Annals of Geriatric Medicine and Research最新文献

Background: Lumbar spinal stenosis (LSS) impairs activities of daily living (ADL) in older adults. Factors associated with ADL impairment in LSS have not been identified. This study aimed to ascertain the pre-admission living conditions in older adults with LSS and investigate the factors associated with impairment in ADL.

Methods: A total of 261 community-dwelling older adults aged ≥65 years with LSS, scheduled for surgery were included. The Oswestry Disability Index (ODI) was used to assess ADL impairment. The Life-Space Assessment was used to assess the extent and frequency of outings. Pain, numbness, continuous walking distance, and health-related quality of life as psychosomatic functions. Falls self-efficacy and the degree of social isolation were assessed as social life status. Factors associated with ADL impairment were examined using multiple logistic regression analysis.

Results: Significant differences were found in psychosomatic functioning, living space, and falls self-efficacy depending on the presence or absence of ADL impairment. The ODI sub-components showed a stronger degree of impairment in pain intensity, walking, standing, and social life. There were significant differences in the frequency of going outside the home and inside the neighborhood, ADL impairment was shown to affect the frequency of outings within close proximity to their lives. Numbness was associated with ADL impairment (odds ratio=1.2; 95% confidence interval 1.1-1.4).

Conclusion: Assessing the degree of numbness is important in predicting ADL impairment in older adults with LSS. Additionally, assessing the living conditions and taking an appropriate approach before admission can help prevent ADL impairment.

Background: Systemic inflammation is associated with poor functional outcomes. However, the effects of improved inflammation on functional indicators remain unclear. This study aimed to clarify the relationship between improvements in systemic inflammation and activities of daily living in patients after stroke.

Methods: This retrospective cohort study included patients post stroke with systemic inflammation upon admission. Systemic inflammation was defined as a modified Glasgow Prognostic Score (mGPS) score of 1-2. Improvement in systemic inflammation was defined as a reduction in mGPS score or blood C-reactive protein (CRP) levels during hospitalization. The primary outcomes were the motor items of the Functional Independence Measure (FIM-motor) at discharge. We applied multiple linear regression analysis to examine whether reduced systemic inflammation was associated with outcomes after adjusting for confounding factors.

Results: Of the 1,490 patients recruited, 158 (median age of 79 years; 88 men) had systemic inflammation on admission and were included in the study. Among these patients, 131 (82.9%) and 147 (93.0%) exhibited reduced mGPS and CRP levels, respectively. The median change in CRP was 2.1 mg/dL (interquartile range, 1.1-3.8). Multivariate analysis revealed that improvements in mGPS (β=0.125, p=0.012) and CRP levels (β=0.108, p=0.108) were independently and positively associated with FIM-motor at discharge.

Conclusions: Improvement in systemic inflammation was positively associated with functional outcomes in patients post stroke. Early detection and therapeutic intervention for systemic inflammation may further improve outcomes in these patients.

Background: Muscle weakness in older adults elevates mortality risk and impairs quality of life, with the phase angle (PhA) indicating cellular health. Polypharmacy, common in geriatric care, could influence PhA. This investigates whether the number of medications and polypharmacy with PhA as a biomarker of muscle quality in older inpatients aged ≥65 and determines the extent to which multiple medications contribute to the risk of reduced muscle quality.

Methods: This retrospective cross-sectional study analyzed data from older inpatients requiring rehabilitation. PhA was measured using bioelectrical impedance analysis. The number of medications taken by each patient was recorded at admission. Polypharmacy was defined as the concurrent use of five or more medications at admission.

Results: In this study of 517 hospitalized older adults (median age 75 years; 47.4% men), 178 patients (34.4%) were diagnosed with sarcopenia. Polypharmacy was present in 66% of patients. The median PhA was 4.9° in men and 4.3° in women. Multivariate linear regression analysis was performed separately for men and women. In men, PhA was negatively correlated with the number of medications (β=-0.104, p=0.041) and polypharmacy (β=-0.045, p=0.383). In women, PhA was negatively correlated with the number of medications (β=-0.119, p=0.026) and polypharmacy (β=-0.098, p=0.063). Analyses were adjusted for age, body mass index, sarcopenia, C-reactive protein, and hemoglobin levels.

