Clinical Interventions in Aging最新文献

Background: Elderly trauma (ET) carries a high mortality rate due to comorbidities, frailty, and limited physiological reserve. Understanding its specific pathophysiology is essential for enabling precision treatment.

Objective: To identify characteristic metabolic dysregulations and specific pathways in geriatric trauma.

Methods: We retrospectively analyzed existing metabolomics data from ET, young and middle-aged trauma (YMAT), elderly controls (EC), and young and middle-aged controls (YMAC).

Results: An IVD integrating 8 significant metabolic pathways (SMPs) from ET vs EC and 10 SMPs from YMAT vs YMAC identified 3 pathways specific to ET: glyoxylate and dicarboxylate metabolism, galactose metabolism, and Pantothenate and coenzyme A (CoA) biosynthesis. The second IVD integrating these pathways with 3 SMPs from EC vs YMAC identified 2 metabolic pathways specific to ET independent of natural aging: glyoxylate and dicarboxylate metabolism, and pantothenate and CoA biosynthesis. Finally, the third IVD integrating them and 7 SMPs from ET vs YMAT identified glyoxylate and dicarboxylate metabolism as unique signature of geriatric trauma.

Conclusion: This study was one of few metabolomics studies that distinguish between geriatric trauma-related metabolic changes and baseline aging factors, and revealed glyoxylate and dicarboxylate metabolism disorder as a key pathway specific to geriatric trauma. Understanding it may inform the development of age-tailored strategies for improving trauma outcomes in the elderly.

Background: With the rapid aging of China's population, osteoporosis and sarcopenia have become major public health challenges. Denosumab, a first-line therapy for osteoporosis, may also improve muscle health, a possibility warranting further investigation.

Objective: This study evaluated the efficacy of denosumab in treating primary osteoporosis in the Chinese population and explored its potential effects on sarcopenia. A Mendelian randomization (MR) analysis was additionally performed to investigate the causal role of the RANKL pathway in sarcopenia.

Methods: This study included two components. In the clinical study, 45 patients with primary osteoporosis received denosumab, of whom 40 completed a 6-month follow-up and 15 completed a 1-year follow-up. Outcomes included bone turnover markers, bone mineral density, muscle strength, and physical performance measures. In the genetic study, two-sample MR was conducted using genome-wide association study (GWAS) summary statistics to assess the causal association between RANKL gene variants and sarcopenia-related traits, including appendicular lean mass and grip strength.

Results: Denosumab significantly reduced bone turnover markers and improved muscle function after 6 months, with further gains in bone mineral density and muscle strength observed at 1 year (all P < 0.05). Muscle mass showed upward but non-significant trends. MR analysis revealed a significant negative association between RANKL expression and both appendicular lean mass and grip strength, with no evidence of heterogeneity or pleiotropy.

Conclusion: Denosumab effectively treats osteoporosis and improves muscle function in Chinese patients. Genetic evidence supports a causal role of the RANKL pathway in sarcopenia, indicating that RANKL overexpression may contribute to its development. By integrating clinical and genetic evidence, our findings suggest that denosumab may represent a promising therapeutic option for patients with concurrent osteoporosis and sarcopenia.

The accelerated global aging process has amplified oral health challenges among older adults, emerging as a critical public health concern impacting quality of life. This study systematically reviews and synthesizes existing literature to construct a theoretical framework for oral frailty (OF) interventions in older adults. By mapping evidence clusters and gaps, we aim to inform evidence-based strategies for improving oral function to promote healthy longevity. This scoping review adhered to the methodology framework established by Arksey and O'Malley, utilizing the PRISMA-ScR guidelines to conduct a systematic search of PubMed, Web of Science, Cochrane, Embase, and PROSPERO, JBI Evidence Synthesis, Open Science Framework (up to October 2025). Eligible English-language primary studies investigating geriatric OF interventions were included for analysis. A total of 11,235 original papers were retrieved, and 14 eligible studies were finally included after deduplication and screening. Of these, 11 were cross-sectional study intervention trials, with 2 review and 1 longitudinal intervention trial. Current interventions primarily target mastication and swallowing dysfunction, focusing less on salivary secretion and oral motor skills disorders. Their effects are heterogeneous due to these differences in intervention type, implementation method, and participant characteristics. Current evidence shows that interventions hold promise for improving oral function in older adults, yet their long-term effects need systematic validation. Future research should prioritize advancements in related mechanisms, innovative technologies, and management-service models to develop universal integrated intervention programs and promote healthy aging.

Introduction: This study compared the quality of postoperative recovery among older patients undergoing day surgery with induction using remimazolam or etomidate.

