Clinical Interventions in Aging最新文献

Background: Laparoscopic partial hepatectomy is a crucial treatment for primary liver cancer but is associated with risks such as bleeding and organ hypoperfusion due to controlled low central venous pressure (CLCVP). Regional cerebral oxygen saturation (rSO₂), measured using near-infrared spectroscopy (NIRS), serves as a reliable indicator of cerebral perfusion. This study aims to investigate the relationship between intraoperative rSO₂ changes, perioperative outcomes, and neurological complications.

Methods: This retrospective study analyzed 218 elderly patients undergoing laparoscopic partial hepatectomy, grouped based on intraoperative rSO₂ reductions of ≥10% and ≥20%. Perioperative complications were assessed. Serum neuron-specific enolase (NSE) levels were measured on postoperative day 3 via enzyme-linked immunosorbent assay. Hemodynamic parameters, including mean arterial pressure (MAP), were monitored intraoperatively.

Results: Among the 218 patients, significant rSO₂ reductions were linked to higher risks of neurological complications. Patients with ≥20% rSO₂ reductions had increased incidences of delirium (30.5% vs 13.0%, p = 0.002), and elevated serum NSE levels (p < 0.05). Declines in MAP during critical intraoperative periods were associated with rSO₂ reductions. Patients with marked rSO₂ drops also experienced prolonged hospital stays.

Conclusion: Intraoperative rSO₂ reductions, especially >20%, are linked to adverse neurological outcomes and delayed recovery. Combined rSO₂ and NSE monitoring offers a robust strategy to optimize cerebral perfusion and improve outcomes.

Purpose:  The rising global population aged over 80 has increased the incidence of degenerative spinal conditions causing lumbar radiculopathy. Minimally invasive treatments such as transforaminal epidural steroid injection (TESI) and percutaneous transforaminal endoscopic discectomy (PTED) are commonly used, yet their comparative effectiveness remains unclear. This study aimed to compare the clinical outcomes, safety, and efficacy of TESI and PTED in patients aged 80 and above.

Patients and methods: A retrospective analysis was conducted on 74 patients with conservative treatment-resistant lumbar radiculopathy. Patients were divided into TESI (n=40) and PTED (n=34) groups. Primary outcomes included Visual Analog Scale scores for back and leg pain (VAS-BP, VAS-LP), Oswestry Disability Index (ODI), and modified MacNab criteria. Secondary outcomes were operative time, fluoroscopy frequency, hospital stay, and complications. Assessments occurred preoperatively and at 1 week, 1, 3, 6, and 12 months post-procedure. Statistical analyses used ANOVA and chi-square tests.

Results:  Both groups showed significant short-term improvement. At 6- and 12-month follow-ups, the PTED group demonstrated superior and sustained outcomes, with greater pain reduction (VAS-BP, VAS-LP), better functional improvement (ODI), and higher excellent/good MacNab rates (87.9% vs 64.9%, p<0.05) compared to TESI. The TESI group had a higher recurrence rate (21.62% vs 6.06%). TESI was associated with shorter procedure times and hospital stays. No serious complications occurred in either group.

Conclusion:  Both TESI and PTED are effective minimally invasive treatments for lumbar radiculopathy in very elderly patients. TESI offers quicker procedures and rapid symptom relief, while PTED provides more durable pain reduction and functional improvement. Treatment plans should be tailored to each individual, in accordance with established geriatric care principles that emphasize the consideration of comorbid conditions, specific pathology, and patient preferences. Further prospective randomized studies are needed to confirm these results.

Objective: This study aimed to integrate the most robust evidence on perioperative oral nutritional supplementation (ONS) for elderly patients with hip fractures into clinical practice and to evaluate its effectiveness.

Methods: Using an evidence-based continuous quality improvement model, we synthesized the best available evidence with the specific clinical context of the research institution, translated it into review indicators and implementation plans, and conducted a baseline audit to identify barriers and facilitators. Based on these findings, a targeted action plan was developed and implemented. Evidence-based interventions were incorporated into routine clinical practice from January 2024 to October 2024. Outcomes before and after implementation were compared, including medical staff knowledge of nutrition and related topics, discharge NRS2002 scores, discharge nutritional risk, serum albumin levels,prognostic nutritional index (PNI), length of hospital stay, number of complications, and adherence to review indicators.

