Clinical Interventions in Aging最新文献

Background: Frailty is a common geriatric syndrome associated with adverse health outcomes. Equol, a metabolite of the soy isoflavone daidzein, has gained attention for its potential health benefits, particularly in bone, muscle, and cardiovascular health. This study examines the association between urinary equol concentration and frailty status in older adults, with participants further classified into equol producers and non-producers.

Methods: A cross-sectional analysis was conducted using data from 651 community-dwelling older adults (aged 70-85) participating in the Itabashi Longitudinal Study on Aging in February 2023. Urinary equol concentration was measured using Enzyme-Linked Immunosorbent Assay, and participants were classified as equol producers (≥1,000 nmol/L) or non-producers (<1,000 nmol/L). Frailty was assessed based on the revised Japanese Cardiovascular Health Study criteria. Binomial logistic regression was used to evaluate the association between equol production and frailty status or its components, adjusting for age and sex.

Results: Of the participants, 57.1% were equol producers. Fifty-five point eight percent were categorized as frail or prefrail. Equol producers had a significantly lower odds ratio (OR) for frailty or prefrailty (OR=0.71; 95% CI, 0.51-0.97) compared to non-producers. Among the frailty components, low physical activity was associated with equol production (OR=0.60; 95% CI, 0.41-0.88).

Conclusion: Equol production was inversely associated with the prevalence of frailty or prefrailty, particularly with respect to maintaining physical activity. This suggests a potential protective role of equol-producing capacity in healthy aging, warranting longitudinal studies to further explore this association.

Objective: To develop and externally validate a simple, accessible prediction model for identifying individuals at risk of hip osteoporosis using routine demographic and laboratory data.

Methods: This retrospective study included 7686 adult patients who underwent hip dual-energy X-ray absorptiometry (DXA) at two medical centers in northern Guangdong, China. A total of 4638 patients were used for model development and 3048 for external validation. Predictors were selected using appropriate imputation and regularized regression techniques to ensure stability across datasets. Model performance was evaluated using discrimination, calibration, and clinical utility metrics.

Results: Four routinely available variables-age, sex, body mass index, and the serum albumin-to-alkaline phosphatase ratio-were identified as the key predictors. The final logistic regression model demonstrated strong discrimination, with an area under the curve of 0.9107 in the development cohort and 0.8286 in the external validation cohort. Sensitivity and specificity were both favorable, and calibration showed good agreement between predicted and observed risk across most probability ranges. Decision curve analysis indicated meaningful net clinical benefit across a wide range of threshold probabilities, supporting the model's potential to improve risk stratification in practice.

Conclusion: We developed and validated a practical predictive model for hip osteoporosis based entirely on information commonly obtained during routine clinical care. Because it requires no specialized testing beyond standard laboratory panels, the model offers a low-cost, scalable screening tool-particularly valuable in settings where DXA access is limited. Its strong performance and ease of application suggest that it may help clinicians identify high-risk patients earlier, guide referral for confirmatory DXA scanning, and support more proactive osteoporosis prevention strategies.

Objective: The dural puncture epidural (DPE) technique is a novel approach for neuraxial anesthesia. While effective for cesarean sections and labor analgesia, its use in orthopedic surgery for elderly patients remains unexplored. This study evaluates the efficacy and safety of DPE in elderly patients undergoing orthopedic surgery.

Methods: A total of 126 elderly patients were randomly assigned to three groups: epidural block (EPL), combined spinal epidural block (CSE), and DPE. The primary outcome was the onset time of anesthesia. Secondary outcomes included maximum anesthesia level, Onset time of motor block, blood pressure, and heart rate at key points, anesthetic efficacy, and adverse reactions such as hypotension, respiratory depression, nausea and vomiting, chills, and bradycardia.

