Clinical Interventions in Aging最新文献

Purpose: Older adults with chronic heart failure often experience significant delays in making healthcare-seeking decisions from the onset of symptom exacerbation to the final decision to seek medical care. Guided by the Health Belief Model and the Theory of Planned Behavior, this study investigates the duration and factors influencing delayed healthcare-seeking decisions following symptom acute exacerbations in older adults with chronic heart failure.

Patients and methods: A cross-sectional study was conducted from November 2023 to June 2024, employed a convenience sampling method, involving 244 older adults with chronic heart failure hospitalized in two general hospitals in Nanjing, China. Data were collected using a questionnaire survey and all research instruments were validated and tested for reliability.

Results: The results showed that the healthcare-seeking decisions time among the 244 patients ranged from 2 hours to 4410 hours, with a median time of 187.5 hours (7.8 days), Q1 of 82.0 hours, and Q3 of 504.5 hours. Regression analysis indicated that symptom management self-efficacy (β = 0.637, P < 0.001), social support (β = -0.195, P < 0.001), heart failure somatic perception (β = -0.159, P = 0.003), speed of onset (β = -0.119, P = 0.028), and attempts at self-management (β = 0.102, P = 0.031) were significantly associated with the delay in healthcare-seeking decisions.

Conclusion: This study revealed that healthcare-seeking decision delays are common among older adults with chronic heart failure in China, primarily influenced by factors such as heart failure somatic perception, social support, symptom management self-efficacy. The findings suggest that strengthening health education, improving social support networks, and optimizing multidisciplinary collaboration may help shorten decision-making time, thereby improving patients' clinical outcomes and quality of life.

Background: Retinal vein thrombosis (RVT) represents a global public health problem, ranking as the second position in prevalence among all retinal vascular pathologies and becoming an "epidemic" with the advanced age of patients. The prevalence of this pathology increases 20 times in patients aged over 80 years, compared to the age of 40-49 years. This pathology can lead to visual impairment, blindness and causes disability, but it is reversible within the first 7 days with timely diagnosis and treatment. The response to anti-VEGF treatment is better with earlier initiation. VEGF suppression not only improves macular edema but also reopens some closed retinal vessels, prevents the progression of vessel closure, and improves retinopathy. Consequently, early diagnosis, competent treatment and rehabilitation, especially in older adults with retinal vascular pathology, are necessary to prevent vision loss and disability. However, there is a lack of studies on mechanisms of RVT development in this demographic group.

Purpose of the study was: To provide a synthesis of the literature regarding the evaluation risk factors and pathogenesis of ocular vascular pathology, with special emphasis on examination methods, clinical characteristics, complications and modern treatment strategies in older adults with retinal vein thrombosis.

Materials and methods: PubMed, Web of Science and Cochrane Library were searched for studies, systematic reviews or meta-analyses reporting the relationship between the central retinal vein (CRV) or its branches thrombosis and patient age in the period from 2015 to 2024. Population-based or cohort studies with maximum population inclusion were selected.

Results: Analysis of modern methods examination - fluorescence angiography of the ocular fundus (FA), an angio-optical coherence tomography (Angio-OCT) study of the retina and Fluorescence angiography allows revealing important pathogenetic aspects of retinal vein occlusion. Understanding all epidemiological, pathogenetic and diagnostic aspects in older adults is paramount for RVT timely effective prevention, clinical intervention and rehabilitation.

Conclusion: The prevalence of retinal vein occlusion increases significantly with age. It is associated with an increase in stroke, cardiovascular events, and mortality. This requires monitoring and treating vascular risk factors.

Purpose: Chronic Post-Surgical Pain (CPSP) is a common surgical complication, but the association between perioperative complications, patients' intrinsic mental status, and 3-month CPSP remains unclear in elderly surgical populations. This study thus aims to identify perioperative risk factors for 3-month CPSP in elderly patients after non-cardiac surgery, with CPSP here defined as pain intensity ≥3 on the Numerical Rating Scale at 3-month follow-up.

Patients and methods: This retrospective study included 367 elderly patients. We first analyzed variables with descriptive statistics, then conducted all subsequent analyses separately for each of the three surgical subgroups, allowing for potential nuances in the contributory patterns of key factors across groups. To predict 3-month CPSP, we used 10 machine learning algorithms. Model performance was assessed via repeated 5-fold cross-validation, and top-performing models were interpreted using SHapley Additive exPlanations (SHAP) to clarify how key factors contribute.

