Clinical Interventions in Aging最新文献

Background: Frailty and falls significantly impact the health and quality of life of older adults with type 2 diabetes (T2D), increasing morbidity and dependency. However, their association in Vietnamese populations remains understudied. This study aimed to examine the association between frailty and fall risk and identify additional fall-related factors among older Vietnamese outpatients with T2D.

Methods: A cross-sectional study was conducted among 740 outpatients with T2D aged ≥60 years at a geriatric hospital in Hanoi, Vietnam, from March 2024 to December 2024. Fall risk was assessed using the 21-item Fall Risk Index (21-FRI), and frailty was determined by the Clinical Frailty Scale (CFS). Four multivariable logistic regression models evaluated frailty's association with falls, adjusting for demographics, diabetes-related factors, and geriatric syndromes.

Results: Among 740 older participants with T2D, 17.8% were frail, and 16.8% reported at least one fall in the past year. Frailty was strongly associated with a higher fall rate (p<0.001). In the fully adjusted logistic regression model, frailty emerged as a powerful and independent predictor of falls, increasing the odds by over four-fold (AOR 4.47, 95% CI 2.00-5.29). Other significant risk factors included advanced age, poor glycemic control, diabetic complications, and co-existing geriatric syndromes (depression, urinary incontinence, cognitive impairment, and sarcopenia).

Conclusion: Routine frailty screening should be integrated into T2D care to identify high-risk older adults and implement tailored fall prevention strategies.

Purpose: To investigate the value of conventional ultrasound combined with shear wave elastography (SWE) for sarcopenia in patients with cardiovascular disease (CVD).

Methods: 114 CVD patients were enrolled in this study, where CVD was defined as physician-diagnosed heart disease and/or stroke. Appendicular skeletal muscle mass index (ASMI), calf circumference, grip strength, and 6-m walking speed were measured. Patients were categorized into non-sarcopenia (n=78) and sarcopenia (n=36) groups. Conventional ultrasound and SWE features were measured in relaxed and passive stretched states, and the presence of flaky myosteatosis echo (FE) in rectus femoris (RF) was evaluated. The differences in clinical indicators, conventional ultrasound and SWE features between the two group were analyzed. The Spearman correlation analysis was used to assess the relationship between clinical indicators and conventional ultrasound/SWE features. Independent predictors of sarcopenia were subsequently, and a combined diagnostic model was established by binary logistic regression analysis based on these predictors.

Results: The sarcopenia group exhibited significantly lower subcutaneous adipose tissue thickness (T/SAT_relaxed), thickness (T/RF_relaxed, T/RF_stretched), cross-sectional area (CSA/RF_relaxed, CSA/RF_stretched, ΔCSA) of RF, and the thickness of RF and vastus intermedius [T/(RF+VI)_relaxed,T/(RF+VI)_stretched], but significantly higher presence of FE/RF compared to the non-sarcopenia group. In terms of SWE features, patients with sarcopenia exhibited significantly lower shear wave velocities (SWV) in the RF (SWV/RF_relaxed, SWV/RF_stretched) and VI (SWV/VI_relaxed, SWV/VI_stretched), as well as the difference in SWV between the two states (ΔSWV/RF, ΔSWV/VI). Finally, the prediction model for sarcopenia in patients with CVD incorporating T/SAT_relaxed, T/RF_stretched, ΔSWV/RF, and SWV/VI_stretched was established, with a sensitivity of 83.3%, specificity of 89.7% and cutoff value of 0.381.

Conclusion: Conventional ultrasound combined with SWE provides a novel and quantitative approach for visualizing alterations in muscle mass and stiffness, facilitating early identification of sarcopenia in CVD patients and offering reliable imaging evidence for clinical intervention.

