Clinical Interventions in Aging最新文献

Purpose: In Ireland, the rise in older adults visiting the ED and being discharged home has led to high rates of adverse outcomes, including disease-related malnutrition. The purpose of this study was to describe the nutrition care needs of older adults as part of a feasibility study exploring a multicomponent transition-to-home intervention from the ED.

Methods: Nutrition characteristics were assessed using clinical records and dietetic assessments from participants in the intervention arm of the ED PLUS pilot RCT. Data were analyzed using the Nutrition Care Process Model to identify nutrition-related problems, estimated intake, and response to intervention.

Results: Our study included nine participants with an average age of 79.5 years. Living arrangements varied, with some living independently, others with formal support, and some with family support. Malnutrition risk was identified using MNA-SF with three participants meeting the threshold. All reported nutritional impact symptoms, with average energy and protein intakes below recommendations. Dietetic interventions were needed for all participants.

Conclusion: While limited by sample size, these exploratory findings offer real-world insights into the nutrition care needs of older adults discharged from the ED and may inform current practice and future research.

Purpose: Geriatric-typical multimorbidity (GTMM) categorizes older patients with multiple geriatric syndromes, but its impact on PHF outcomes remains unexplored. This study evaluates GTMM's influence on PHF patients within three months after fracture, aiming to improve geriatric care strategies.

Methods: Patients ≥65 years with a PHF diagnosis (ICD S42.2) between 2011 and 2022 were included. GTMMs were collected within two years prior to PHF. Patients were categorized into five treatment groups based on surgical intervention (reverse total shoulder arthroplasty (RTSA), locked plate fixation (LPF, sLPF), other fracture fixations) or non-surgical management. A multivariable Cox hazard model analyzed associations between treatment groups, GTMMs, and three-month outcomes: complications, major adverse events (MAE), thromboembolic events (TE), and mortality.

Results: Between January 2011 and December 2022, 95,324 patients were identified with PHF, 43% of whom underwent surgery. The median patient age was 79, and 70% were categorized as geriatric. Mortality within three months was 4.3% (95%-CI: 4.15-4.41%), with major adverse events (MAE) and thromboembolic events (TE) occurring in 7.1% (95%-CI: 6.90-7.23%) and 5.6% (95%-CI: 5.41-5.70%) of cases, respectively. Geriatric-typical multimorbidity (GTMK) cognitive deficits were an independent risk associated factor for inferior outcome in surgically treated patients, while conditions like incontinence and malnutrition resulted in increased rates of mortality, MAEs, and TEs in all patients (p < 0.05).

Conclusion: GTMKs are associated with worse outcome in both operative and non-operative treated patients. The impact of GTMKs, such as cognitive deficits, incontinence, decubitus ulcers and malnutrition, were found to be risk-associated factors.

Purpose: Sarcopenic obesity patients are likely to develop exacerbated metabolic dysfunction, while the mechanism linking sarcopenia and obesity is still unclear. This study aims to explore hub genes and immune-metabolic dysregulation related to the molecular pathogenesis of sarcopenia and obesity.

Methods: We used a public Gene Expression Omnibus (GEO) dataset to identify hub genes associated with sarcopenia and obesity. Weighted gene co-expression network analysis (WGCNA), protein-protein interaction (PPI), differentially expressed gene (DEG) analysis, GO/KEGG functional enrichment analyses and immune cell infiltration analysis were conducted to identify hub genes. Subsequently, these hub genes underwent multi-level validation.

Results: Integrated bioinformatics analysis identified 16 shared hub genes linked to the sarcopenia-obesity nexus. These genes were mainly enriched in immune-related pathways, as supported by immune infiltration profiling. External validation in independent cohorts confirmed CD52 as a common and central gene in both sarcopenia and obesity datasets, showing significant associations with immune cell characteristics. Mendelian randomization analysis indicated potential causal links between genetically predicted CD52 levels and reduced hand grip strength as well as increased body mass index, and these results were further supported by PCR assays in clinical samples.

Conclusion: The integrative analysis indicates that CD52 may function as a novel immunometabolic mediator in SO pathogenesis, underscoring its potential as a candidate biomarker for further study.

Introduction: This retrospective observational study aimed to evaluate the safety and efficacy of Enhanced Recovery After Surgery (ERAS) protocols in older adult patients (≥65 years) with hepatocellular carcinoma (HCC) undergoing radical hepatectomy.

Methods: In this retrospective observational study, 498 patients who underwent radical resection for HCC between January 2018 and December 2023 were included and divided into four groups: Older adult ERAS (OE Group, n=60), Younger adult ERAS (YE Group, n=148), Older adult non-ERAS (ONE Group, n=88), and Younger adult non-ERAS (YNE Group, n=202). Propensity score matching (PSM) was performed to balance baseline covariates, generating three pairwise matched cohorts: PSM-OE Group 1 vs PSM-YE Group (both n=37), PSM-OE Group 2 vs PSM-ONE Group (both n=53), and PSM-OE Group 3 vs PSM-YNE Group (both n=35). Short-term postoperative outcomes were compared across groups.