Results: Of 367 patients, the overall prevalence of 3-month CPSP was 25.07%, with significant variation across surgical subgroups: 48.05% in orthopedic surgery, 10.34% in urinary tumor surgery, and 7.14% in abdominal tumor surgery. The Random Forest model showed strong, consistent predictive ability across the three subgroups. Frailty was a key shared risk factor for CPSP across all surgical types, and further analyses identified surgery-specific risk factors.

Conclusion: These findings demonstrate that data-driven models can reliably predict CPSP across studied surgical types, with frailty state as a universal risk factor and distinct surgery-specific profiles supporting tailored perioperative risk assessment and prevention strategies.

Background: Hypertensive heart disease (HHD) in older adults is characterized by structural remodeling and subtle functional impairment that may escape conventional echocardiography. This study aimed to determine the diagnostic value of two-dimensional speckle tracking echocardiography (2D-STE)-derived left atrial strain rates for functional assessment in elderly patients with HHD.

Methods: In this retrospective, single-center cohort, 236 patients aged ≥65 years were enrolled (January 2023-January 2025): 118 with echocardiographic HHD and 118 age-matched hypertensive controls without structural abnormalities. Transthoracic echocardiography with 2D-STE quantified mean peak left atrial strain rates in late diastole (mSRa), early diastole (mSRe), and systole (mSRs). Elderly HHD patients were stratified by New York Heart Association (NYHA) class. Group comparisons used t-tests, and receiver operating characteristic (ROC) curves with area under the curve (AUC) evaluated discrimination.

Results: Compared with controls, the HHD group had larger left ventricular end-diastolic diameter (LVEDD 60.29 ± 5.26 vs 48.17 ± 5.46 mm; P<0.001), lower left ventricular ejection fraction (LVEF 51.10 ± 7.25% vs 61.21 ± 4.96%; P<0.001), and impaired atrial mechanics (mSRa -2.20 ± 0.27 vs -2.75 ± 0.30 s^{- 1}; P<0.001; mSRe -2.29 ± 0.33 vs -1.90 ± 0.38 s^{- 1}; P<0.001; mSRs 1.34 ± 0.30 vs 2.15 ± 0.31 s^{- 1}; P<0.001). Within HHD, NYHA III-IV showed worse strain than NYHA I-II (eg, mSRa -1.90 ± 0.26 vs -2.48 ± 0.23 s^{- 1}; P<0.001). ROC analysis demonstrated excellent discrimination of functional severity: AUC 0.916 for mSRa (cut-off -2.367 s^{- 1}; sensitivity 96.8%; specificity 76.7%), AUC 0.876 for mSRe (-2.302 s^{- 1}; 91.6%; 65.0%), and AUC 0.881 for mSRs (1.361 s^{- 1}; 92.5%; 68.7%) (all P<0.001).

Conclusion: In elderly HHD, 2D-STE-derived atrial strain rates (mSRa, mSRe, mSRs) are significantly impaired, correlate with NYHA class, and provide high diagnostic accuracy for differentiating mild versus severe functional limitation. These indices may serve as sensitive, non-invasive markers to support early detection and clinical stratification in this population. Prospective studies are needed to establish prognostic utility.

Background: Bloodstream infections (BSIs) are associated with significant mortality, particularly in elderly patients. Escherichia coli (E.coli) is the most common causative organism in BSIs, but non-E.coli BSIs are associated with increased morbidity and mortality. Predictive biomarkers including the neutrophil-to-platelet ratio (NPAR) have not been well studied in elderly hospitalized patients. Our study aimed to compare the mortality in patients with E.coli and non-E.coli BSIs and, evaluate NPAR as a potential predictive biomarker for E.coli infection in extremely elderly inpatients.

Methods: A single-center, retrospective cohort study was conducted, involving 510 elderly patients diagnosed with bloodstream infections. Patients were divided into two groups based on the pathogen responsible for the infection: E.coli (n=92) and non-E.coli (n=418). Clinical data, comorbidities, and laboratory parameters were systematically collected. Kaplan-Meier survival analysis and Cox proportional hazards models were used to assess mortality risk, adjusting for relevant confounding variables. The predictive value of NPAR for E.coli bloodstream infection was analyzed via odds ratios (OR) and trend tests. Microbiological analysis of blood samples was performed according to the Clinical and Laboratory Standards Institute protocols.

Results: Non-E.coli BSIs was associated with greater mortality compared to E.coli BSI; hazard ratio (HR)=0.43 (95% CI=0.21, 0.88; P=0.021). NPAR was a significant predictor of E.coli BSI; for continuous NPAR, the odds of E.coli BSI decreased by 12% per unit increase in NPAR (OR=0.88; 95% CI=0.84, 0.93; P<0.001). The odds ratio of the lowest tertile of NPAR versus rest was 0.21 (95% CI=0.11, 0.40, P<0.001).

