Annals of Geriatric Medicine and Research最新文献

Background: Elderly patients visiting the emergency department (ED) are at increased risk of adverse outcomes, including ED revisits and mortality. Sarcopenia quantification by point-of-care ultrasound (POCUS) may be a useful bedside screening tool, especially when traditional frailty screening instruments, reliant on history taking, cannot be used. This study evaluated whether POCUS measurement of rectus femoris cross-sectional area (RFcsa) can predict adverse outcomes in elderly patients visiting the ED.

Methods: In this single-centre prospective study, patients aged ≥70 years presenting to the ED of a Dutch university hospital and enrolled in the Acutelines data and biobank were included. RFcsa was measured using POCUS. ROC-analysis assessed the overall accuracy of RFcsa for prediction of the primary outcome, which was defined as the composite of ED revisit or death within 3 months. Logistic regression determined the added value of RFcsa to Karnofsky Performance Score (KPS).

Results: During the study period, a total of 68 patients were included. 26 patients (38%) met the primary endpoint. RFcsa showed excellent intra-rater reliability (ICC = 0.98). However, the accuracy to predict the composite endpoint was low, with an area under the curves (AUC) of 0.53 (0.39-0.66) for unadjusted RFcsa and, 0.51 (0.36-0.66) for sex-adjusted RFcsa and 0.53 (0.37-0.68) for height-adjusted RFcsa. The addition of RFcsa in a multivariate logistic regression model with KPS did not increase the overall explained variance in the primary endpoint.

Conclusion: In elderly patients presenting in the ED, POCUS-measured RFcsa does not predict ED revisits or death within 3 months.

Renal function declines with age as the kidneys become more vulnerable to inflammation and cellular senescence. This study examined gene expression changes linked to renal aging and assessed whether short-term calorie restriction (CR), a known anti-aging intervention, could reverse these alterations. Using RNA-seq data, we applied bioinformatics, systems biology, and molecular biology approaches to identify differentially expressed genes during aging and under CR. Gene Ontology and pathway analyses revealed that both aging and CR altered the expression of key senescence-associated secretory phenotype (SASP) genes, including cytokines and chemokines (Il1b, Ccl3, Ccl5, Il19, and Il24) and growth factors (Timp1 and Mmp12). Renal aging is also associated with an increased expression of cell cycle arrest markers (P15INK4B (Cdkn2b), P16INK4A (Cdkn2a), and P21 (Cdkn1a)), which are suppressed by CR, suggesting a link to cellular senescence. Quantitative analysis of renal tissue samples confirmed the age-associated upregulation of these genes at the transcriptional level, and CR effectively attenuated these changes. Among these genes, we focused on the members of the IL-20 family, particularly Il19 and Il24. Furthermore, experimental induction of cellular senescence using H₂O resulted in elevated Il19 and Il24 expression alongside other senescence markers. These findings suggest that aging and short-term CR regulate the IL-20 family expression, potentially influencing cellular senescence. Our study suggests that Il19 and Il24 are associated with age-related renal decline and may represent hypothesis-generating candidates, highlighting potential molecular targets for future mechanistic and therapeutic investigations.

Background: Although a recent study reported an association between cachexia, as defined by the Asian Working Group for Cachexia (AWGC), and lower functional recovery at discharge among post-stroke patients capable of oral intake during the convalescent rehabilitation phase, its impact on functional recovery in patients with dysphagia remains unclear. This study aimed to evaluate the association between cachexia, according to AWGC criteria, and both functional status and discharge destinations among inpatients with dysphagia.

Methods: This prospective cohort study enrolled 198 inpatients with dysphagia from eight convalescent rehabilitation hospitals. Cachexia was defined using the AWGC criteria at baseline. The primary outcome was the total Functional Independence Measure (FIM) at discharge, while the secondary outcomes were the Food Intake LEVEL Scale (FILS) score and discharge destinations. We applied generalized linear models to evaluate the association between cachexia and total FIM score at discharge, adjusting for age, sex, baseline FILS score, comorbidities, and use of enteral nutrition.