Results: A total of 49 cases before and 44 cases after the implementation of evidence-based practice were analyzed. Post-implementation, adherence to the review indicators improved significantly, with overall compliance increasing from 0-10.7% to 25-100% (P < 0.05). Medical staff knowledge scores on nutrition and related topics increased significantly from (61.07±12.36) to (85.57±16.89) (t = 6.195, P < 0.001). In addition, after implementation, discharged patients showed significantly lower nutritional risk and NRS2002 scores, as well as improved PNI (P < 0.05). Although discharge serum albumin levels increased and both length of hospital stay and number of complications decreased, these changes did not reach statistical significance.

Conclusion: This pilot project demonstrates that implementing an evidence-based protocol for perioperative ONS in elderly hip fracture patients is both feasible and effective. The intervention significantly improved healthcare staff knowledge, enhanced adherence to care standards, and reduced patients' nutritional risk, thereby supporting faster recovery and promoting continuous quality improvement in nursing care.

Objective: Complications from surgery as well as the side effects of postoperative chemotherapy, can lead to a decline in the treatment effect of elderly cancer patients, which is closely related to pre-frailty. This study aimed to analyze the prevalence and influencing factors of preoperative pre-frailty in elderly patients with gastric cancer, explore its predictive value, and construct a risk prediction model.

Methods: 317 elderly gastric cancer patients was recruited from the 1^st Hospital of China Medical University between September 1, 2022, to December 18, 2024. Fried Frailty Phenotype, Health Literacy Scale for Chronic Patients, and Quality of Life Instruments for Gastric Cancer Patients. Logistic regression analysis was employed to identify the influencing factors of pre-frailty. ROC curve was used to evaluate the predictive value of the identified factors, and RStudio software was utilized to construct a Nomogram-based risk prediction model.

Results: Among the 317 included patients, 177 (53.4%) were pre-frail. Binary Logistic regression identified age, comorbidity, hemoglobin concentration, malnutrition risk, depression status, and GI symptoms as independent influencing factors (all P<0.05). ROC curve analysis showed that the area under the curve (AUC) was 0.986 [95% CI (0.972, 0.999)]with an optimal cutoff value of 0.452, corresponding to a sensitivity of 0.889 and a specificity of 0.945.

Conclusion: The prevalence of preoperative pre-frailty is high in elderly patients with gastric cancer. Clinicians should pay attention to elderly, patients with combidity, low hemoglobin, malnutrition risk, poor mental healthy, and obvious gastric cancer-specific symptoms. The constructed risk prediction model demonstrates good predictive accuracy and discriminative ability.

Purpose: The purpose of this study was to explore dynamic changes of respiratory microbiome in elderly patients undergoing prolonged mechanical ventilation (PMV) by isothermal microfluidic amplification chip technology (IAMC).

Methods: The study enrolled patients in six general hospitals in Beijing. Patients who developed Ventilator-associated pneumonia (VAP) within the observation period were enrolled in the VAP group, while those without VAP were categorized in non-VAP group. The study adopted IAMC technology to dynamically monitor the differences in the detection rates of bacteria, fungi, and viruses in the two groups. The conventional microbiological tests (CMT) were performed to clarify the correlation between KPC and drug resistance phenotype of K. pneumoniae.

Results: Among 218 patients, 78 were diagnosed with VAP. The pulmonary microbiota composition of patients without VAP was relatively stable. Compared with the non-VAP group, the detection rates of Enterococcus faecalis, Epstein-Barr virus, and Herpes simplex virus were significantly increased in the VAP group, whereas those of Haemophilus influenzae and Serratia marcescens were significantly reduced. In the VAP group, the detection rates of Enterococcus faecalis and Epstein-Barr virus were higher after the occurrence of VAP than before. A high correlation was observed between the KPC genotype of K. pneumoniae and its resistance phenotype.

Conclusion: Viruses and Gut microbes might be closely related to the development of VAP in elderly undergoing PMV. The detection of the KPC gene of K. pneumoniae can guide antibiotic selection, and IAMC can aid in quickly identifying pathogens and facilitate targeted treatment.

Clinical trial registration number: ChiCTR2100051343.