Conclusion: Non-E.coli BSIs are associated with greater mortality in elderly patients, while low NPAR is strongly associated with E.coli BSI. These findings suggest that NPAR may be useful for early risk stratification and clinical management of elderly patients with BSIs.

Purpose: To investigate serum programmed cell death factor 4 (PDCD4) and a disintegrin and metalloproteinase 10 (ADAM10) expression in elderly patients with atherosclerotic acute myocardial infarction (AMI) and assess their prognostic value.

Methods: A retrospective analysis was conducted on 134 elderly patients with atherosclerotic AMI (disease group) and 110 healthy controls. Serum PDCD4 and ADAM10 levels were measured using ELISA. Based on prognosis, patients were divided into good prognosis (n=79) and poor prognosis groups (n=55). Clinical factors and biomarker levels were compared between groups. Logistic regression identified independent predictors of poor prognosis, and receiver operating characteristic (ROC) curves assessed predictive performance.

Results: Serum PDCD4 and ADAM10 levels were significantly higher in AMI patients compared with controls, and further elevated in the poor prognosis group (P<0.05). Poor prognosis was also associated with older age, diabetes, STEMI, larger infarct size, anterior wall infarction, higher Killip class and GRACE score, elevated NT-proBNP and hs-CRP, and reduced LVEF (P<0.05). Logistic regression confirmed elevated PDCD4 and ADAM10, diabetes, Killip class ≥II, GRACE score ≥140, STEMI, anterior infarction, NT-proBNP increase, and reduced LVEF as independent predictors of poor prognosis (P<0.05). ROC analysis showed AUCs of 0.837 for PDCD4, 0.859 for ADAM10, and 0.931 for their combination, with the combined model outperforming either marker alone (P<0.05).

Conclusion: Serum PDCD4 and ADAM10 are elevated in elderly atherosclerotic AMI patients and independently associated with poor prognosis. Combined detection may provide improved prognostic assessment, although further studies are warranted to validate these findings.

Background: Sarcopenia is an age-related condition characterized by loss of muscle mass and function. Nephrolithiasis represents a prevalent urological disorder that imposes a substantial burden on healthcare resources. However, the association between sarcopenia and nephrolithiasis remains poorly characterized.

Methods: A total of 2586 older adults were included in this cross-sectional study. We used the univariate and multivariate logistic regression models to assess the relationship between nephrolithiasis and sarcopenia. Additionally, stratified analyses and propensity score matching (PSM) were performed to account for potential confounding factors.

Results: The prevalence of sarcopenia in the present study was 7.2%. In Model 4, which integrated for all relevant covariates, nephrolithiasis was associated with approximately a 190% increased prevalence of sarcopenia compared to non-nephrolithiasis patients (OR: 2.912, 95% CI: 1.708-4.968, P <0.001). Following PSM, the results also confirmed the association between nephrolithiasis and sarcopenia (OR: 4.426, 95% CI: 1.547-12.661, P = 0.006). Notably, this association was more pronounced in subgroups including males (OR: 3.296, 95% CI: 1.436-7.564, P = 0.005), lower education level (OR: 8.127, 95% CI: 3.057-21.609, P <0.001), and diabetes (OR: 6.686, 95% CI: 2.626-17.027, P <0.001).

Conclusion: Our findings demonstrate that nephrolithiasis is positively related to the potential risk of sarcopenia in Chinese older adults. This finding indicates that nephrolithiasis may contribute to sarcopenia development, thereby emphasizing that prevention and intervention strategies for sarcopenia should account for the adverse effects of nephrolithiasis.

Background: Due to the increase in life expectancy, the prevalence of older adults with chronic diseases is gradually increasing. Intrinsic capacity (IC) is an important indicator for assessing the physical condition of older adults. Older adults often experience a decline in IC before serious illness develops. Early screening for IC decline and timely interventions are essential. The goal of this study was to explore the patterns of IC impairment and their influencing factors in older adults with chronic diseases, and to provide a reference for the development of interventions to enhance their IC.

Methods: We conducted a cross-sectional study of 8427 older adults (≥60 years) in Zunyi City, China. A composite score for IC, covering the cognitive, sensory, locomotion, vitality, and psychological domains, was calculated using a weighting method. Data were collected on demographics, chronic conditions, and a battery of standardized assessments. These included measures of functional capacity (BADL, IADL), cognitive status (CMMS), physical performance (SPPB), nutritional risk (MNA-SF), depressive symptoms (GDS-15), and sensory function (vision, hearing).

