Clinical Interventions in Aging最新文献

Purpose: Frailty and cognitive impairment are closely associated with postoperative delirium. The purpose of this study was to compare the ability of screening tools assessing preoperative frailty and cognitive impairment to predict Postoperative delirium (POD) and the association with prevalence of postoperative complications, Intensive Care Unit (ICU) admission, and the hospital length of stay.

Patients and methods: Two hundred and ninety-nine patients aged ≥60 years presenting for elective major thoracic or abdominal surgery were divided into preoperative frailty and no frailty groups or cognitive impairment and no cognitive impairment groups. The primary outcome was the incidence of postoperative delirium. The secondary outcomes included postoperative complications, ICU admission, and hospital lengths of stay.

Results: Frailty (25.6% VS 14.6%, P = 0.017) and cognitive impairment (32.7% VS 13.4%, P < 0.001) were associated with POD. However, the area under the receiver operating characteristic curve (AUC-ROC) between frailty (0.657 [95% CI 0.60-0.71]) and cognitive impairment (0.661 [95% CI 0.60-0.71]) for POD was not different (P = 0.9) and both lower than the integrated predictive model of age, body mass index (BMI), American Society of Anesthesiologists (ASA) status, duration of surgery, morphine equivalent, surgical risk, frailty and cognitive impairment (0.814 [95% CI 0.77-0.86], P < 0.0001, P < 0.0001). Besides, frailty (15.6% vs 6.3%, P = 0.010) and cognitive impairment (16.3% vs 8.0%, P = 0.029) was associated with the incidence of postoperative complications.

Conclusion: Preoperative frailty and cognitive impairment were associated with POD. However, preoperative frailty or cognitive impairment by themselves were comparably poor predictors of POD. A comprehensive predictive model including age, BMI, ASA status, duration of surgery, morphine equivalent, surgical risk, frailty and cognitive impairment was more useful to predict POD.

Objective: To investigate the impact of body mass index (BMI) on preoperative characteristics, lower urinary tract symptoms (LUTS), intraoperative variables, surgical outcomes and postoperative complications.

Methods: This is a retrospective observational study including 891 benign prostate hyperplasia (BPH) patients who underwent GreenLight Laser photoselective vaporization of the prostate (PVP) between 2014 and 2020. Clinical characteristics, uroflowmetry parameters, and surgery related parameters were extracted from electronic health records. Patients were categorized into different weight groups based on Taiwanese populations' BMI criteria. Statistical analyses, involving descriptive statistics, correlation analyses, and independent t-tests, were employed to examine associations between BMI and relevant variables.

Results: Pearson's correlation analysis indicated a negative correlation between BMI (r = -0.172, p < 0.001) and age, and positive correlations with total prostate volume (TPV) (r = 0.123, p < 0.001) and transition zone volume (TZV) (r = 0.083, p = 0.017). Obese patients were found to be younger (p=0.007) and have larger TPVs (p=0.010) but showed no significant differences in International Prostate Symptom Scores (IPSS) scores when compared to non-obese patients. Notably, obese patients had lower preoperative and postoperative post-void residual (PVR), whereas non-obese patients exhibited a more significant PVR reduction post-surgery. BMI did not significantly affect surgical parameters or postoperative complications.

Conclusion: In BPH patients treated with PVP, obese individuals were younger with larger prostates but had similar IPSS scores compared to non-obese patients. Obese patients had lower pre and post-surgery PVR, while non-obese patients saw greater PVR improvements. BMI plays a nuanced role BPH patients' characteristics.

Purpose: This study aimed to explore the mediating role of social support between depression and frailty in older adults with cancer and the regulatory role of the income level.

Patients and methods: A convenient sampling method was used to select 448 older adults with cancer from the cancer-related departments of 3 hospitals in Bengbu City, Anhui Province, China. The sociodemographic and disease-related data were collected and examined using the frailty phenotype scale, social support scale, and older adults depression scale. We examined the mediating effects using Models 4 and 59 in the SPSS PROCESS 3.5 macro program.

Results: Depression was negatively correlated with social support and its various dimensions (P < 0.05, r = -0.249 to -0.100). Frailty was positively associated with depression (P < 0.01, r = 0.388). The frailty was negatively correlated with the total score of social support and objective support (P< 0.01, r= = -0.232 to -0.182). Social support partially mediated depression and frailty, with the mediating effect accounting for 15.74% of the total development. The income level regulated only the first stage path in the mediating model (B = -0.227, P<0.001), and the mediating effect of the income level displayed individual differences.