Background: Osteoporotic vertebral compression fracture (OVCF) is a prevalent fragility fracture in older adults, often managed with conservative treatment. However, elderly patients are particularly prone to poor prognoses under conservative management, which warrants early identification. This systematic review aims to summarize the risk factors for poor long-term prognosis in older OVCF patients receiving conservative treatment, facilitating early recognition during initial diagnosis.

Methods: This systematic review followed the PRISMA statement criteria and searched the literature until June 2025. The inclusion criteria were patients with OVCFs who underwent conservative treatment only and had at least three months of follow-up. Poor prognoses include no pain relief, dysfunction, and complications such as collapse, nonunion, and kyphosis deformity. The Newcastle‒Ottawa Scale (NOS) was used to screen for articles with a low risk of bias.

Results: This systematic review included 26 articles that met our inclusion criteria. These articles involved 4319 participants (80.2% female), with an average age of 72.91 years. OVCF patients with advanced age, previous spine fracture and steroid medication uses had a poor prognosis. On X-ray, poor prognoses are associated with thoracolumbar involvement, vertebral instability, middle‒column injury, initial fracture parameters, and specific fracture morphology. Additionally, specific MRI signal changes (such as diffuse low-intensity signals on T2WI, linear black sign on STIR) and fatty degeneration of the paravertebral muscle are also risk factors.

Conclusion: All methods, including nonimaging, X-ray, and magnetic resonance imaging (MRI), can effectively predict the poor prognosis for OVCF patients treated conservatively. Early identification of these geriatric-specific risk factors can optimize treatment selection for elderly individuals, mitigating functional decline and improving quality of life.

Purpose: This study aimed to report the 3-year clinical outcomes of corneal endothelial keratoplasty (EK) in late-stage elderly patients (≥75 years) compared with younger patients (<75 years).

Study design: Retrospective observational study.

Methods: Patients who underwent EK, including Descemet's stripping automated keratoplasty (DSAEK) and non-Descemet stripping and automated endothelial keratoplasty (nDSAEK) with bullous keratopathy (BK) at Keio University Hospital between 2016 and 2018, were included. Patient characteristics, graft survival rate, best corrected visual acuity (BCVA), corneal endothelial cell density (ECD), and complications were compared between the late elderly group (75 years or older) and the younger group (<75 years old) stratified by surgical procedure.

Results: Among the 64 eyes and 55 patients who underwent EK, 31 eyes and 30 patients were in the late elderly group (81.4±3.7 years), and 33 eyes and 25 patients were in the younger group (66.2±9.1 years). There was no difference between the groups in terms of the cause of BK, and PBK was more common in the DSAEK group in the late elderly group (p = 0.029). There was no difference in graft survival between the two groups during the follow-up period. In the late elderly group, graft survival was significantly better in the nDSAEK group than in the DSAEK group (p = 0.045). BCVA and postoperative ECD improved in both groups. There were no differences in intraoperative or postoperative complications between the late elderly and younger groups.

Conclusion: EK for BK in late elderly patients resulted in postoperative visual improvement, with similar efficacy and safety to those of EK for BK in younger patients.

Background: To address the regional heterogeneity of Alzheimer's disease, a large-scale epidemiological study of 12,421 elderly individuals was conducted in southwestern China to depict its unique risk characteristics.

Methods: A total of 12,421 subjects were selected via cluster sampling from southwestern China after low quality data were filtered out. On the basis of investigations and medical imaging examinations, three groups were distinguished: the AD, mild cognitive impairment (MCI), and normal control groups. The risk factors for AD and MCI were analysed via a multivariate logistic regression model.

Results: This study identifies a high burden of cognitive impairment in southwestern China, with 22.07% of adults aged ≥60 years exhibiting cognitive decline and 5.81% diagnosed with Alzheimer's disease rates surpassing national and global averages. Key risk factors included age >80 years, female sex, low education, rural residence, surgical history, and urological comorbidities. These findings underscore the need for region-specific prevention strategies, prioritizing older, less-educated rural women through combined cognitive and vascular interventions, while integrating cognitive screening into primary care in underserved areas for early detection and intervention.