Results: The onset time of anesthesia in the DPE group was significantly shorter than in the EPL group (17.6±4.0 min vs 19.2±3.9 min, P=0.037) but longer than in the CSE group (17.6±4.0 min vs 7.0±2.8 min, P<0.001). The Onset time of motor block was notably longer in the DPE group compared to the CSE group (20.6±3.8 min vs 9.2±3.9 min, P<0.001). At five minutes post-anesthesia, mean arterial pressure was significantly higher in the DPE group than in the CSE group (88.2±7.0 mmHg vs 84.4±7.6 mmHg, P=0.018); however, no significant difference was found between the EPL and DPE groups. Additionally, there were no significant differences among all three groups regarding hemodynamic parameters at other assessed time points, incidence of adverse reactions, or anesthetic effects.

Conclusion: The onset time of DPE is faster than that of EPL, its impact on the circulatory system is less than that of CSE, and it has a satisfactory anesthetic effect, which may improve the anesthesia management in elderly orthopedic surgeries.

Background: Laparoscopic partial hepatectomy is a crucial treatment for primary liver cancer but is associated with risks such as bleeding and organ hypoperfusion due to controlled low central venous pressure (CLCVP). Regional cerebral oxygen saturation (rSO₂), measured using near-infrared spectroscopy (NIRS), serves as a reliable indicator of cerebral perfusion. This study aims to investigate the relationship between intraoperative rSO₂ changes, perioperative outcomes, and neurological complications.

Methods: This retrospective study analyzed 218 elderly patients undergoing laparoscopic partial hepatectomy, grouped based on intraoperative rSO₂ reductions of ≥10% and ≥20%. Perioperative complications were assessed. Serum neuron-specific enolase (NSE) levels were measured on postoperative day 3 via enzyme-linked immunosorbent assay. Hemodynamic parameters, including mean arterial pressure (MAP), were monitored intraoperatively.

Results: Among the 218 patients, significant rSO₂ reductions were linked to higher risks of neurological complications. Patients with ≥20% rSO₂ reductions had increased incidences of delirium (30.5% vs 13.0%, p = 0.002), and elevated serum NSE levels (p < 0.05). Declines in MAP during critical intraoperative periods were associated with rSO₂ reductions. Patients with marked rSO₂ drops also experienced prolonged hospital stays.

Conclusion: Intraoperative rSO₂ reductions, especially >20%, are linked to adverse neurological outcomes and delayed recovery. Combined rSO₂ and NSE monitoring offers a robust strategy to optimize cerebral perfusion and improve outcomes.

Aim: To identify distinct frailty trajectories and their determinants in older adults during the first six months after percutaneous coronary intervention (PCI), guided by the Health Ecology Model.

Design: A prospective observational design.

Methods: This study investigated the frailty status of elderly patients who underwent PCI surgery at a tertiary hospital in Ningxia, China, from November 2023 to May 2024, within six months after discharge. The Latent Growth Mixture Model was utilized to identify trajectories of frailty and classify participants based on these trajectories. Then, multivariable logistic regression analysis was employed to analyze the predictive factors of different trajectories. The reporting of this study adhered to the STROBE checklist.

Results: 218 elderly patients completed follow-up after PCI. There were three frailty trajectories among elderly people after PCI: the Low-Ascending Group (32.6%), the Middle-Alleviation Group (37.6%), and the High-Fluctuating Group (29.8%). Multivariate logistic regression analysis showed that depression, self-efficacy, occupation, NYHA class, and types of medication were influencing factors of their frailty trajectories (P<0.05).

Conclusion: The high proportion of frailty among elderly individuals after PCI should be a cause for concern. Additionally, targeted interventions based on frailty trajectories and measures like depression screening, self-efficacy support, and polypharmacy management are needed to address frailty in elderly post-PCI patients.

Impact: This study highlights the importance of tracking the frailty status of elderly patients after PCI, providing a new perspective and theoretical basis for healthcare professionals to design personalized and targeted intervention plans to prevent or ameliorate frailty.

Patient or public contribution: No patient or public contribution. The study only included patients who were research participants.

Purpose: Decline in pulmonary function (PF) and respiratory muscle strength (RMS) is influenced by environmental and genetic factors and is inconsistently linked to cognitive outcomes. This study explores the associations between PF, RMS, and cognitive function among community-dwelling older adults in China, analyzing interactions with APOE Ɛ4 and the mediating effect of serum total bilirubin.

