disability in older adults. Curvilinear dose-response associations suggest that maintaining adequate hand dexterity could be a key strategy to support functional independence.

The increasing proportion of older adult drivers presents a growing road safety challenge in Korea, highlighted by a significant rise in traffic accidents involving individuals aged 65 years and older. In response, Korean authorities have implemented mandatory cognitive and physical assessments for license renewal, complemented by community-based educational programs. However, international comparisons reveal that the involvement of physicians as gatekeepers in assessing driver fitness is more robust in the United States and Canada, where legal frameworks either permit or require healthcare professionals to report medically at-risk drivers to licensing authorities. These systems balance public safety with patient confidentiality by providing statutory protection for reporting physicians, though barriers such as legal ambiguity, concerns over liability, and inconsistent practices persist. Evidence suggests that mandatory reporting laws increase physician engagement and reporting rates, yet emotional and ethical dilemmas may hinder compliance. In Korea, strengthening the physician's role in the driver license management system-supported by legal immunity and clear guidelines-could enhance early identification of at-risk drivers and reduce accident rates among older adults. A multidisciplinary approach, involving secondary assessments by occupational therapists and licensing authorities, is recommended to ensure objective evaluation of driving competence. Adopting a reporting model may further clarify responsibilities and improve outcomes. Ultimately, integrating physicians more actively into the licensing process is essential for safeguarding both older adult drivers' autonomy and public safety in an aging society.

Background: To ascertain the construct validity and reliability of a self-administered web-based assessment of intrinsic capacity (IC). The study design was a cross-sectional analysis using data from a prospective cohort.

Methods: We included data from 6,434 respondents (mean age 65.33±5.81 years; 52.4% women) of the Singapore Life Panel population study who participated in the online surveys in March 2022 and May 2022. Incremental nested factor structures of IC were modelled with confirmatory factor analysis (CFA) and their goodness-of-fit were assessed mainly with root mean square error of approximation (RMSEA), comparative fit index (CFI), Tucker-Lewis index (TLI), and standardized root mean square residual (SRMR). With the most parsimonious model as our eventual factor structure, we further evaluated IC and its domains with reliability indices.

Results: CFA demonstrated construct validity for the second-order factor structure with acceptable overall model fit: χ2(147)=7,696.276, p<0.001; CLI=0.947; TLI=0.938; RMSEA=0.089; SRMR=0.051. Amongst the domains, vitality had highest factor loading (0.889), whereas locomotion and cognition (0.534 and 0.601, respectively) had lowest loadings with the second-order IC factor. All five IC domains and the general IC factor fulfilled reliability thresholds (construct validity [CR] or hierarchical omega ≥0.7; average variance extracted ≥0.5); psychological and locomotion domains have high CR (>0.9), whereas vitality and sensory domains have lower values of CR.

Conclusion: Our study provides proof-of-concept evidence regarding the construct validity and reliability of a self-administered web-based assessment of IC index that can potentially be scalable in other population settings.

Background: To develop and apply a multidimensional Social Frailty Index (SFI) to estimate the prevalence of social frailty among older adults in four departments of Colombia.

Methods: A cross-sectional, analytical study was conducted using secondary data from the 2016 Survey on Health, Well-being, and Aging (SABE Colombia). The study included 3,506 individuals aged 60 years and older residing in Antioquia, Caldas, Risaralda, and Quindío. Variables from demographic, health, and social domains were analyzed using principal component analysis to construct the SFI. Individuals scoring above the 75th percentile were classified as socially frail.

Results: The prevalence of social frailty was 25.3% (95% confidence interval, 23.8-26.7), with higher rates observed among men (29.2%) and individuals aged 75 years and older (32.4%), as well as among residents of Antioquia. Four latent components were identified: functional dependence; social engagement and participation; social and emotional isolation; and perceived health and healthcare quality. The index showed consistency with theoretical frameworks and international tools.

Conclusion: This multidimensional index allows for early identification of vulnerable older adults, supporting targeted interventions and public health planning. Further research is needed to standardize measurement criteria and to evaluate the predictive value of social frailty in relation to outcomes such as disability, multimorbidity, mortality, and quality of life.