Results: Results showed that postoperative pain control was significantly superior in PSM-OE Group 1 compared to PSM-YE Group (91.9% vs 70.3% pain-free, p=0.018) and in PSM-OE Group 2 compared to PSM-ONE Group (90.6% vs 69.8% pain-free, 7.328, p=0.013), with no significant difference between PSM-OE Group 3 and PSM-YNE Group (85.7% vs 74.3%, p=0.319). PSM-OE Group 2 had significantly shorter length of hospital stays (LOS: 13.17±4.71 vs 16.68±6.42 days, p=0.002) and length of postoperative stays (LPS: 6.94±3.26 vs 9.64±5.02 days, p=0.001) than PSM-ONE Group, while PSM-OE Group 3 also showed shorter LOS (13.31±4.74 vs 17.34±9.75 days, p=0.031) and LPS (7.26±3.53 vs 10.49±6.58 days, p=0.013) compared to PSM-YNE Group. The complication rate was notably lower in PSM-OE Group 2 than PSM-ONE Group (χ²=13.747, p=0.001), with no significant differences in complication rates between other matched pairs. Blood transfusion rates, average hospitalization costs, liver reserve function (assessed by PALBI score), and 30-day readmission rates (p=0.700) showed no significant differences across all matched cohorts. Multivariate regression analysis confirmed ERAS as an independent factor associated with reduced LOS (OR=1.733, p=0.038), LPS (OR=1.901, p=0.015), postoperative pain (OR=5.014, p=0.035), and complications (OR=5.235, p=0.021).

Conclusion: ERAS protocols are safe and effective in enhancing postoperative recovery for older adult patients with HCC undergoing hepatectomy, supporting their adoption as standard perioperative care for this population.

Aim: Vitamin B-12 deficiency is common among older adults and can lead to irreversible neurological damage and severe complications if not treated early. Despite its clinical significance, effective management remains challenging due to the absence of simple and sensitive biomarkers for early detection and for monitoring treatment response.

Purpose: This pilot study evaluated the feasibility and potential of the urinary methylmalonic acid (uMMA)/creatinine ratio as a biomarker of vitamin B-12 deficiency in older adults, while exploring clinical responses following supplementation.

Participants and methods: A 3-month quasi-experimental pre-post study was conducted with 53 community-dwelling adults aged ≥70 years. Participants provided 4 monthly fasting urine samples to enable tandem mass spectrometry analysis of the uMMA/creatinine ratio before and after 1200 µg/day of peroral vitamin B-12 supplementation. Balance (Berg Balance Scale, Activities-specific Balance Confidence Scale), cognitive function (Montreal Cognitive Assessment), and neurophysiological markers (motor evoked potentials [MEP] latency) were assessed before and after supplementation.

Results: All urine filter paper samples were successfully received and analyzed, with most participants (n = 45) maintaining a supplementation adherence rate of 95% or higher. Supplementation led to a statistically significant reduction in uMMA/creatinine levels, accompanied by significant improvements in both balance and cognitive performance. A significant correlation was observed between the reduction in the uMMA/creatinine ratio and cognitive improvement. No significant changes were detected in MEP latency.

Conclusion: Urinary methylmalonic acid is a promising biomarker for assessing vitamin B-12 deficiency and treatment response in older adults. Larger, well-designed studies with extended supplementation periods are needed to confirm its clinical utility and better evaluate the impact of prolonged supplementation on balance, cognitive and neurophysiological outcomes.

Background: With the prevalence of diabetes on the rise, healthcare systems worldwide are facing a serious burden. This study aims to explore the performance of fingertip capillary blood glucose (CBG), the Chinese Diabetes Risk Score (CDRS) and their combined application in identifying diabetes and prediabetes using glycosylated hemoglobin as a diagnostic criterion.

Methods: We conducted a cross-sectional study from April to September 2022, involving 6868 urban and rural residents aged 60 and above in Qiyang City, Hunan Province. We utilized a logistic regression model combined with Receiver Operating Characteristic (ROC) curves to analyze and evaluate the effectiveness of using CBG alone or in conjunction with the CDRS for screening diabetes and prediabetes.

Results: The prevalence of diabetes mellitus and prediabetes mellitus was 21.6% and 33.9%, respectively, among the 6868 elderly people. The area under the ROC curve (AUCs) of FCBG (fasting capillary blood glucose), the CDRS≥25 and FCBG+CDRS≥25 for detecting diabetes (prediabetes) were 0.756 (0.571), 0.570 (0.552) and 0.773 (0.590), respectively. The AUCs of RCBG (random capillary blood glucose), the CDRS≥25 and RCBG+CDRS≥25 in identifying diabetes (prediabetes) were 0.769 (0.590), 0.542 (0.526), and 0.775 (0.593), respectively.

Conclusion: In large-scale community screening in China, CBG is more effective than CDRS for detecting diabetes in the elderly. The combination of the CDRS and CBG provides a practical and efficient strategy that could improve community-based screening efficiency for diabetes in the elderly. However, the limited accuracy of CBG and CDRS for prediabetes highlights the need for more specific methods in screening this condition.