Results: Overall, 87.56% of participants showed IC impairment. Latent class analysis identified three distinct patterns of IC impairment: a "Higher IC group", a "Cognitive-locomotion domain-impaired mid-IC group", and a "Locomotion-impaired predominantly low-IC group", which comprised 23.2%, 59.96%, and 16.84% of the sample, respectively; age, BMI, BADL, IADL, sex, educational level, marital status, type of medical insurance, average household monthly income, drinking, annual physical examination, socialization, and exercise were all influential factors in the patterns of IC (P<0.05).

Conclusion: The impairment of IC in older adults is group heterogeneous and affected by different factors; using IC as a multi-categorical variable is beneficial to refine the patterns of IC impairment; healthcare professionals should carry out early targeted interventions for different patterns of older adults to enhance their IC and promote healthy aging.

Purpose: Frailty is a prevalent geriatric syndrome that is strongly related to systemic inflammation; nevertheless, sex differences in its association with inflammation remain poorly understood. We aimed to investigate sex-specific associations between inflammatory biomarkers and frailty in a large cohort of hospitalized older adults.

Patients and methods: This cross-sectional study with 4,438 older adults aged ≥65 years was conducted at Taizhou First People's Hospital (Taizhou, China) between 23/08/2024 and 31/05/2025. The 28-item Frailty Index (FI-28, score ≥0.25 indicates frail) was used to measure frailty. High-sensitivity CRP (hs-CRP) (immunofluorescence), interleukin-6 (IL-6), interleukin-10 (IL-10), and tumor necrosis factor-alpha (TNF-α) (flow cytometry) were measured; biomarkers underwent ln-transformation. Multivariate logistic regression was used to calculate adjusted odds ratios (aORs) for frailty per 1 standard deviation (SD) rise in ln-transformed biomarkers, controlling for confounders. Sex-specific differences were evaluated using interaction tests.

Results: Women experienced frailty at a higher rate than men did (37.68% vs 22.8%, P < 0.001). After adjustment, high levels of IL-6, hs-CRP, and IL-10 in frail older adults were significantly linked to frailty risk (all P < 0.001). Nevertheless, TNF-α did not (p = 0.983). The relationship of frailty with IL-6, hs-CRP, and IL-10 was found to be significantly altered by sex, according to interaction tests (P_interaction < 0.001). The relationship of inflammatory markers with frailty risk differed by sex. In women, raised hs-CRP, IL-6, and IL-10 (all P < 0.001) levels showed a strong link to greater frailty risk. In men, though these markers were significantly related to frailty, their strength was lower: hs-CRP, IL-6, and IL-10 (all P < 0.001). TNF-α showed no independent association in either group.

Conclusion: In older adults, elevated levels of hs-CRP, IL-6, and IL-10 are associated with higher frailty risk; the associations are significantly stronger in women than in men. These findings emphasize considering sex differences in frailty management; however, longitudinal studies are required to confirm causality.

Objective: To establish the prevalence of cognitive frailty (CF) among older adults residing in nursing homes and to evaluate the relationship between this condition and the prevalence of hearing impairment and dysphagia.

Measurements: A cross-sectional study of 451 individuals 60+ years of age living in nursing homes in Chengdu, Sichuan, China. The FRAIL and Chinese Mini Mental Status (CMMS) scales were respectively employed to measure physical frailty (PF) and cognitive functionality, with the results being used to separate subjects into four groups: cognitively intact non-PF individuals ("robust" group), cognitively impaired non-PF individuals ("MCI-only" group), cognitively intact individuals with PF ("PF only" group), and cognitively impaired individuals with PF ("CF" group). Individuals in these groups were evaluated for demographic characteristics, geriatric syndrome, and disease status. Hearing impairment was screened by self-report, and dysphagia was screened using the Eating Assessment Tool (EAT-10). Risk factors were evaluated through a stepwise logistic regression approach.

Results: In total, 451 individuals (144 male, 307 female; mean age: 84.15±5.63 years) were enrolled in this study. CF was found it impact 18.6% of this cohort. Risk factors significantly associated with CF in stepwise logistic regression analyses included hearing impairment (P=0.008, OR=3.936, 95% CI=1.433-10.813) and dysphagia (P=0.046, OR=3.441, 95% CI=1.021-11.601). The CF group also contained a larger proportion of individuals affected by dysphagia and hearing impairment relative to the MCI-only and robust groups, respectively.

Conclusion: CF affects approximately 20% of older adults in nursing home environments, and both hearing impairment and dysphagia are strongly associated with an increased risk of CF.