Conclusion: The number of medications at admission negatively impacted PhA in older inpatients, highlighting the importance of reviewing prescribed drugs and their interactions.

Background: Sarcopenia is a muscle-wasting condition that affects older individuals. It can lead to changes in movement patterns, which can increase the risk of falls and other injuries.

Methods: Older women participants aged ≥65 years who could walk independently were recruited and classified into two groups based on knee extension strength (KES). Participants with low KES scores were assigned to the possible sarcopenia group (PSG; n=7) and an 8-week exercise intervention was implemented. Healthy seniors with high KES scores were classified as the reference group (RG; n=4), and a 3-week exercise intervention was conducted. Kinematic movement data were recorded during the intervention period. All participants' exercise repetitions were used in the data analysis (number of data points=1,128).

Results: The PSG showed significantly larger movement patterns in knee rotation during wide squats compared to the RG, attributed to weakened lower limb strength. The voting classifier, trained on the movement patterns from wide squats, determined that significant differences in overall movement patterns between the two groups persisted until the end of the exercise intervention. However, after the exercise intervention, significant improvements in lower limb strength in the PSG resulted in reduced knee rotation range of motion and max, thereby stabilizing movements and eliminating significant differences with the RG.

Conclusion: This study suggests that exercise interventions can modify the movement patterns in older individuals with possible sarcopenia. These findings provide fundamental data for developing an exercise management system that remotely tracks and monitors the movement patterns of older adults during exercise activities.

Background: Falls pose a significant risk to older adults, often leading to severe injury and disability. One potential contributing factor to falls is footwear, particularly shoes with destabilizing features. This systematic review assessed the effects of destabilizing shoes on stability control and fall prevention in older adults, highlighting their effectiveness in balance control and fall prevention, and the detailing the specific review methodology.

Methods: We thoroughly searched relevant databases and meticulously screened the identified studies based on predetermined inclusion and exclusion criteria. We then extracted data from 30 eligible studies with various study designs and shoe types and synthesized this information to assess the impact of destabilizing shoes on balance and gait measures, fall incidence, and other relevant outcomes.

Results: While certain types of destabilizing shoes may improve specific aspects of balance and proprioception, they can also adversely affect steadiness control and potentially increase the risk of falls if not appropriately used. Therefore, the use of destabilizing shoes should be carefully considered and tailored to individual needs, with proper guidance and training to minimize fall risk.

Conclusion: The findings of this review significantly inform footwear design and selection in older adults and emphasize the need for additional research. By synthesizing the available evidence, this review highlights the potential benefits and risks associated with destabilizing shoes and suggests the need for careful evaluation of their use on a case-by-case basis. This review serves as a basis for future guidelines on the use of destabilizing shoes in older adults with the aim of developing effective fall prevention interventions.

Background: The use of transport other than cars is a modifiable factor in the association between driving cessation and social frailty. Clarifying this relationship may serve as a new preventive measure against social frailty among current non-drivers. This study examined the potential association of driving status and transport use with social frailty, as well as between the frequency of transport use and social frailty, among current non-drivers.

Methods: This study included 977 middle-aged and older adults (average age, 65.3±4.8 years). The participants were classified as transport users (more than a few times a week) and transport non-users (less than a few times a month). Based on driving status and transport use, the groups were further classified into current driver, current non-driver/transport user, and current non-driver/transport non-user groups. The relationships between driving status, transport use, and social frailty were examined using multiple logistic regression.

Results: The current non-driver group and the transport non-user group were significant association with a higher social frailty. The current non-driver/transport user group showed no association with social frailty compared with the current driver group. The odds ratio for the social frailty rate for The current non-driver/transport non-user group was 2.14 (95% confidence interval, 1.25-3.73).

Conclusions: Participants who neither drive nor take transport showed significant associations with increased social frailty. Compared with current driver/transport use, current non-driver/transport non-use was associated with social frailty.

Background: This study aimed to investigate the potential association between the combination of low physical activity and low dietary diversity with mild cognitive impairment (MCI) in older Japanese adults.