Patients and methods: About 1,081 Hubei Memory and Aging Cohort (HMACS) participants underwent PF (PEF, FEV1 and FVC), RMS (MIP and MEP) assessment, cognitive tests, APOE genotyping, and bilirubin measurement. Multivariate logistic regression and general linear regression were used to analyze associations.

Results: Among 1,081 participants (mean age 70.52 ± 5.55 years), 26.1% had cognitive impairment. Lower PF and RMS scores were associated with cognitive impairment. Higher comprehensive PF (c-PF) and RMS indices protected against cognitive impairment (eg, c-PF: OR = 0.482-0.609, P < 0.05; MEP: OR = 0.464, P = 0.005). PF and RMS indices correlated positively with global cognition, memory, language, and executive function. Sex differences were noted, with males (n = 449, 41.5%) showing associations between MIP/MEP and global cognition, memory, and language, while females (n = 632, 58.5%) showed broader associations. APOE Ɛ4 status (n = 330) did not affect these associations. Serum total bilirubin levels (n = 977) correlated with pulmonary and cognitive function but did not mediate the associations.

Conclusion: PF (especially PEF) and RMS (especially MEP) indices are significantly associated with cognitive function and impairment in older adults, independent of APOE Ɛ4 status. These findings provide biomarkers for assessing cognitive health risk and a basis for interventions targeting PF and RMS to preserve cognitive function.

Background: Postoperative delirium (POD) is a prevalent and devastating complication in elderly patients undergoing major surgery, marked by substantial increases in morbidity, mortality, and long-term cognitive decline. However, treatment and prevention methods are limited. Accumulating evidence suggests that vagus nerve stimulation effectively enhances cognitive function.

Objective: To evaluate the efficacy of transcutaneous auricular vagus nerve stimulation (taVNS) on POD in elderly patients undergoing major non-cardiac surgery.

Methods: Patients aged ≥65 years scheduled for major non-cardiac surgery were randomly assigned to either the active taVNS group or the sham taVNS group, with stimulation targeting the cymba conchae or earlobe, respectively. In both groups, stimulation was initiated 5 minutes prior to anesthesia induction and continued until the end of surgery. The only difference between the two groups was the stimulation site. The primary outcome was the incidence of POD during the first 3 postoperative days.

Results: A total of 150 patients (median age, 73 years; 96 women [64%]) completed this trial. The incident POD risk was 12% (n = 9) vs 25.3% (n = 19) in active-taVNS and sham-taVNS groups, respectively (relative risk, 0.47; 95% CI, 0.23-0.98; P = 0.036). The mediation analysis revealed that postoperative sleep quality played a significant mediating role in the effect of taVNS on POD (z = -2.30, P = 0.02).

Conclusion: In this study, taVNS reduces the incidence of POD in elderly patients undergoing major non-cardiac surgery, possibly by improving postoperative sleep quality. We suggest that this non-invasive neuromodulation technique could be considered as a potential preventive strategy for POD. Further validation in future large-scale randomized controlled trials is warranted.

Purpose:  The rising global population aged over 80 has increased the incidence of degenerative spinal conditions causing lumbar radiculopathy. Minimally invasive treatments such as transforaminal epidural steroid injection (TESI) and percutaneous transforaminal endoscopic discectomy (PTED) are commonly used, yet their comparative effectiveness remains unclear. This study aimed to compare the clinical outcomes, safety, and efficacy of TESI and PTED in patients aged 80 and above.

Patients and methods: A retrospective analysis was conducted on 74 patients with conservative treatment-resistant lumbar radiculopathy. Patients were divided into TESI (n=40) and PTED (n=34) groups. Primary outcomes included Visual Analog Scale scores for back and leg pain (VAS-BP, VAS-LP), Oswestry Disability Index (ODI), and modified MacNab criteria. Secondary outcomes were operative time, fluoroscopy frequency, hospital stay, and complications. Assessments occurred preoperatively and at 1 week, 1, 3, 6, and 12 months post-procedure. Statistical analyses used ANOVA and chi-square tests.

