Clinical Interventions in Aging最新文献

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.

Objective: To evaluate the diagnostic value of maximum standardized uptake value (SUVmax), total lesion glycolysis (TLG), and metabolic tumor volume (MTV) in 18F-FDG PET/CT combined with serum forkhead box protein M1 (FOXM1) for detecting lymph node metastasis (LNM) in colorectal cancer (CRC).

Methods: A retrospective study was conducted on 107 CRC patients who underwent 18F-FDG PET/CT and serum FOXM1 testing, with postoperative pathology as the reference standard. Patients were divided into LNM-positive (n=52) and LNM-negative (n=55) groups. PET/CT metabolic parameters (SUVmax, TLG, MTV) and serum FOXM1 levels were compared, correlations were analyzed by Spearman's test, and receiver operating characteristic (ROC) curves were plotted to assess diagnostic efficacy.

Results: SUVmax was significantly higher in LNM-negative patients, whereas TLG, MTV, and serum FOXM1 were higher in LNM-positive patients (all P<0.05). Serum FOXM1 showed negative correlation with SUVmax (r=-0.356) and positive correlation with TLG and MTV (r=0.564, 0.549). The combined model of SUVmax, TLG, MTV, and FOXM1 yielded the highest diagnostic performance (AUC=0.971, sensitivity=92.2%, specificity=94.3%).

Conclusion: SUVmax, TLG, MTV, and FOXM1 are interrelated and, when combined, provide superior diagnostic value for CRC LNM, though validation in larger, multicenter cohorts is needed.

Purpose: To evaluate and compare the safety, efficacy, and patient-centered outcomes of three enucleation techniques-bipolar transurethral enucleation of the prostate (B-TUEP), thulium laser enucleation (ThuLEP), and robotic-assisted simple prostatectomy (RASP)-in older adult patients (>60 years) with large-volume benign prostatic hyperplasia (BPH >80 cm³), a population at increased surgical risk and underrepresented in prior comparative studies.

Patients and methods: This study retrospectively analyzed 127 patients aged 60 to 90 years who underwent B-TUEP (n=43), ThuLEP (n=58), or RASP (n=26) between 2014 and 2024. All procedures were performed by a single surgeon. Preoperative and 12-month postoperative outcomes-including IPSS, Qmax, post-void residual (PVR), and quality of life (QoL)-were assessed. Complication profiles, including urinary tract infection (UTI), prolonged analgesic requirement (PAR), and unexpected return visits (URV), were evaluated to reflect real-world risks in the older adults population.

Results: All three surgical techniques resulted in significant and sustained improvements in IPSS, Qmax, and PVR, with no significant intergroup differences at 12 months. ThuLEP demonstrated the lowest postoperative pain and analgesic use, RASP had the lowest UTI incidence, and B-TUEP was associated with the shortest operative time. Kaplan-Meier analysis showed comparable long-term medication-free survival across groups (p = 0.085). Quality of life scores improved in all groups, with numerically better outcomes observed in the RASP group.

Conclusion: In older adult patients with large BPH, B-TUEP, ThuLEP, and RASP all offer effective and durable symptom relief with distinct perioperative advantages. Given the heightened risks associated with aging-including infection, delayed recovery, and medication burden-this study underscores the importance of tailored surgical decision-making in patients over 60. All three techniques are viable, and selection should be guided by individual patient priorities and risk profiles.

Background: Frailty is a critical geriatric syndrome associated with adverse surgical outcomes, yet preoperative risk prediction models for older adults undergoing abdominal surgery remain underdeveloped. This study aimed to identify frailty risk factors and establish a predictive nomogram in this population.

Methods: We enrolled 790 older patients undergoing abdominal surgery at Hunan Provincial People's Hospital from February 2022 to September 2022. Frailty was assessed using the Tilburg Frailty Index. Univariate analysis, LASSO regression and multivariate analysis were used in turn to identify independent risk factors for frailty. The nomogram was developed based on the independent risk factors. The sample was randomly divided into a test group (75%) and a validation group (25%). The area under the curve (AUC) of the receiver operating characteristic (ROC) was calculated to assess the predictive performance of the nomogram.