Conclusion: The frailty of older adults with cancer is associated with depression and social support. A good level of social support can alleviate depression and reduce the risk of frailty, while a low level of social support may exacerbate the vicious cycle between depression and frailty, with income levels playing a regulatory role in this process.

Background: Several objective and comprehensive nutritional assessment methods have been used for predicting adverse outcomes in elderly patients with various diseases. However, their predictive value for long-term adverse outcomes in elderly patients with atrial fibrillation (AF) is unclear. This study aimed to explore the prognostic significance of the four nutritional indices, namely Prognostic Nutritional Index (PNI), Geriatric Nutritional Risk Index (GNRI), Controlling Nutritional Status (CONUT), and High-Sensitivity Modified Glasgow Prognostic Score (HS-mGPS), in evaluating the long-term prognosis in elderly patients with AF.

Methods: This retrospective study was conducted at a single center and included a total of 261 elderly patients with AF from December 2015 to December 2021. Patients were divided into all-cause death and survival groups based on the follow-up results. Kaplan-Meier analysis and COX regression were conducted to explore the relationship between all-cause mortality and nutritional scores. In addition, Receiver Operating Characteristic (ROC) curves were used to compare the predictive value of the four nutritional screening tools for the endpoint event.

Results: During the follow-up period, 119 cases (45.59%) of all-cause mortality were recorded. The cumulative incidence of all-cause death was significantly higher in participants with a lower PNI, lower GNRI, higher CONUT, and higher HS-mGPS levels. And the low PNI (HR 1.325, 95% CI 1.032-2.857, P=0.025) and the high HS-mGPS (HR 2.166, 95% CI 1.281-4.326, P=0.023) groups were independently and significantly associated with increased risk of all-cause death analyzed by multivariate COX regression. Additionally, PNI showed the best area under the curve value (AUC: 0.696, 95% CI 0.632-0.760 P < 0.001) for the prediction of all-cause mortality compared with the other nutritional indices.

Conclusion: Among the four nutritional risk screening tools, PNI might be a simple and useful indicator in predicting the long-term prognosis of elderly patients with AF.

Background: Early supported discharge (ESD) facilitates early discharge from acute hospitals with continued rehabilitation in the home environment from a multi-disciplinary team at the same intensity as would be received in the inpatient setting. Emerging evidence suggests it can have a positive impact on the care of older adults on discharge from the acute hospital setting to home. This study aims to characterize an inreach model of ESD for older adults discharged from four hospitals in the Mid-West of Ireland and describe its impact on clinical and process outcomes at 30 and 180 days.

Methods: Consecutive older adults referred for ESD from four hospitals were recruited over six-months. Baseline assessments were carried out on initial review, and patients were followed up at 30 and 180 days by an independent outcome assessor. Outcomes measured include functional status, frailty, health related quality of life, mortality, and healthcare utilization.

Results: One hundred and thirty older adults (mean age 76.62 years, SD 9.81 years) were recruited, 44 for surgical complaints and 86 for medical complaints. The ESD service was provided over a median of 31 (medical) - 44 (surgical) days, primarily by physiotherapy and occupational therapy. The incidence of functional decline was 16.41% at 30 days and 27.5% at 180 days. There was a significant improvement in the self-reported function from index visit 72.94 (19.50) mean standard deviation (SD) to 30 days 84.05 (21.08) mean (SD) which was maintained at 180 days 80.53 (30.93) mean (SD). Frailty was independently associated with incidence of functional decline at 30 days (OR 2.06, 95% CI 1.39 to 3.06) and 180 days (OR 1.7, 95% CI 1.29 to 2.24).

Conclusion: An ESD model of care can have significant effects on patient outcomes for older adults admitted to hospital at 30 and 180 days, without increasing the risk of unscheduled Emergency Department re-presentation. Future research should explore the impact of an ESD model of care on specific older adult cohorts.

Purpose: To investigate the role of Mini Nutritional Assessment-Short Form (MNA-SF) in predicting postoperative complications in older patients (≥75 years) undergoing lumbar fusion surgery.

Patients and methods: Patients who had undergone posterior lumbar fusion surgery between June 2019 and September 2021 were enrolled. Those with an MNA-SF score of 12 or higher were categorized as the Nourished group, while those with a score less than 12 were placed in the Malnutrition-Risk group. Preoperative, intraoperative, and postoperative variables between groups were compared. Patients were then re-classified based on the presence of major complications, univariate analysis and multivariate logistic regression was used to identify risk factors for major complications.

