Clinical Interventions in Aging最新文献

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.

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.