Perioperative neurocognitive disorders, including postoperative delirium, delayed neurocognitive recovery and mild/major postoperative neurocognitive disorder, are common complications that affect older adults after surgery. Postoperative delirium, which occurs in 10-60% of major surgery patients, can increase the risk of delayed neurocognitive recovery and postoperative neurocognitive disorder, which affects 10-25% of patients. Preoperative and postoperative assessment of neurocognitive functioning typically involve the use of screening tools, such as Mini-Cog or 4AT. Despite the availability of evidence-based cognitive screening tools, many patients remain undiagnosed in clinical settings. Both postoperative delirium and postoperative neurocognitive disorder can lead to long-term cognitive and emotional complications, such as forgetfulness, trouble with initiating tasks, and mood disturbances. Next of kin experience considerable distress when witnessing delirium in a family member, a situation that is frequently exacerbated by a lack of information from health care professionals. Ethical challenges arise when cognitive impairment impacts patients' decision-making capacity, raising concerns about autonomy, use of restraints, and resource allocation. Informing patients about their risk of postoperative neurocognitive disorder before surgery is vital; however, it is not standardized in clinical practice. Further, there is a notable lack of interventions aimed at promoting neurocognitive recovery, with most guidelines relying on expert consensus. This narrative review therefore aims to explore recent advances in perioperative neurocognitive recovery, focusing on symptomatology, patient and next of kin experiences, assessments, care interventions and ethical aspects.

Purpose: To investigate the predictive value of Traditional Chinese Medicine Constitution (TCMC) in cognitive frailty (CF) among older adults and explore its potential influencing pathways.

Patients and methods: From 2021 to 2023, a total of 905 older participants were recruited from three geographic regions in China: Southwest (Sichuan), East (Shanghai), and North (Beijing). A multidimensional survey (including TCMC assessment) was conducted. Prediction models were developed using nomogram and C5.0 decision tree algorithms. Internal and external validations were performed. The KHB method was applied for mediation analysis.

Results: Logistic regression identified Qi-stagnation constitution (QSC) and Qi-deficiency constitution (QDC) as important risk factors for CF (P < 0.01). Both the C5.0 decision tree model and Nomogram model based on TCMC demonstrated strong predictive performance (AUC=0.824 and 0.812, respectively). External validation indicated superior extrapolability of the C5.0 model (AUC=0.810 vs 0.772). Mediation analysis revealed that sleep quality partially mediated the association between QSC and CF (P < 0.05), with a mediation proportion of 22.7%.

Conclusion: QSC and QDC were identified as modifiable risk factors for CF. Prediction models based on TCMC demonstrated strong predictive performance and generalizability. Furthermore, QSC may worsen CF progression through its detrimental effects on sleep quality, identifying its clinical applicability as both a risk stratification factor and a prevention focus for CF.

Purpose: Urinary incontinence is a common health issue among older women, negatively affecting quality of life. Although pelvic floor muscle training (PFMT) is recommended as the first-line treatment, its uptake remains low. We previously developed a PFMT-based complex intervention to improved adherence and implementation fidelity among community-dwelling older women. This study aimed to test its acceptability and feasibility.

Patients and methods: This study consisted of two parts. First, a cluster randomized controlled pilot trial was conducted in Changsha, China. Four community daycare centers were randomly assigned to the intervention arm (receiving the PFMT-based complex intervention) or the control arm (receiving health education). Primary outcomes were the acceptability, appropriateness and feasibility of the complex intervention. Additionally, a mixed-method process evaluation was conducted to assess the implementation fidelity and the contextual factors influencing the implementation outcomes, with quantitative data collected from research logs and qualitative data from interviews, respectively.

Results: From October 2023 to January 2024, the pilot trial enrolled 36 eligible older women, with 22 in the intervention arm and 14 in the control arm. Compared with health education, the complex intervention demonstrated greater acceptability, appropriateness, and feasibility, with mean differences and corresponding 95% confidence intervals being 1.25 (0.19, 2.31), 1.25 (-0.02, 2.53) and 2.29 (0.78, 3.81), respectively. The process evaluation revealed that the complex intervention was implemented successfully, with 48% of the approached older women enrolled and intervention content delivered as planned. However, low motivation, monotonous content, limited promotion and inadequate attention were identified as barriers requiring further improvement.

Conclusion: Our preliminary findings indicate that the PFMT-based complex intervention, developed with consideration of participants' preferences and implementation influence factors, is acceptable and feasible. These findings support a larger confirmatory trial and indicate that future research should further improve data collection strategies, adopt objective outcome measures, and optimize intervention components.

Purpose: Olfactory dysfunction has emerged as a marker of neurodegeneration and frailty in older adults, yet its value for perioperative risk stratification remains underexplored. This prospective study aimed to assess the interplay between three olfactory modalities (Threshold, Discrimination, Identification: TDI), baseline frailty, and postoperative outcomes in older patients undergoing surgery.