Results: Of 198 patients, the median age was 83.0 (interquartile range, 77.0 to 88.0) years; 111 (56.1%) were women, and 33 (16.7%) had cachexia. After adjusting for covariates, cachexia was not significantly associated with total FIM score at discharge (β = 0.03 [95% CI, -0.10 to 0.15], p = 0.66), FILS (β = 0.23 [95% CI, -0.53 to 1.00], p = 0.55), or discharge destinations including discharge to home (β = 0.25 [95% CI, -0.75 to 1.35], p = 0.63).

Conclusions: Cachexia, as defined by the AWGC, was not significantly associated with either functional status at discharge or discharge destinations among inpatients with dysphagia undergoing convalescent rehabilitation.

Background: Hypertension and chronic pain frequently co-occur in older adults. However, research on this association in older hypertensive patients is scarce. Self-perceptions of aging (SPA)-one's concept about aging-correlates with pain-related quality of life (pQOL) and predicts medication adherence, a pillar of blood pressure (BP) control. This study examined the association between pQOL and uncontrolled BP in older hypertensive patients, exploring whether SPA and medication adherence mediate it: a novel exploration of psychological-behavioral pathways in pain-hypertension association.

Methods: The study involved 622 hypertensive patients aged 60 and above in Suzhou, China. Variables were compared using ANOVA and χ2 tests, respectively. Adjusted binary logistic regression models examined the pQOL-uncontrolled BP relationship, while Spearman correlation analyzed associations between pQOL, medication adherence, and negative control. We performed chain mediation analysis (PROCESS Macro) with bootstrapping.

Results: Higher pQOL scores significantly predicted uncontrolled BP (Q2, Q3, Q4; odds ratio [OR]=2.77, 5.50, 3.45; p=0.002, <0.001, 0.001, respectively). Negative control mediated the relationship between pQOL (b=-0.007, p<0.001) and uncontrolled SBP (OR=0.670, p<0.01, respectively), while the chain mediation of negative control and medication adherence contributed to both uncontrolled SBP (mediation effect=0.017, p<0.01) and uncontrolled DBP (mediation effect=0.018, p<0.01).

Conclusion: Higher pQOL scores was associated with higher prevalence of uncontrolled BP. The mediating role of negative control and medication adherence was identified in the relationship between pQOL and uncontrolled BP (SBP/DBP) in older hypertensive patients.

Background: Vertebral compression fractures (VCFs) are common among older adults, with the highest prevalence observed in Japan. These fractures cause pain, reduce quality of life, and increase the need for physical therapy. This study identified key factors at admission that predict walking ability at discharge in patients with VCFs.

Methods: This retrospective cohort study included 143 patients aged ≥65 years with VCFs. VCFs are fractures in which only the anterior column of the vertebral body collapses. The primary variables assessed upon admission included the revised Hasegawa Dementia Scale (HDS-R) score, grip strength, skeletal muscle mass index (SMI), and phase angle (PhA). Propensity score matching was applied to adjust for background factors, after which a logistic regression analysis using a generalized linear model was conducted to determine whether these variables influenced walking ability at discharge.

Results: Significant associations were observed between walking ability at discharge and HDS-R score at admission (p<0.001, effect size [ES]=0.42), grip strength (p=0.027, ES=0.23), SMI (p=0.025, ES=0.23), and PhA (p<0.001, ES=0.40). Logistic regression analysis indicated that HDS-R score (odds ratio [OR]=1.19, p=0.005) and PhA (OR=3.21, p=0.015) during admission significantly predicted walking ability at discharge.

Conclusion: Walking ability at discharge in patients with VCFs can be predicted based on early assessments. In particular, HDS-R score and PhA at admission may serve as key indicators for prognosis in patients with VCFs.

Background: This study aims to estimate the average life expectancy of the Tokugawa Shogun family by analyzing historical documents. The data is also compared to modern Japanese life expectancy figures.

Methods: The lifespan of members of the Tokugawa Shogun family is estimated based on data from Edo-period documents. We assess survival rates by age, sex, and other factors. Lunar calendar dates are converted into solar calendar dates, and birth years are counted as age 0 to ensure that the estimated life expectancy is comparable to modern Japanese estimates, free from bias.