Conclusion: Elderly individuals in southwestern China exhibit a high prevalence of cognitive impairment, with AD associated with complex risk factors including established contributors like advanced age, dementia family history, alcohol abuse, and multisystem comorbidities-while notably identifying surgical history and urolithiasis as region specific risk signals. These findings underscore regional, environmental, and ethnic influences on AD pathogenesis, requiring tailored prevention/treatment. Future priorities include integrating brief cognitive screening into primary care, targeting high-risk groups (eg, undereducated rural elderly women), and establishing prospective cohorts to clarify causal links between urolithiasis, surgical history, and cognitive decline for refined region-adapted AD prevention.

Chronic Obstructive Pulmonary Disease (COPD) is a progressive respiratory disorder frequently observed in older adults and is often accompanied by aging-related conditions such as sarcopenia, cognitive impairment, and immune dysfunction. Malnutrition is a major yet underrecognized contributor to poor outcomes in this population, accelerating disease progression and functional decline. This integrative review critically examines the clinical value of three widely used nutritional assessment tools-the Mini Nutritional Assessment (MNA), the Patient-Generated Subjective Global Assessment (PG-SGA), and the Nutritional Risk Screening 2002 (NRS-2002)-in identifying malnutrition and guiding targeted interventions for older adults with COPD. A systematic literature search was conducted in PubMed, Embase, and Web of Science databases for studies published between 2010 and 2025, using combinations of the keywords COPD, older adults, malnutrition, and nutritional assessment tools. Studies addressing both nutritional screening (risk detection) and nutritional assessment (comprehensive evaluation) were included to clarify their conceptual and practical distinctions. Findings indicate that while all three tools are useful for detecting nutritional risk, their sensitivity, specificity, and clinical applicability differ across settings. The MNA is most suitable for community and outpatient populations, the PG-SGA offers comprehensive evaluation for hospitalized or comorbid patients, and the NRS-2002 is effective for early inpatient screening and prognosis prediction. Integrating these tools into multidisciplinary COPD management enables early identification of malnutrition, sarcopenia, and immune dysfunction, supporting timely, personalized nutrition interventions. Future research should focus on standardizing tool selection, incorporating biomarkers and digital health technologies, and exploring AI-assisted assessments to enhance precision and applicability in diverse clinical contexts. This review underscores that routine nutritional assessment is not merely supportive care but an essential component of precision management for older adults with COPD.

Background: Femoral neck fractures (FNFs) represent a significant public health challenge in aging populations. Total hip arthroplasty (THA) has emerged as the preferred surgical management for active geriatric patients over 60 years old. However, standardized, evidence-based rehabilitation protocols specifically tailored to the Chinese healthcare context remain limited.

Purpose: This study aimed to develop and validate an expert consensus-based exercise program for geriatric Chinese patients with FNFs undergoing THA, addressing gaps in pre-operative preparation, post-operative care, and home-based rehabilitation continuity.

Patients and methods: Using the Model for Evidence-Based Practice Change framework, we conducted a multi-phase study: (1) needs assessment through semi-structured interviews with 21 healthcare professionals; (2) systematic evidence synthesis from 16 high-quality sources; and (3) iterative refine the program through two-round Delphi consultation with 15 multidisciplinary experts from orthopedics, rehabilitation medicine, nursing, and management.

Results: The Delphi process demonstrated high expert engagement (response rates: 93.75% round 1, 100% round 2) and acceptable authority (Cr=0.917). Expert coordination improved across rounds, with Kendall's W values increasing from 0.244-0.287 (round 1) to 0.104-0.371 (round 2) for different item levels, and coefficient of variation decreasing from 0.00-0.64 to 0.00-0.14. 11 items with CV>0.25 were eliminated after round 1, reflecting initial variability in expert opinions. The iterative consensus process yielded a four-domain program structure: (1) in-hospital pre-operative rehabilitation, (2) in-hospital post-operative rehabilitation, (3) out-of-hospital home-based rehabilitation, and (4) follow-up care. The final program comprises 4 first-level items, 17 second-level items, and 63 third-level items with specific operational parameters including timing, frequency, intensity, and methods adapted to Chinese clinical practice patterns.

Conclusion: Through rigorous expert consensus methodology, this study developed a comprehensive, multi-level rehabilitation framework for geriatric FNFs patients undergoing THA in China, achieving acceptable agreement on program content and feasibility. As consensus-based findings, prospective validation is essential to establish clinical effectiveness and guide evidence-based implementation.