Clinical Interventions in Aging最新文献

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.

Objective: This study aims to explore the latent profile characteristics of cognitive function in older adults living with diabetes and analyze the influencing factors, providing theoretical evidence for early intervention.

Methods: A cross-sectional study design was used to select older adults living with diabetes hospitalized at a tertiary hospital as the study population. Cognitive function was assessed using the Mini-Mental State Examination (MMSE). Demographic characteristics, disease-related data (such as duration of diabetes, BMI, and HbA1c levels), and lifestyle factors (such as sleep quality, physical activity, and social support) were collected. Latent profile analysis (LPA) was employed to classify cognitive function, and ordered multinomial logistic regression was performed to analyze the influencing factors of each cognitive profile.

Results: A total of 564 patients were included. Latent profile analysis of cognitive impairment identified three categories: complete cognitive impairment (12.82%), partial cognitive impairment (54.74%), and at-risk cognitive impairment (32.44%). Logistic regression analysis revealed that gender, education level, duration of diabetes, HbA1c, diverse intellectual activities, and nutrition were independent factors influencing cognitive impairment (P<0.05).

Conclusion: Cognitive impairment in older adults living with diabetes exhibits distinct profile characteristics and is influenced by multiple factors. Interventions should focus on improving blood glucose control, promoting diverse intellectual activities, and enhancing social support to delay the decline in cognitive function.

Background: Cognitive decline in older adults with Cardiovascular Disease (CVD) is frequently mediated by chronic inflammation, oxidative stress, and cellular dysfunction. However, reliable biomarkers for early detection are still lacking. Phase angle (PhA), a sensitive bioelectrical impedance analysis (BIA) parameter reflecting cellular health and nutritional status, may serve as a novel tool for detecting cognitive impairment in this population.

Methods: In this cross-sectional study, 340 CVD patients (mean age: 80.8 ± 8.0 years; 36.5% male) were recruited from the Zhejiang Elderly Health Monitoring Cohort. PhA was measured using the InBody S10. Participants were stratified into cognitive impairment (n = 138) and cognitively normal (n = 202) groups based on Mini-Mental State Examination (MMSE) scores adjusted for education level. Group differences were analyzed via independent t-tests, Mann-Whitney U-tests, and chi-square tests. Binary logistic regression evaluated the association between PhA and cognitive ability.

Results: The cognitive impairment group exhibited significantly lower PhA (P < 0.001), older age, reduced grip strength, smaller calf circumference, slower gait speed (all P < 0.001), along with lower education levels and poorer physical activity intensity (both P<0.01). Additionally, they demonstrated worse performance in activities of daily living, nutritional status, balance, and swallowing function, along with greater frailty severity (all P < 0.001). Multivariate analysis confirmed PhA as an independent predictor of cognitive ability after adjusting for age, education, physical activity, grip strength, gait speed, and calf circumference (β = -0.474, OR = 0.62, 95% CI: 0.43-0.89, P = 0.01). ROC curve analysis revealed an optimal PhA threshold of 4.75° for cognitive impairment detection (specificity: 70.3%).

Conclusion: Reduced PhA is independently associated with cognitive impairment risk in older CVD patients. Its noninvasive, cost-effective measurement supports its potential as a community screening tool and may provide a critical target for early intervention.

Introduction: Dependent older persons with limitations in activities of daily living (ADL) often experience reduced functioning and require ongoing support from family caregivers and community-based care systems.

Purpose: This study aimed to explore the experiences, challenges, and care needs of family caregivers providing care for dependent older persons in urban communities.

Methods: A qualitative descriptive design was employed. Twenty-five family caregivers residing in Bangkok, Thailand, were purposively recruited. Participants were family members who had provided primary care for a dependent older person for at least six months and were able to communicate in Thai. Data were collected through in-depth, semi-structured interviews guided by Donabedian's model of healthcare quality. Each interview lasted approximately one hour, and the interview guide was validated by three experts (content validity index = 0.97). Data were analyzed using conventional content analysis.