Results:  Both groups showed significant short-term improvement. At 6- and 12-month follow-ups, the PTED group demonstrated superior and sustained outcomes, with greater pain reduction (VAS-BP, VAS-LP), better functional improvement (ODI), and higher excellent/good MacNab rates (87.9% vs 64.9%, p<0.05) compared to TESI. The TESI group had a higher recurrence rate (21.62% vs 6.06%). TESI was associated with shorter procedure times and hospital stays. No serious complications occurred in either group.

Conclusion:  Both TESI and PTED are effective minimally invasive treatments for lumbar radiculopathy in very elderly patients. TESI offers quicker procedures and rapid symptom relief, while PTED provides more durable pain reduction and functional improvement. Treatment plans should be tailored to each individual, in accordance with established geriatric care principles that emphasize the consideration of comorbid conditions, specific pathology, and patient preferences. Further prospective randomized studies are needed to confirm these results.

Objective: This study aimed to integrate the most robust evidence on perioperative oral nutritional supplementation (ONS) for elderly patients with hip fractures into clinical practice and to evaluate its effectiveness.

Methods: Using an evidence-based continuous quality improvement model, we synthesized the best available evidence with the specific clinical context of the research institution, translated it into review indicators and implementation plans, and conducted a baseline audit to identify barriers and facilitators. Based on these findings, a targeted action plan was developed and implemented. Evidence-based interventions were incorporated into routine clinical practice from January 2024 to October 2024. Outcomes before and after implementation were compared, including medical staff knowledge of nutrition and related topics, discharge NRS2002 scores, discharge nutritional risk, serum albumin levels,prognostic nutritional index (PNI), length of hospital stay, number of complications, and adherence to review indicators.

Results: A total of 49 cases before and 44 cases after the implementation of evidence-based practice were analyzed. Post-implementation, adherence to the review indicators improved significantly, with overall compliance increasing from 0-10.7% to 25-100% (P < 0.05). Medical staff knowledge scores on nutrition and related topics increased significantly from (61.07±12.36) to (85.57±16.89) (t = 6.195, P < 0.001). In addition, after implementation, discharged patients showed significantly lower nutritional risk and NRS2002 scores, as well as improved PNI (P < 0.05). Although discharge serum albumin levels increased and both length of hospital stay and number of complications decreased, these changes did not reach statistical significance.

Conclusion: This pilot project demonstrates that implementing an evidence-based protocol for perioperative ONS in elderly hip fracture patients is both feasible and effective. The intervention significantly improved healthcare staff knowledge, enhanced adherence to care standards, and reduced patients' nutritional risk, thereby supporting faster recovery and promoting continuous quality improvement in nursing care.

Objective: Complications from surgery as well as the side effects of postoperative chemotherapy, can lead to a decline in the treatment effect of elderly cancer patients, which is closely related to pre-frailty. This study aimed to analyze the prevalence and influencing factors of preoperative pre-frailty in elderly patients with gastric cancer, explore its predictive value, and construct a risk prediction model.

Methods: 317 elderly gastric cancer patients was recruited from the 1^st Hospital of China Medical University between September 1, 2022, to December 18, 2024. Fried Frailty Phenotype, Health Literacy Scale for Chronic Patients, and Quality of Life Instruments for Gastric Cancer Patients. Logistic regression analysis was employed to identify the influencing factors of pre-frailty. ROC curve was used to evaluate the predictive value of the identified factors, and RStudio software was utilized to construct a Nomogram-based risk prediction model.

Results: Among the 317 included patients, 177 (53.4%) were pre-frail. Binary Logistic regression identified age, comorbidity, hemoglobin concentration, malnutrition risk, depression status, and GI symptoms as independent influencing factors (all P<0.05). ROC curve analysis showed that the area under the curve (AUC) was 0.986 [95% CI (0.972, 0.999)]with an optimal cutoff value of 0.452, corresponding to a sensitivity of 0.889 and a specificity of 0.945.

Conclusion: The prevalence of preoperative pre-frailty is high in elderly patients with gastric cancer. Clinicians should pay attention to elderly, patients with combidity, low hemoglobin, malnutrition risk, poor mental healthy, and obvious gastric cancer-specific symptoms. The constructed risk prediction model demonstrates good predictive accuracy and discriminative ability.