Results: The prevalence of frailty among older patients undergoing abdominal surgery was 74.18%. Eight independent risk factors were identified: advanced age (OR=1.32), lower BMI (OR=1.28), limited education (OR=1.45), laparoscopy (OR=1.67), tumor comorbidity (OR=2.01), diabetes (OR=1.89), antihyperlipidemic drug use (OR=1.53), and elevated interleukin-6 (OR=1.76). The nomogram demonstrated acceptable discrimination, with AUCs of 0.748 (the test group) and 0.707 (the validation group).

Conclusion: Our findings demonstrate a nomogram to predict the probability of frailty for older patients undergoing abdominal with acceptable predictive performance. The nomogram is helpful in guiding further targeted and effective intervention and prevention efforts to decrease frailty and improve health outcomes.

Introduction: With rapid global aging, older colorectal cancer (CRC) patients are increasing, yet their clinical and molecular characteristics remain inadequately characterized. This comparative study systematically analyzed clinical and molecular characteristics of older CRC patients aged 60-80 years and those aged ≥80 years to provide evidence for individualized treatment strategies.

Methods: Older CRC patients who underwent radical surgery at Peking University Third Hospital from October 2015 to June 2023 were retrospectively included. Patients were categorized as older-age group (≥80 years, n=214) and younger-age group (≥60 and <80 years, n=958). Clinicopathological characteristics and disease-free survival (DFS) were analyzed. Transcriptome sequencing and analysis was performed on 244 primary CRC tissues (53 older-age and 191 younger-age).

Results: Among 1172 patients, the older-age group demonstrated distinctive clinical features: reduced chemotherapy receipt, elevated CEA levels, more right-sided tumors, more mucinous adenocarcinomas, larger tumor size, and higher mismatch repair deficiency (dMMR) prevalence (all P<0.05). DFS was significantly shorter in the older-age group (P<0.001), with age ≥80 years identified as an independent risk factor (HR=1.530, 95% CI: 1.022-2.290, P=0.039). Transcriptomic analysis revealed unique biological characteristics in the older-age group: upregulation of neural regulation and extracellular matrix remodeling pathways, downregulated immune responses with increased M2 macrophage infiltration, and enrichment of CMS1 and CMS4 molecular subtypes.

Conclusion: CRC patients aged ≥80 years exhibit higher dMMR rates and shorter DFS, with molecular features of immunosuppression, ECM remodeling, and enhanced neural-tumor interactions, challenging the assumption of slow CRC progression in very older patients. These findings provide basis for personalized treatment strategies in this underrepresented and growing population.

Purpose: The aim of the study was to identify demographic, clinical, and institutional predictors influencing the selection of percutaneous vertebroplasty (PVP) versus conservative management in older adults with osteoporotic vertebral compression fractures (OVCFs).

Patients and methods: We conducted a retrospective cohort study using the Kaohsiung Medical University Hospital Research Database, including 1688 patients aged ≥50 years hospitalized for OVCFs (2018-2022). Patients were categorized into PVP (n = 385) and conservative management (n = 1,303) groups. Independent predictors of treatment selection were identified using multivariable logistic regression.

Results: Significant predictors of vertebroplasty selection included advanced age (≥85 years), severe pain (VAS 8-10), congestive heart failure, diabetes mellitus, and analgesic usage, while a higher comorbidity burden (CCI ≥2) reduced the likelihood of receiving PVP. Regional hospitals were more likely than medical centers to perform vertebroplasty.

Conclusion: Patient age, pain severity, specific comorbidities, analgesic requirements, and institutional factors significantly influenced treatment selection for OVCFs. These findings underscore the need for individualized, risk-adapted strategies. Given the retrospective design, causal inferences should be interpreted with caution.