Clinical Interventions in Aging最新文献

Background: Chronic illnesses among older adults require effective self-management strategies. Community health coaching, which provides personalized guidance and support, has shown promise in improving self-management behaviors and patient activation. This study examines the impact of health coaching on self-management among older adults and investigates the mediating role of patient activation.

Methods: A cross-sectional study was conducted with 200 older adults with chronic illnesses attending primary healthcare centers in Riyadh, Saudi Arabia. Data were collected using the Patient Activation Measure (PAM-13), Self-Management Behavior Scale (SMBS), and Health Coaching Perception Questionnaire (HCPQ). Multiple regression and mediation analyses were conducted to assess the relationships between health coaching, patient activation, and self-management behaviors.

Results: Health coaching was significantly associated with improved self-management behaviors (β = 0.42, p < 0.001). Higher satisfaction with coaching was related to better medication adherence and dietary modification. Patient activation partially mediated the relationship between health coaching and self-management, with an indirect effect coefficient of 0.22 (p < 0.01). The results highlight the role of activation in enhancing health coaching effectiveness.

Conclusion: Community health coaching positively influences self-management behaviors in older adults, with patient activation serving as a critical mediator. Integrating health coaching into primary care could improve chronic illness management and support healthy aging.

Background: Hip fractures have become a significant health concern, particularly among super-aged patients, who were at a high risk of postoperative pneumonia due to their frailty and the presence of multiple comorbidities. This study aims to establish and validate a model to predict postoperative pneumonia among super-aged patients with hip fracture.

Methods: Data were derived from the Chinese PLA General Hospital (PLAGH) Hip Fracture Cohort Study, and we included 555 super-aged patients (≧80 years old) with hip fracture treated with surgery. Patient's demographics, comorbidities, laboratory tests, and surgery types were collected for analysis. All patients were randomly splitting into a training group and a validation group according to the ratio of 7:3. The majority of patients were used to train models, which was tuned using a series of algorithms, including decision tree (DT), random forest (RF), extreme gradient boosting machine (eXGBM), support vector machine (SVM), neural network (NN), and logistic regression (LR).

Results: The incidence of postoperative pneumonia was 7.2% (40/555). Among the six developed models, the eXGBM model demonstrated the optimal model, with the area under the curve (AUC) value of 0.929 (95% CI: 0.900-0.959), followed by the RF model (AUC: 0.916, 95% CI: 0.885-0.948). The LR model had an AUC value of 0.720 (95% CI: 0.662-0.778). In addition, the eXGBM model demonstrated the optimal prediction performance in terms of accuracy (0.858), precision (0.870), F1 score (0.855), Brier score (0.104), and log loss (0.349). It also showed favorable calibration ability and favorable clinical net benefits across various threshold risk.

Conclusion: This study develops and validates a reliable machine learning-based model to predict pneumonia specifically among super-aged patients with hip fracture following surgery. This model can serve as a useful tool to identify postoperative pneumonia and guide clinical strategies for super-aged patients with hip fracture.

Background: The postoperative health status of elderly patients has a substantial impact on both the individuals themselves and their families, and this impact became more pronounced with advancing age. The aim of this study was to identify risk factors that can predict the health status of patients aged 80 and over after major abdominal surgery and to establish a nomogram model.

Methods: We conducted a retrospective study of elderly patients (aged 80+) who underwent major abdominal surgery at the First Affiliated Hospital of Soochow University from January 2017 to June 2023. Least absolute shrinkage and selection operator (lasso) regression analysis was employed to identify potential perioperative factors associated with the patients' health status one year post-surgery. Subsequently, logistic regression was then used to refine these factors for the model. The nomogram's performance was assessed through discriminative ability, calibration, and clinical utility in both training and validation datasets.

Results: In total, 576 and 145 individuals were allocated to the training and validation sets, respectively. Lasso regression first identified 10 variables as candidate risk factors. After further screening through univariate and multivariate logistic regression, it was confirmed that seven variables, including tumor, operative duration, left ventricular ejection fraction (LVEF), blood transfusion, direct bilirubin, erythrocyte, and self-care, were included in the final nomogram model. The Hosmer-Lemeshow test, with a P-value of 0.835, indicates that the model was well-fitted. The area under the Receiver Operating Characteristic curve (ROC-AUC) for the model on the training set was 0.81 (95% CI 0.764-0.855), and for the validation set, it was 0.83 (95% CI 0.751-0.91). Additionally, the calibration curves and decision curve analyses in both the training and validation sets demonstrated the accuracy and clinical applicability of the predictive model.

Conclusion: The nomogram has a good predictive ability for the health status of older patients aged 80 years and above after abdominal surgery for one year, which can help clinical doctors develop better treatment plans.

Background: Common fall risk assessment scales are not ideal for the prediction of falls in stroke patients. The study aimed to develop and verify a dynamic nomogram model for predicting the falls risk in stroke patients during rehabilitation.