Background: The AD8 is a validated informant-based interview for early dementia detection. Research suggests the utility of self-rated AD8 to identify milder dementia forms in research settings. This study compares the factor structure, reliability, and diagnostic performance between AD8-self and AD8-informant for early cognitive impairment (ECI) in a clinical setting.

Methods: 515 patient-informant dyads [43 cognitively intact and 472 ECI] from a tertiary memory clinic completed both self-reported and informant AD8. We conducted exploratory factor analysis to determine the factor structure, Cronbach's alpha for internal consistency, and receiver operating characteristic (ROC) curve analysis for ECI, including a subgroup analysis for mild cognitive impairment (MCI).

Results: The mean age and education of ECI participants were 75.61 years (range, 51-95) and 5.6 years (range, 0-20), respectively, and 72.6 years (range, 51-89) and 6.8 years (range, 0-16) in the MCI subgroup. Unlike AD8-informant's one-factor structure, AD8-self had a two-factor structure corresponding to memory and non-memory domains. AD8-self demonstrated lower reliability (Cronbach's Alpha: ECI 0.666 vs. 0.764; MCI 0.663 vs. 0.709). In ECI, AD8-informant (cut-off ≥3) showed better diagnostic performance (Sensitivity: 89%, Specificity: 79%) than AD8-self (cut-off ≥4) (Sensitivity: 27.1%, Specificity: 95.3%) (AUC: 0.915 vs. 0.593, p<0.001). Similar results were found in MCI (Sensitivity: 64.7% vs 26.5%; Specificity:79.1% vs 95.3%; AUC:0.745 vs 0.600, p=0.002).

Conclusion: AD8-self has a distinct factor structure, lower reliability, and inferior diagnostic performance compared to AD8-informant for ECI/MCI detection. Our result do not support AD8-self as a standalone tool for detecting ECI or MCI.

Microscopic polyangiitis (MPA) is a rare ANCA-associated vasculitis that poses unique diagnostic and therapeutic challenges in seniors. We describe a 90-year-old female with diabetes, hypertension and heart failure who presented with anasarca and rapid renal failure. Evaluation revealed MPO-ANCA positivity, and renal biopsy confirmed pauci-immune crescentic glomerulonephritis. Her course was complicated by anemia and deep vein thrombosis. She was managed with high-dose corticosteroids, rituximab, and supportive hemodialysis, achieving improvement in renal function. This case highlights how comorbidities may obscure recognition of vasculitis and how assessment of frailty and baseline function are essential in weighing risks of immunosuppression in the seniors. Clinicians should maintain vigilance for ANCA-associated vasculitis in older adults with unexplained renal decline and tailor therapy to balance disease control with vulnerability to treatment toxicity.

Background: Phase angle (PhA) reflects cellular integrity and muscle quality. However, evidence is limited regarding whether an increase in PhA is associated with improvements in activities of daily living (ADL) and skeletal muscle mass. This study aimed to investigate the association between change in PhA and prognosis in terms of ADL and skeletal muscle mass in post-stroke patients undergoing rehabilitation.

Methods: This retrospective cohort study was conducted at a convalescent rehabilitation hospital in Japan. Patients with a PhA at admission below the cutoff values (4.76° for males and 4.11° for females) were included. Patients were categorized into a PhA-increase group (>0) and a non-increase group (≤0). Outcomes included the Functional Independence Measure (FIM)-motor score and skeletal muscle mass index (SMI) at discharge. Multivariate regression was used to assess associations.

Results: A total of 253 patients were included (mean age 78.0 ± 10.9 years; 51% women). The median [IQR] PhA at admission was 3.70° [3.20, 4.10], and the median change during hospitalization was 0.00° [-0.20, 0.30]. Of these, 119 patients had increased PhA and 134 did not. Change in PhA was independently associated with higher FIM-motor scores (β = 0.078, P = 0.040) and greater SMI (β = 0.454, P < 0.001) at discharge.

Conclusions: In post-stroke patients, an increase in PhA during hospitalization was associated with better functional and muscular outcomes. PhA may therefore serve as a valuable biomarker for assessing the efficacy of rehabilitation.