Results: A total of 240 patients were enrolled, with 182 in the Nourished group and 58 in the Malnutrition-Risk group. The Malnutrition-Risk group exhibited a higher incidence of major complications (46.6% vs 23.1%, p = 0.001) and comprehensive complications index (18.42 ± 18.00 vs 12.65 ± 15.87, p = 0.021), Oswestry Disability Index (27.52 ± 23.44 vs 20.45 ± 20.42, p = 0.029) and longer recovery times (12.53 days vs 10.15 days, p =0.033). Length of stay (LOS) were also increased in the Malnutrition-Risk group (19.22 ± 10.67 vs 16.04 ± 7.69, p = 0.014). Multiple regression analysis identified nutritional risk and malnutrition, as assessed by MNA-SF, as independent factors associated with postoperative major complications (OR 2.81, 95% CI 1.42-5.53, p = 0.003).

Conclusion: Preoperative nutritional risk or malnutrition is an independent risk factor for major complications among older patients undergoing posterior lumbar fusion surgery. The MNS-SF emerges as a convenient and effective tool for promptly screening the nutritional status of older patients, prompting subsequent nutritional evaluation or intervention before surgery.

Purpose: To investigate the relationship between intravenous tirofiban, the number of retrieval attempts and symptomatic intracranial hemorrhage (sICH) in patients with successful EVT.

Patients and methods: We used the data from the Endovascular Treatment With versus Without Tirofiban for Patients with Large Vessel Occlusion Stroke (RESCUE BT) Trial. The primary outcome was sICH, which was defined according to the Heidelberg Bleeding Classification. The association between the number of retrieval attempts and the rate of sICH was investigated using multivariable logistic regression.

Results: A total of 866 patients were included in our analysis. In overall cohort, tirofiban (OR: 1.853, 95% CI: 1.039-3.307) and more than 2 passes (3 versus 0-1: OR: 2.482, 95% CI: 1.124-5.481; 2 versus 0-1: OR: 0.813, 95% CI: 0.389-1.696) were significantly associated with the occurrence of sICH. A significant interaction between the use of tirofiban and the increasing number of attempts was found (p for interaction = 0.02), whereby the presence of sICH was significantly associated with tirofiban (OR: 5.534, 95% CI: 1.586-19.315) in the subgroup of multiple passes (>2 passes group), while none was seen in the subgroup of 0-2 passes. The results of the sensitivity analysis also showed that more than 2 passes (3 versus 1: OR: 2.841, 95% CI: 1.102-7.323; 2 versus 1: OR: 0.852, 95% CI: 0.346-2.097) were significantly associated with the occurrence of sICH in the tirofiban group but not in the placebo group.

Conclusion: In patients with multiple attempts, intravenous tirofiban may increase the risk of sICH. Further research and individualized risk assessment are necessary to determine the most appropriate strategy of intravenous tirofiban for EVT patients, especially considering details of thrombectomy procedures.

Registration: : URL: http:// www.chictr.org.cn; Unique identifier: ChiCTR-INR-17014167.

Background: The significant occurrence of oral frailty (OF) in older patients highlights the necessity of addressing this concern. OF is associated with complications and mortality in elderly patients. The objective of this study is to identify unfavorable outcomes in older patients with OF to increase awareness and mitigate risks.

Methods: This review employed specific MeSH terms to perform an extensive literature search on OF and its unfavorable outcomes across PubMed, Web of Science, Embase, Cochrane Library, Scopus, and CINAHL databases. The review included English-language papers published from inception to March 31, 2024, focusing on individuals aged 60 and above, adverse outcomes related to OF, and studies employing cross-sectional or cohort designs.

Results: The review comprised 28 articles: 20 cross-sectional and 8 prospective cohort studies. Among these articles, 10 were rated as "Good" and 18 as "Fair", reflecting the high quality of the literature. Next, 20 OF assessment tools were summarized, and the most frequently used methods for assessing OF were the methods of Tanaka et al and Oral Frailty Index-8 (OF-8). The most frequently unfavorable outcomes related to OF in the elderly were physical frailty, malnutrition, low dietary variety, social withdrawal, disability, and low gait speed.

Conclusion: High levels of OF significantly increase the risk of adverse outcomes in older adults, including physical frailty, malnutrition, low dietary variety, social withdrawal, disability, and low gait speed. Effective risk stratification and management are essential to reduce these outcomes.