Patients and methods: We enrolled adults aged 65 years or older scheduled for elective aortic/lower limb vascular or orthopedic procedures under general anesthesia. The day before surgery, patients underwent olfactory testing using the Sniffin' Sticks extended test (yielding a composite TDI score), and frailty evaluation with the Edmonton Frail Scale (EFS) and Clinical Frailty Scale. Postoperative moderate/severe complications or death occurring within one year were recorded. Statistical analyses included univariable and multivariable regression adjusted for age, sex, comorbidities, and surgical parameters.

Results: From 362 screened patients, a final cohort of 209 patients (160 orthopedic, 49 vascular) was included after accounting for ineligibility, 42 refusals, and 6 data access exclusions. Lower olfactory performance (TDI score ≤ the 25^th percentile) was identified in 74 (35.4%) patients. Frailty (EFS ≥6/17) was present in 51 cases (24.4%). Frail patients had significantly lower TDI scores (median 25.25 vs 28.75, p<0.001), with all three modalities independently correlated with frailty after adjustment. Within one year, 54 (25.8%) experienced postoperative complications and 3 (1.4%) patients died. Reduced olfaction was associated with a higher risk of postoperative morbidity/mortality (39.2% vs 20.7%, p=0.004), and this association remained significant after accounting for age and gender, comorbidities, surgery type, and frailty. Lower olfactory performance, but not frailty, predicted poor outcomes in vascular patients (odds ratio 6.34, p=0.004), while only frailty was predictive in orthopedic patients.

Conclusion: Global poorer olfaction is closely associated with frailty and may serve as a robust indicator of adverse postoperative outcomes in older adults, beyond conventional frailty scales.

Background: The synergistic effect of fibrinogen and albumin on long-term mortality remains unclear in senile patients with coronary artery disease (CAD). This study aimed to evaluate the association between fibrinogen-to-albumin ratio (FAR) and 10-year mortality, and to develop a model to predict survival probability in senile patients with CAD.

Methods: In total, 819 senile patients with CAD were enrolled on the basis of the China Geriatric Cardiovascular Comorbidity Study.

Results: Compared with patients in the lowest FAR (FAR-Q1) group, the median overall survival (OS) was 2631 days, and patients in the highest FAR (FAR-Q4) group had the shortest OS, with a median of 311 days (p < 0.0001). Multivariate Cox regression suggested FAR as a crucial factor affecting long-term mortality of patients with CAD (HR = 37.75, 95% CI = 4.10-347.98; p < 0.05). Five features associated with long-term mortality were selected using Least Absolute Shrinkage and Selection Operator (LASSO) regression: age, hemoglobin, albumin, FAR, and lnNT-proBNP. The area under the receiver operating characteristic curve (AUC) was 0.838 for multivariate Cox regression and 0.829 for LASSO regression. The restricted cubic spline curve showed a significant J-shaped relationship between FAR and mortality, with a cut-off point of 0.09 (p for nonlinear < 0.001). A time-dependent nomogram was constructed based on five features selected using LASSO regression. The time-dependent AUC remained in the range of 0.69-0.73, indicating the relatively stable power of this model.

Conclusion: FAR was independently associated with long-term mortality, and a prognostic model based on FAR may aid risk stratification in senile patients with CAD.

Introduction: The elderly population is steadily increasing, concurrently with the incidence of pubic rami fractures (PRFs), impacting function, morbidity and mortality. We aimed to assess functional background, clinical course, hemoglobin decline, transfusion needs, complications, and long-term survival.

Methods: A retrospective cohort study. Data was collected from patients hospitalized in a geriatric internal medicine ward, due to PRFs between 2012 and 2022. Demographic, clinical, and outcome data were recorded and analyzed.