Results: Family caregivers reported six significant challenges: limited caregiving knowledge and skills, time constraints, caregiving isolation, declining personal health, financial burden, and difficulties managing the older person's emotional and behavioral problems. Eight key needs emerged: access to reliable health information, online health services, transportation assistance, home healthcare, financial and psychosocial support, home environment modification, and recognition from healthcare authorities. Guided by Donabedian's framework, findings were categorized into inputs (caregiver and system attributes), processes (caregiving activities), and outcomes (quality and continuity of care supported by digital technologies).

Conclusion: Family caregivers of dependent older persons in urban settings face complex, interrelated challenges that affect their well-being. Strengthening integrated community and health support systems, together with evidence-based caregiver empowerment programs, is essential for promoting sustainable, high-quality long-term care.

Background: Optimal dosing of rivaroxaban in very elderly (≥80 years) nonvalvular atrial fibrillation (AF) patients remains debated, particularly concerning ultra-low-dose (5 mg daily) regimens derived from clinician judgement. This study aimed to describe real-world comparative outcomes associated with these clinician-selected dosing regimens.

Methods: The study included 1389 very elderly nonvalvular AF patients (≥80 years) who received rivaroxaban between January 2018 and December 2022, with 373, 604, and 412 patients receiving 5 mg, 10 mg, and 15/20 mg daily, respectively. Baseline characteristics were balanced using stabilized inverse probability of treatment weighting (IPTW). The outcomes included composite efficacy outcomes (stroke, systemic embolism, myocardial infarction and cardiovascular death) and major bleeding. Subgroup analysis and plasma trough level comparisons were conducted to further assess consistency and pharmacokinetics.

Results: The composite efficacy event rates were 9.3%, 6.6%, and 7.0% for the 5 mg, 10 mg, and 15/20 mg groups, respectively. After IPTW, there was no statistically significant difference in composite efficacy outcomes between three groups (HR for 10 mg vs 5 mg: 0.71, 95% CI: 0.44-1.15; HR for 15/20 mg vs 5 mg: 0.91, 95% CI: 0.52-1.59). However, major bleeding occurred in 1.6%, 3.6%, and 6.1% of patients, exhibited a dose-dependent increase. The 15/20 mg group had a 4.27-fold higher risk compared to the 5 mg group (HR: 4.27, 95% CI: 1.66-10.97), while the 10 mg group showed no significant elevation (HR: 2.11, 95% CI: 0.82-5.40). Subgroup analysis confirmed consistent efficacy and safety trends across specified subgroups. Plasma trough concentrations were significantly higher in the 15/20 mg group compared to the 5 mg group, with no significant difference between the 10 mg and 5 mg groups.

Conclusion: In very elderly AF patients, ultra-low-dose rivaroxaban (5 mg daily) provided comparable efficacy to higher doses while significantly reducing major bleeding. This regimen may be a balanced option for high-risk elderly populations.

Purpose: The purpose of this study was to construct and validate a preoperative and intraoperative factor-based nomogram model to predict the risk of prolonged postoperative length of stay after primary total knee arthroplasty for osteoarthritis patients.

Materials and methods: The study included patients undergoing primary TKA for knee osteoarthritis between June 2022 and November 2024. Patients were randomly split into training (70%) and validation (30%) cohorts. Potential predictors were screened using LASSO regression and subsequently incorporated into a multivariate logistic regression to build the nomogram. The model's performance was assessed using the area under the receiver operating characteristic curve, calibration curves, and decision curve analysis.

Results: A total of 295 patients were included, with an average age of 66.58 ± 6.88 years. Least absolute shrinkage and selection operator regression identified 12 potential predictors, and multivariate logistic regression further refined these to four independent risk factors: age, knee flexion range of motion, operation time, and American Society of Anesthesiologists classification. The nomogram demonstrated strong predictive performance, with the area under the receiver operating characteristic curve values of 0.912 (95% CI: 0.858-0.966) in the training set and 0.817 (95% CI: 0.697-0.938) in the validation set. Calibration curves showed excellent agreement between predicted and observed outcomes, and decision curve analysis indicated significant clinical utility across a wide range of threshold probabilities.

Conclusion: The model, based on age, knee flexion range of motion, operation time, and American Society of Anesthesiologists classification, provides a practical tool for clinicians to assess individual risks, optimize resource allocation, and improve patient outcomes. It is important to note that this was a single-center, retrospective study, and further validation in multi-center, prospective cohorts is recommended to confirm its generalizability.