Annals of Geriatric Medicine and Research最新文献

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: To investigate the incidence and perioperative risk factors for postoperative delirium (POD) in non-dementia older patients who underwent anesthesia for non-cardiac surgery.

Methods: This prospective cohort study was conducted on 195 non-dementia older patients, aged 60 years or older, who were hospitalized after non-cardiac surgery and anesthesia. The Confusion Assessment Method for the Intensive Care Unit was used to evaluate the occurrence of POD. Incidence of POD was reported. We conducted univariate and multivariate logistic regression to identify the risk factors associated with POD.

Results: A total of 195 patients were enrolled; 172 completed the study. POD occurred in seven patients within three days after anesthesia, which is a 4.1% incidence of POD. Multivariate logistic analysis showed arrhythmia, coagulopathy, urinary comorbidity, minimum intraoperative heart rate, and minimum post-anesthesia care unit (PACU) pain score as independent risk factors for POD. A minimum PACU pain score >1 is the optimum cutoff pain score for developing POD, with a sensitivity of 85.7% and a specificity of 69.1%. The postoperative complication rate and in-hospital mortality were significantly higher for patients with POD compared to those without POD.

Conclusion: The incidence of POD in the study population is 4.1%. Arrhythmia, coagulopathy, urinary comorbidity, minimum intraoperative heart rate, and minimum PACU pain score were independent risk factors for POD. The minimum PACU pain score is the strongest independent risk factor of POD. POD is associated with increased postoperative complications and in-hospital mortality rates in non-dementia older patients.

Background: The need for support focused on frailty and quality of life (QoL) in older adults is increasing. The Kihon Checklist (KCL) is a comprehensive and easy-to-use tool to assess frailty in older adults. Previous studies have shown associations between frailty and QoL; however, few studies have investigated the association between frailty using the KCL and QoL. In this study, the quantitative relationship between the KCL and QoL in community-dwelling older adults was investigated.

Methods: This cross-sectional study included from participants in the 2017-2019 baseline survey of a cohort study of community-dwelling older adults in Sapporo, Japan. The World Health Organization-Five Well-Being Index (WHO-5) was used to assess QoL. The KCL was used to assess frailty, and the relationship between frailty and QoL was examined using binomial logistic regression analysis and restricted cubic spline models.

Results: Four-hundred participants were included in the analysis. Of the participants, 22.5% had a lower QoL and they were more likely to have frailty than healthy participants (p<0.001). The KCL scores were significantly associated with a lower QoL (p<0.001). Furthermore, the association between the KCL score and QoL was linear, and subscales of activities of daily living, and depressive mood were significantly associated with a lower QoL.

Conclusion: The KCL, a comprehensive frailty questionnaire, was associated with a lower QoL in older adults. To maintain QoL in community-dwelling older adults, it is necessary to provide them with appropriate support from the stage before they are identified as frail by the KCL.

Background: The co-occurrence of frailty, sarcopenia, and malnutrition was well studied in inpatient and nursing home settings, which was associated with higher risk of all-cause mortality. Multicentre data in community-dwelling outpatient setting were lacking. 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 FRAIL scale, Asian Working Group for Sarcopenia 2019 consensus, and Mini Nutritional Assessment Short Form, respectively.

Results: The prevalence of frailty, possible sarcopenia, and malnutrition in community-dwelling older outpatients were 13.6%, 45.5%, and 5.3%, respectively. The prevalence of co-occurrence of frailty, possible sarcopenia and malnutrition was 3.3%. It was associated with transient ischemic attack (TIA) and cerebrovascular accident (odds ratio [OR]=5.53, 95% confidence interval [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). Overlap of three evaluated syndromes was found in 24.1%, 7.2%, and 61.3% of subjects with frailty, possible sarcopenia, and malnutrition, respectively. It was characterized by a substantial proportion of female sex, older adults with low educational attainment, diabetes mellitus, hypertension, cognitive impairment, multimorbidity, and 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.

Background: This study investigates factors influencing cane use among older adults and identifies most significant determinants.

Methods: This study is a cross-sectional study. A total of 160 community-dwelling older adults (mean age, 79±7 years) were included in the analysis. Binomial logistic regression analysis was conducted using the presence or absence of cane use as the dependent variable, and the associated factors were investigated.

Results: There were 108 participants (mean age, 77±7 years) in the cane-non-using group and 52 (mean age, 83±6 years) in the cane-using group. Factors associated with the presence or absence of cane use were open-eyed one-leg standing time (odds ratio [OR]=0.81; 95% confidence interval [CI], 0.70-0.93; p=0.003) and depressed mood (OR=2.78; 95% CI, 1.31-5.91; p=0.008).

Conclusion: Older adults with reduced balance ability and depressive mood need to use a cane. This highlights the need to assess balance ability and depressed mood in prescribing a cane to older adults. Appropriate prescription of canes has the potential to enrich the lives of older adults by contributing to their safe range of activities.

Background: Calf muscle circumference is a potential alternative for measuring skeletal muscle mass. However, the association between calf muscle circumference and sarcopenia and the reliability of sarcopenia diagnosis based on calf muscle circumference have not been well reported. In this study, we aimed to determine the usefulness of calf muscle circumference measurement in the diagnosis of sarcopenia.