Background: Pre-frailty and frailty are dynamic and potentially reversible conditions in older adults, associated with increased risks of disability, hospitalization, and mortality. Evidence supports movement-based interventions as effective strategies to prevent and mitigate these outcomes.

Objective: This mini narrative review synthesizes recent scientific evidence on movement-based interventions for pre-frail and frail older adults, with emphasis on clinical outcomes, barriers to implementation, and digital innovations.

Methods: A structured and iterative search was conducted using the AI-based Consensus platform, which integrates major biomedical databases. From 1,049 identified records, 281 were screened, 205 assessed in full text, and 36 studies (systematic reviews, meta-analyses, and randomized controlled trials published between 2019 and 2025) met the inclusion criteria. Eligible studies evaluated movement-based interventions reporting outcomes such as strength, mobility, cognition, mood, or quality of life.

Results: Multicomponent, resistance, and mind-body exercises consistently improved muscle strength, balance, mobility, executive function, and psychological well-being. Digital strategies, including exergames and mobile applications, showed comparable effectiveness to traditional programs and enhanced accessibility. However, implementation remains constrained by adherence challenges, infrastructural and professional limitations, and the digital divide. Research gaps persist in institutionalized populations, long-term follow-up, and standardized protocols.

Conclusion: Movement-based interventions are safe, clinically effective, and scalable strategies to promote healthy aging in frail populations. To maximize their real-world impact, future research should prioritize standardized protocols, pragmatic long-term trials, inclusive recruitment, and equity-focused digital strategies aligned with global healthy aging policies.

Purpose: The Timed Up and Go (TUG) is a 20-foot gait assessment, with TUG-dual task (DT) serial subtractions to determine dual-task cost. Alzheimer's disease (AD) risk is established using plasma biomarkers and APOE genotyping.

Methods: We investigated: 1) TUG/TUG-DT differences between AD low-risk cognitively unimpaired (CU) older adults (N = 74), AD high-risk CU older adults (N = 87), and mild cognitively impaired (MCI) older adults (N = 33) and 2) the relationship between TUG/TUG-DT performance and plasma biomarkers. One hundred and ninety-four older adults ages 55-80 completed TUG/TUG-DT, a fasting blood draw, and APOE genotyping. Scores on the Clinical Dementia Rating Scale (CU = 0; CI = ≥0.5) and Montreal Cognitive Assessment (CU ≥ 24; CI = ≤23) determined whether participants were placed into the CU low-risk, CU high-risk, or MCI groups. Risk level for CU participants were assessed by APOE genotyping. Those participants who carried at least one copy of the APOE ε4 allele were designated to the high-risk group (n = 87). Participants with no APOE ε4 allele were assigned to the low-risk group (n = 75).

Results: MCI participants took longer to perform the TUG than CU participants (p < 0.001). CU high-risk and MCI group performed similarly on step counts, while the CU low-risk took significantly fewer steps (p<0.001). Speed predicted whether someone was below an AD-risk threshold for pTau217 in CU participants (n = 150). Exploratory generalized additive models showed plasma biomarkers predicted gait metrics in CU groups.

Conclusion: Step count may be more sensitive, compared to speed alone, in identifying those in preclinical AD stages. Gait metrics (speed and efficiency) played a key role as a clinical manifestation of early AD pathophysiology determined by blood-based biomarker concentration. Combining these assessments offers a multidimensional, cost-effective approach for preclinical-AD screening and potential early intervention.

Background: The relationship between plasma free triiodothyronine (FT3) levels and the risk of ventricular arrhythmias (VA) in patients with acute myocardial infarction (AMI) remains unclear.

Objective: This study aimed to investigate whether the level of FT3 influences VA in patients with AMI.

Methods: A multicenter prospective study was conducted to collect patients diagnosed with AMI from three centers between January 2018 and December 2021. Patients were categorized into VA and Non-VA groups. FT3 levels were compared between groups, and multivariate logistic regression analyses were performed to evaluate the relationship.

Results: A total of 3277 consecutive patients (mean age: 64.6 years) were included, with 123 (3.9%) developing VA during hospitalization. The VA group had significantly lower FT3 levels compared to the Non-VA group ([3.74 ± 0.77 pmol/L] vs [4.13 ± 0.81 pmol/L], P < 0.001). Multivariate analysis identified FT3 level as an independent predictor of VA risk (adjusted odds ratio [OR]: 0.761; 95% confidence interval [CI]: 0.591-0.980; P = 0.035). A dose-dependent association was observed, with progressively lower VA risks across increasing FT3 quartiles (P _trend = 0.007). Each 1 standard deviation decrease in FT3 levels was associated with a 19.9% increased VA risk (OR = 0.801; 95% CI: 0.651-0.984; P = 0.035).

Conclusion: This study confirmed a significant association between plasma FT3 levels and the risk of ventricular arrhythmias during hospitalization in patients with myocardial infarction. Low FT3 levels are associated with an increased risk of VA in patients with AMI.