Methods: An observational study design was adopted, 488 stroke patients were treated in a tertiary hospital from March to September 2022 were investigated for fall risk factors and related functional tests. We followed up by telephone within 2 months after that to understand the occurrence of falls. Forward stepwise regression was used to analyze the data, and a dynamic nomogram model was developed.

Results: During follow-up, three patients died, and 16 failed the follow-up, with a failure rate of 3.89%. Among 469 patients, 115 experienced falls, with a fall incidence rate of 24.4% and a cumulative of 163 falls. The fall risk was higher among patients aged 60-69, and ≥80 years than among patients aged <60 years. Patients with a fall history within the last 3 months, or a Berg balance scale (BBS) score of <40, or combined with anxiety had a higher fall risk. The differentiation of the dynamic nomogram model was evaluated. The area under the receiver operating characteristics curve (AUC-ROC), sensitivity, specificity of the model was 0.756, 66.09% and 73.16%, respectively. The AUC-ROC of the model was 0.761 by using the Bootstrap test, and the calibration curve coincided with the diagonal dashed line with a slope of one. The Hosmer-Lemeshow good of fit test value was χ²=2.040, and the decision curve analysis showed that the net benefit was higher than that of the two extreme curves.

Conclusion: Independent fall risk factors in stroke patients are age, had a fall history within the last 3 months, anxiety, and with the BBS score below 40 during rehabilitation. The dynamic nomogram prediction model for stroke patients during rehabilitation has good differentiation, calibration, and clinical utility. The prediction model is simple and practical.

Objective: To assess the sleep status and prevalence rate of the elderly in southeast coastal areas of China, and analyze related factors.

Methods: A questionnaire survey was conducted among elderly individuals in Wenzhou City, Zhejiang Province, situated in the southeast coastal areas of China, using a multi-stage random sampling method. A total of 903 elderly people aged ≥ 60 years were selected for the survey. The questionnaire aimed to assess their sleep status using PSQI and to evaluate related factors using Self-designed General Information and Health Behavior Questionnaires, SAS, GDS-15, ESS, AD8, SHAP, WHOQOL-BREF, among other tools. Logistic regression was applied to analyze the influencing factors of sleep disorders.

Results: Among the 903 elderly individuals who participated in the survey, 316 cases (35.0%) had a PSQI score > 7. Females exhibited a higher prevalence rate of poor subjective sleep quality (24.9% vs 17.6%) and difficulty falling asleep (32.8% vs 22.5%) compared to males. Drinking green tea (OR = 0.1.841, 95% CI, 1.220-2.777, P <0.05) had the strongest association with poor sleep. The duration of nap time ranging from 30 to 90 minutes (OR = 0.492, 95% CI= 0.340-0.713, P < 0.001) and specifically a 90-minute nap (OR = 0.441, 95% CI = 0.234-0.832, P < 0.05) were both significantly associated with a decreased risk of experiencing poor sleep quality.

Conclusion: The prevalence in this population is 35%. Several factors contribute to this prevalence, including tea consumption, anxiety, daytime sleepiness, cognitive decline, environmental influences, awareness of sleep health, knowledge about sleep, and detrimental habits. Specifically, the consumption of green tea negatively impacts sleep quality, while taking naps longer than 30 minutes is associated with a reduced risk of poor sleep. These findings can inform the development of targeted preventive strategies and interventions aimed at mitigating sleep disorders in the elderly population.

Background: Functional sarcopenia is characterized by decreased physical performance and grip strength despite preserved muscle mass. The effectiveness of a program combining exercise and nutritional support-known interventions for individuals with low muscle mass-was evaluated for its impact on older adults with functional sarcopenia.

Methods: An unblinded, parallel-group randomized controlled trial was conducted in a public medical center in a rural Korean community. Eligible older adults with functional sarcopenia were randomized into either the intervention group, receiving a 12-week program of group exercises and nutritional support, or the control group, receiving education on lifestyle management. Outcomes measured included changes in gait speed, grip strength, physical performance, and quality of life indices.

Results: The study enrolled 42 participants, with 21 allocated to each group. Compared with the control group, the intervention group showed significant improvements in the primary outcome of gait speed (mean change (m/s) 0.24 vs 0.00, p<0.001) and secondary outcomes, such as Short Physical Performance Battery scores, grip strength, and quality of life. No significant adverse events were reported.

Conclusion: The 12-week exercise and nutritional intervention significantly enhanced physical performance, grip strength, and quality of life among community-dwelling older adults with functional sarcopenia. This suggests that strategies commonly recommended for sarcopenia, including exercise and nutritional support, are also beneficial for individuals with functional sarcopenia, indicating the potential for broader application of such interventions.

Introduction: Older adults frequently attend Emergency Departments (EDs) and experience high rates of adverse outcomes, including functional decline, re-presentation, and unplanned hospital admissions. Developing effective interventions to prevent these outcomes is a priority. Healthcare providers (HCPs) are well positioned to create integrated care pathways for older adults discharged from the ED. ED PLUS is a physiotherapy-led, multidisciplinary model that bridges the care transition between the ED and the community. It initiates a Comprehensive Geriatric Assessment (CGA) in the ED and provides multidisciplinary follow-up to the patient for six weeks post-discharge.