Results: The mean life expectancy at birth for males in the Tokugawa Shogun family is 20.93±25.03 years, and for females, it is 20.53±25.16 years. The pooled result for both sexes is 20.75±25.00 years.

Conclusions: The life expectancy of the Tokugawa Shogun family is lower than that of modern Japanese, despite their status as the supreme elite class in Edo-period Japan. This reduced life expectancy is primarily attributed to high infant mortality rates, though survival rates for individuals aged 10 and above remained relatively consistent.

Background: Caring for very frail community-dwelling older adults is challenging because of their complicated medical backgrounds. The lack of timely medical support leads to frequent Accident and Emergency Department (AED) attendance, prolonged hospitalizations, and discharge problems. Integrated Care at Home (ICAH) program aims to support aging in place by establishing an on-site, need-based, integrated medical care model, so as to reduce hospital burden and caregiver stress.

Methods: The ICAH program serves community-dwelling frail elderly who are bedridden, functionally dependent, in need of intensive medical and nursing care, and with frequent or prolonged hospitalizations, by providing regular on-site community nurse and geriatrician visits, ad-hoc consultations and caregiver support. This retrospective observational study included patients recruited to ICAH between February 1, 2018 to August 31, 2023. We reviewed our service provision, patients' demographics, 180-day AED visits and hospitalization days, and caregivers' 3-month Relative Stress Scale.

Results: Seventy-six patients were recruited with a median age of 90 and a median Clinical Frailty Scale of 8. Among them, 92% had advanced dementia, 30% had deep pressure injuries, and 43% had recurrent sepsis within a year; 3.7 nursing and 0.4 medical visits were delivered per patient per month. The 180-day AED attendance rates decreased from 15.3 to 3.2 per 1,000 PD (patient days) (p<0.001). Rates of hospitalization days decreased from 266.4 to 29.7 per 1,000 PD (p<0.001). Median Relative Stress Scale decreased from 24.5 to 16 (p=0.001) at 3 months.

Conclusion: The ICAH program is able to facilitate community care for the very frail elderly, significantly reducing their AED attendance, hospital stay, and caregiver stress.

Background: This study examined factors associated with later-life preparation among aging individuals with disabilities living in South Korea.

Methods: We used secondary data from 2,942 individuals aged 50 and older from the Disability Life Panel Survey and performed binary logistic regression.

Results: Most participants did not prepare for later life and were men, had a high school education or less, and were unemployed. Logistic regression identified factors associated with later-life preparation: education level and employment status (sociodemographic characteristics), types of disability and recent health condition (health condition), self-esteem and disability acceptance (psychological factors), and residential environment assessment and satisfaction with family relationships (environmental factors).

Conclusion: These findings highlight the need for a comprehensive approach to preparing aging individuals with disabilities for later life.

Background: Phase angle (PhA) is a potential indicator of nutritional status and functional outcomes. However, optimal regional PhA cutoff values for predicting activities of daily living (ADL) post-stroke are unclear. We aimed to determine these cutoffs and assess whether PhA adds prognostic value to established clinical models.

Methods: In this retrospective cohort study, stroke patients undergoing inpatient rehabilitation had body composition and PhA measured via multi-frequency bioelectrical impedance analysis. The primary outcome was ADL independence at discharge (motor Functional Independence Measure >78). Receiver operating characteristic (ROC) curves identified optimal PhA cutoffs; logistic regression assessed their predictive value, adjusting for confounders. Incremental discriminative ability was evaluated using area under the ROC curve (AUC) comparisons with DeLong's test.

Results: Among 1,080 patients (median age, 75.6 years; 54.1% men), optimal PhA cutoffs were: whole-body (women 3.90°, men 4.60°), non-paretic upper limb (4.45°, 4.90°), and non-paretic lower limb (4.00°, 4.80°). Higher PhA values above these cutoffs were independently associated with ADL independence (all p<0.05). Adding whole-body PhA to the baseline model improved AUC from 0.937 to 0.970 (ΔAUC=0.033; p=0.011); significant gains were observed for limb PhA.

Conclusions: Optimal site-specific PhA cutoffs predict ADL independence at discharge in post-stroke patients. PhA provides significant incremental prognostic value beyond established clinical models, supporting its use in tailoring rehabilitation strategies.