Methods: Data from 600 older adults (mean age, 74.1±6.4 years; women, 62.0%) were analyzed. We evaluated dietary variety based on the Food Frequency Score (FFS; maximum 30 points) by assessing the 1-week consumption frequencies of ten foods. An FFS of ≤16 indicated low dietary diversity. We assessed MCI using the National Center for Geriatrics and Gerontology Functional Assessment Tool. Physical activity levels was determined based on participant responses to two questions: "Do you engage in moderate levels of physical exercise or sports aimed at health?" and "Do you engage in low levels of physical exercise aimed at health?" Participants who responded "No" to both questions were classified as having low physical activity levels. We classified the participants into robust, low-dietary diversity, low-physical activity, and coexistence groups.

Results: The overall prevalence of MCI was 20.7%, with rates in the robust, low dietary diversity, low physical activity, and coexistence groups of 17.7%, 24.7%, 25.0%, and 41.9%, respectively. Multiple logistic regression analysis revealed that low dietary diversity and physical activity were associated with MCI in older adults (odds ratio=2.80, 95% confidence interval 1.22-6.28).

Conclusion: The results of the present study demonstrated the association of the co-occurrence of low dietary diversity and low physical activity with MCI. Older adults with both risk factors may require early detection, as well as physical activity and dietary interventions.

Background: Data on cardiopulmonary fitness in older adults in the longer term after coronavirus disease 2019 (COVID-19) are of interest as the time required for the full recovery of physical fitness after COVID-19 remains unclear. Some studies have reported that patients do not recover physical fitness for up to 6 or 12 months after COVID-19, whereas other studies have observed full recovery after 12-months. Therefore, this study evaluated and compared the cardiopulmonary responses induced by the 6-minute walk test (6MWT) and 1-minute sit-to-stand-test (1-min-STST) results at 3, 6, and 12 months in older adults with and without COVID-19.

Methods: This study included 59 older adults aged ≥60 with and without a history of COVID-19. The cardiopulmonary response parameters including heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse oxygen saturation (O2 sat), rate of perceived exertion (RPE), and leg fatigue were evaluated in the participants after 6MWT and 1-min-STST assessments.

Results: Post-COVID-19, older adults showed statistically significant differences in HR, SBP, DBP, O2 sat, RPE, leg fatigue, 6MWT time, and 1-min-STST step numbers at 3, 6, and 12 months (p<0.001). Moreover, older adults showed statistically significant differences in HR, SBP, DBP, RPE, leg fatigue, O2 sat, and 6MWT distance at 3 months post-COVID-19 compared with those in older adults without COVID-19 (p<0.001).

Conclusion: While older adults showed recovery of cardiopulmonary response parameters according to 6MWT and 1-min-STST findings at the 12-month follow-up post-COVID-19, these results of these measurements did not return to the values observed in older adults without COVID-19.

Background: This study aimed to validate the Geriatric Trauma Outcome Score (GTOS) for predicting mortality associated with trauma in older Korean adults and compare the GTOS with the Trauma and Injury Severity Score (TRISS).

Methods: This study included patients aged ≥65 years who visited the Chungbuk National University Hospital Regional Trauma Center between January 2016 and December 2022. We used receiver operating characteristic curves and calibration plots to assess the discrimination and calibration of the scoring systems.

Results: Among 3,053 patients, the median age was 77 years, and the mortality rate was 5.2%. The overall GTOS-predicted mortality and 1-TRISS were 5.4% (interquartile range [IQR], 3.7-9.5) and 4.7% (IQR, 4.7-4.7), respectively. The areas under the curves (AUCs) of 1-TRISS and GTOS for the total population were 0.763 (95% confidence interval [CI], 0.719-0.806) and 0.794 (95% CI, 0.755-0.833), respectively. In the Glasgow Coma Scale (GCS) ≤12 group, the in-hospital mortality rate was 27.5% (79 deaths). The GTOS-predicted mortality and 1-TRISS in this group were 18.6% (IQR, 7.5-34.7) and 26.9% (IQR, 11.9-73.1), respectively. The AUCs of 1-TRISS and GTOS for the total population were 0.800 (95% CI, 0.776-0.854) and 0.744 (95% CI, 0.685-0.804), respectively.

Conclusion: The GTOS and TRISS demonstrated comparable accuracy in predicting mortality, while the GTOS offered the advantage of simpler calculations. However, the GTOS tended to underestimate mortality in patients with GCS ≤12; thus, its application requires care in such cases.