Purpose: This study aimed to explore the views and experiences of older adults and HCPs involved in the ED PLUS intervention to inform the design of a future definitive trial.

Methods: A descriptive qualitative design was used. Older adults (n = 9) and HCPs (n = 10) who participated in the intervention arm of the ED PLUS trial were invited to participate in semi-structured interviews exploring their experience and perspective of the ED PLUS intervention. These interviews were audio-recorded, transcribed, and analysed using reflexive thematic analysis.

Results: Nine older adults and six HCPs consented to participate. The evaluation highlighted stakeholders' experiences and suggested modifications for optimising ED PLUS. Four themes emerged: ED PLUS bridged the transition between care settings for older adults.Stakeholder collaboration and investment were key enablers of implementation.Organisational, logistical, and personnel issues impeded the intervention's delivery.There is potential for service optimisation and expansion.

Conclusion: This evaluation emphasises the important role of physiotherapists and other HCPs in transitional care delivery for older adults. The findings will inform future trials of the ED PLUS model, aiming to improve outcomes for this population.

Purpose: The impact of periprocedural myocardial injury (PPMI) according to VARC-3 criteria in patients undergoing transcatheter aortic valve replacement (TAVR) remains unclear. This study aimed to investigate the incidence, risk factors, and prognosis of PPMI in patients with severe aortic who underwent TAVR in China.

Materials and methods: Between September 2012 and November 2021, 516 patients with severe aortic stenosis who underwent TAVR at the Fuwai Hospital were consecutively enrolled. PPMI was defined according to the VARC-3 criteria as a 70-fold increase of upper reference limit in cardiac troponin I (cTnI) levels. We compared the baseline characteristics, perioperative conditions, and in-hospital and long-term endpoints between the PPMI and non-PPMI groups. Logistic regression analysis was used to determine the predictors of PPMI. Survival probabilities for outcomes between the PPMI and non-PPMI groups were estimated using the Kaplan-Meier method.

Results: Of the enrolled patients (mean age: 75.5±7.2 years, 57.5% male), the incidence of PPMI was 20.5%. The median cTnI was 24.9 (interquartile range: 11.4-60.2) times the upper reference limit. After multivariable adjustment, female sex (odds ratio [OR]: 3.01, 95% confidence interval [CI]: 1.88-4.82, P < 0.001), anticoagulant use (OR: 0.27, 95% CI: 0.08-0.96, P = 0.043), balloon-expandable valve (OR: 0.27, 95% CI: 0.09-0.79, P = 0.017), and secondary valve implantation (OR: 2.66, 95% CI: 1.40-5.03, P = 0.003) were significantly associated with PPMI. Patients with PPMI had short- and long-term outcomes similar to those without PPMI.

Conclusion: Female sex and secondary valve implantation are predictors of an increased risk of PPMI, whereas baseline anticoagulant use and the use of balloon-expandable valves are protective factors. The presence of PPMI does not seem to indicate poor short- or long-term prognosis in patients undergoing TAVR.

Background: Adequate sedation is important for elderly patients undergoing endoscopic retrograde cholangiopancreatography (ERCP). Patient state index (PSI) via the SedLine® system has been utilized for real-time monitoring of anesthesia depth in surgical patients. We aimed to assess the correlation between PSI and Modified Observer's Assessment of Alertness/Sedation (MOAA/S) scores in elderly patients undergoing ERCP.

Methods: This prospective cohort study included 57 elderly patients scheduled for ERCP procedures. Patients received target-controlled infusion of propofol, titrated to the sedation level of MOAA/S scores of 1 and 2. The MOAA/S scores and PSI values were recorded during sedation and recovery. We also documented procedure and recovery time, oversedation (PSI < 25 for at least 10 min and EEG burst suppression), adverse events, and fatigue scores (0-10, higher scores indicating more fatigue).

Results: All patients completed this study (mean age of 73 years and 63% male), with a mean procedure time of 53 min and recovery time of 37 min. Five patients (8.8%) experienced PSI < 25 for at least 10 min, and three of them (5.3%) showed EEG burst suppression. No patients developed desaturation or intra-procedural awareness. Hypotension and abdominal pain were uncommon. Nine patients (15.8%) experienced mild dizziness or nausea. The median (IQR) fatigue score was 3 (2-4) at recovery room discharge. A significant correlation was observed between the MOAA/S scores and PSI values (Spearman correlation coefficient ρ = 0.742, P < 0.001). When patients were at the MOAA/S scores of 1 and 2, the median PSI was 50 (95% CI: 48 to 52).

Conclusion: PSI provides a useful and real-time monitoring of sedation for elderly patients undergoing ERCP. Our results showed a significant correlation between the PSI values and MOAA/S scores and suggested a PSI value of 50 with a range of 48 to 52 for maintaining adequate sedation.

Trial registration: Chinese Clinical Trial Registry (ChiCTR2400079859).