Clinical Interventions in Aging最新文献

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.

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.