Methods: A cross-sectional study was conducted using data collected from 63 older adults (40 male and 23 female; mean age, 79.7±6.5 years) using day-care rehabilitation. Sarcopenia was defined according to the guidelines of the 2019 Asian Working Group for Sarcopenia (AWGS 2019). The association between sarcopenia and calf muscle circumference was determined using multiple regression analysis, and the reliability of sarcopenia diagnosis based on calf muscle circumference was determined using the kappa coefficient.

Results: Overall, 36.5% (30.4% female and 40.0% male) of the participants had sarcopenia. Calf muscle circumference was independently associated with sarcopenia. The best cutoff points for calf muscle circumference to identify older adults at risk of low skeletal muscle mass were 28.7 cm and 31.1 cm for female and male participants, respectively. Furthermore, the kappa coefficient between sarcopenia diagnosed using calf muscle circumference and that diagnosed using the AWGS 2019 criteria was 0.80.

Conclusions: Calf muscle circumference is independently and significantly associated with sarcopenia in older adults requiring long-term care. Calf muscle circumference is a surrogate for skeletal muscle mass and thus may be used to diagnose sarcopenia.

Background: The recent published Korean Working Group on Sarcopenia (KWGS) guideline includes the concept of functional sarcopenia. The study investigated the prevalence of sarcopenia and its association with health-related adverse outcomes defined by the KWGS in community-dwelling older adults.

Methods: Data were sourced from the Korean Longitudinal Study on Health and Aging, focusing on Koreans 65 aged and above. The definitions of sarcopenia and functional sarcopenia followed the KWGS. The risks of falls, mobility limitation, and death were analyzed using logistic regression and Cox proportional hazard.

Results: Of the 594 participants, 145 (24.4%) were classified as having functional sarcopenia and 129 (12.0%) with sarcopenia. Both showed an increased prevalence with age. Functional sarcopenia had higher risks of mobility limitation (odds ratio [OR]=3.461; 95% confidence interval [CI], 1.956-6.121) and mortality (hazard ratio [HR]=1.775; 95% CI, 1.229-2.564). Sarcopenia was associated with falls (OR=7.376; 95% CI, 1.500-36.272), mobility limitation (OR=2.057; 95% CI, 1.172-3.611) and mortality (HR=1.512; 95% CI, 1.054-2.169).

Conclusion: Functional sarcopenia is a prevalent condition that is associated with mobility limitation and mortality in community-dwelling older adults. This highlights the clinical relevance of functional sarcopenia and supports its inclusion in sarcopenia diagnosis.

Background: In vitro and animal studies have demonstrated that bone morphogenetic protein-7 (BMP-7), renowned for its osteogenic properties, also exerts beneficial effects on muscle metabolism by enhancing myogenesis and reversing muscle atrophy. Despite being proposed as a common regulatory factor for both muscle and bone, the impact of BMP-7 on human muscle health has not been thoroughly investigated.

Methods: This cross-sectional study involved 182 community-dwelling older adults who underwent a comprehensive geriatric assessment in South Korea. Sarcopenia was diagnosed using Asian-specific cutoffs, and serum BMP-7 levels were quantified via enzyme immunoassay.

Results: The mean age of the participants was 72.2±7.3 years, with 62.6% being female. After adjustments for confounders, serum BMP-7 levels were not significantly different between individuals with and without sarcopenia, nor were there differences based on skeletal muscle mass, strength, or physical performance levels (p=0.423 to 0.681). Likewise, no correlations were detected between circulating BMP-7 levels and any sarcopenia assessment metrics such as skeletal muscle index, grip strength, gait speed, or chair stand completion times (p=0.127 to 0.577). No significant associations were observed between increases in serum BMP-7 concentrations and the risk of sarcopenia or poor muscle phenotypes (p=0.431 to 0.712). Stratifying participants into quartiles based on serum BMP-7 levels also indicated no differences in sarcopenia-related parameters (p=0.663 to 0.996).

Conclusion: Despite experimental evidence supporting BMP-7's role in muscle metabolism, this study found no significant association between serum BMP-7 levels and clinical indicators of muscle health in older adults. These findings challenge the utility of serum BMP-7 as a biomarker for sarcopenia in this demographic.

Background: Older people living with human immunodeficiency virus (OPLWHIV) on antiretroviral therapy are aging and face an increased risk of non-communicable diseases. The burden is costly and demands sustainable care for HIV comorbidity. The aim is to understand the experiences of OPLWHIV comorbidity attending healthcare services.

Methods: The 28 reviewed articles focused on experiences of OPLWHIV comorbidity attending healthcare services. The scoping review employed content analysis. A literature search was conducted on databases like PubMed, EBSCOhost, Google Scholar, and Subnet. Articles were restricted to English and published between 2013 and 2024. The study population included 50-85 years old.

Results: OPLWHIV comorbidity needs standardized, coordinated, and resourced healthcare services because of the unique difficulties of older adults.

Conclusions: OPLWHIV comorbidity experienced difficulties accessing coordinated services addressing complex pharmacoeconomics and psycho-social issues in resourced primary health care institutions, with promotive and preventive care to strengthen the healthcare system.