Results: The study comprised 165 patients, mean age 85.9±6.4 years; 138 (83.6%) were women, 133 (80%) had experienced at least one PRF, an additional 32 cases had experienced another pelvic fracture. Functionally, 76 (46%) were independent, 49 (29.7%) partially dependent, and 40 (24.2%) fully dependent. Cognitively, 106 (64.2%) were preserved, 29 (17.6%) experienced a cognitive decline, and 30 (18.2%) suffered from dementia. The complication rate was 15.1%, half from infectious diseases. One-year mortality was 20%. The average maximum decrease in hemoglobin occurred 4.4 days post-fracture, with a difference in average admission hemoglobin between those who required blood transfusions and those who did not (9.81 g/dL and 12.06 g/dL) (p=0.0001). Almost 10% of the elderly needed blood transfusions. Logistic regression analysis identified two independent predictors for blood transfusions: an admission hemoglobin level <10 g/dL and the presence of cognitive decline or dementia. The model showed high accuracy, with a ROC AUC of 0.885, sensitivity of 0.875, and specificity of 0.792. Over half of the patients returned home; 35% were transferred to rehabilitation facilities.

Conclusion: This study provides new and important information on PRFs in the elderly. We recommend closely monitoring these patients because of complications, functional decline, need for rehabilitation, and the high risk of significant blood loss peaking several days post-fracture, thereby, requiring transfusions, particularly, in elderly individuals suffering from cognitive decline or dementia and low initial hemoglobin.

Purpose: Falls pose a significant health risk to older adults, often resulting in adverse outcomes. Despite the recognition of effective interventions, the psychological aspect of fear of falling (FoF) remains under-addressed. The Fear of Falling Questionnaire-Revised (FFQ-R) (15 and 6-item) was developed to assess FoF. However, no Swedish version is available, necessitating its translation and evaluation of psychometric testing. This study aimed to translate the FFQ-R (15 and 6-item) and examine the psychometric properties of the Swedish versions in healthy community-dwelling adults aged ≥ 60 years.

Patients and methods: This study used a cross-sectional design to translate and assess the psychometric properties of the FFQ-R(S) (15 and 6-item) for healthy community-dwelling older adults. Translators, experts, and community-dwelling older adults participated in the process. Confirmatory factor analysis was used to assess the fit of the model. Scale reliability was measured with ordinal α.

Results: The translation resulted in minor changes and demonstrated satisfactory content validity. Confirmatory factor analysis showed that the FFQ-R(S) model, with four latent factors and 15 items, was not analyzable due to non-convergence. For the two-factors and six items, FFQ-R(S), the ordinal α values for the scales' harm outcome (HO) and degree of threat (DT), measuring reliability, were 0.70 and 0.88, respectively. The confirmatory factor analysis yielded mixed fit indices, where values of standardized root mean square residual, comparative fit index, and Tucker-Lewis index suggested a good fit of the model to the sample, whereas the χ² test and the value of root mean square error of approximation indicated a lesser good fit.

Conclusion: The Swedish version of the 6-item FFQ-R demonstrates acceptable psychometric properties. Moreover, the six items align with the two factors, DT and HO. Based on these findings, we recommend using the Short FFQ-R(S) (6-item) to assess FoF in primary fall prevention efforts for community-dwelling older adults.

Purpose: This study aimed to develop a systematic, evidence-based rehabilitation intervention tailored for elderly patients undergoing TKA, informed by stakeholders, and evaluate its impact on patient outcomes.

Patients and methods: Guided by the Knowledge-to-Action (KTA) Framework, this study comprised two sequential phases. In the knowledge creation phase, we systematically synthesized evidence through comprehensive retrieval, critical appraisal, and integration of high-quality rehabilitation programs for elderly patients undergoing TKA from domestic and international literature. During the action cycle phase, expert panel discussions and stakeholder interviews were conducted to identify barriers and facilitators of implementation, culminating in the co-development of a finalized intervention program. A quasi-experimental study was subsequently implemented to assess its preliminary efficacy in this target population.

Results: Fourteen high-quality sources were synthesized to form 17 evidence-based recommendations across six dimensions. Through expert panels and stakeholder interviews, a structured rehabilitation program was developed, addressing key barriers and implementation strategies. In the subsequent quasi-experimental study (n = 60), patients in the intervention group showed significantly better postoperative pain control, range of motion, and knee function compared to controls (all P < 0.05), with no baseline differences between groups.

Conclusion: The evidence-based rehabilitation program significantly enhanced functional recovery parameters, and pain control efficacy compared to standard care. Implementation of this structured intervention framework demonstrates clinically meaningful improvements in early postoperative outcomes following TKA.