Methods: This multicenter, randomized, parallel-group, double-blinded trial with a non-inferiority design was conducted in three tertiary university hospitals. Older patients undergoing day surgery were randomly assigned to receive either remimazolam or etomidate for pump-induced general anesthesia. The primary outcome was the 15-item Quality of Recovery (QoR-15) score on postoperative day 1 (POD1). The mean difference between the groups was compared against a non-inferiority margin of -8. Secondary outcomes included the QoR-15 score on POD2, scores for the five QoR-15 dimensions, and vital signs at predefined time points.

Results: In total, 118 older patients were randomized to the two groups. In the per-protocol set, the QoR-15 score on POD1 was 133.7 ± 12.9 in the remimazolam group, versus 131.2 ± 17.3 in the etomidate group, with a mean difference of 2.5 [95% confidence interval [CI]: -3.2, 8.2). In the modified intention-to-treat set, the QoR-15 scores were 133.5 ± 12.9 and 131.2 ± 17.6 in the remimazolam and etomidate groups, respectively, with a mean difference of 2.3 (95% CI: -3.3, 7.8). The lower limit of the confidence interval exceeded the predefined non-inferiority cutoff of -8, confirming the non-inferiority of remimazolam (P < 0.001). We compared the QoR-15 dimension scores on POD1 with the baseline scores in both groups. In the remimazolam group, only the physical independence score on POD1 was higher than at baseline, whereas in the etomidate group, the total QoR-15, physical comfort, physical independence, and emotional state scores were all lower on POD1 than at baseline. During anesthesia maintenance, the remifentanil dosage was higher in the remimazolam group than in the etomidate group (890.1 ± 5.7 µg vs 745.1 ± 45.3 µg, P = 0.037).

Conclusion: In older patients undergoing day surgery, remimazolam exhibited non-inferiority to etomidate for anesthesia induction in terms of QoR-15 scores on POD1.

Objective: Postoperative delirium (POD) and cognitive decline (POCD) are linked to inflammatory brain injury, and nucleotide-binding oligomerization domain-like receptor family pyrin domain-containing 1 (NLRP1) participates in neuroinflammation. Here, we investigated influential factors of serum NLRP1 levels and its predictive significance on POD and POCD of elderly patients with hip fracture.

Materials and methods: In this observational analytical study, serum NLRP1 levels were quantified in 100 controls, and preoperatively and postoperatively in 271 elderly patients undergoing hip fracture surgery. Primary outcome was postoperative three-month POCD [Montreal cognitive assessment (MoCA) scores below 26], and secondary outcomes included in-hospital POD and serum NLRP1 levels. The associations with them were analyzed using multivariate methods.

Results: Compared to controls, patients had markedly heightened postoperative, but not preoperative, serum NLRP1 levels. Postoperative serum NLRP1 levels were independently associated with postoperative C-reactive protein levels and FRAIL scores. Postoperative serum NLRP1 and FRAIL scale scores were independently associated with POD, and together with POD, were also independently related to the MoCA scores and effectively predicted POCD. The results of the regression analyses were comparatively robust based on collinearity evaluation, sensitivity analysis, subgroup analysis, interactivity investigation, and restricted cubic spline analysis. The independent predictors of POD and POCD were integrated separately to form the respective models. The models were graphically delineated via nomograms and were efficaciously used to distinguish the risk of POD or POCD based on the calibration, decision, and receiver operating characteristic curves. By applying mediation analysis, POD may partially mediate the association between the postoperative serum NLRP1 levels and POCD.

Conclusion: Serum NLRP1 may be a potential predictor of POD and POCD in elderly patients undergoing hip fracture surgery and the combined use of FRAIL and NLRP1 may optimize the efficiency of screening in high-risk populations.

Objective: Falls are a major public health concern for older adults, and exercise is considered a key strategy for fall prevention. This study aimed to evaluate the efficacy of a novel combined intervention of Basic Tai Chi and Roliball on balance, mobility, and cognitive function in community-dwelling older adults, and to compare its effects with traditional Tai Chi programs, thereby providing a novel structured physical activity approach for localized fall prevention and control.

Patients and methods: One hundred and thirty-five participants aged ≥60 years were divided equally into structured Basic Tai Chi combined with Roliball demonstration (TC+RB-D), Basic Taichi Chuan (TC) and 24-from simplified Tai Chi (24-TC). During the 12-week intervention period, participants attended three in-person sessions per week (90 minutes/session). All measures were assessed before and after the intervention.

Results: Compared with the 24-form Tai Chi group, the TC group and TC+RB-D group showed significant improvements in GS, TUG, BBS, and MoCA. The TC+RB-D group showed significant improvement on the mFES (β=0.463, 95% CI: 0.366-0.561, p<0.001). The TC group demonstrated a unique advantage on the EC-SLS (β = 2.705, 95% CI: 0.989-4.421, p = 0.002). The TC+RB-D group was not inferior to the traditional 24-form simplified Tai Chi in functional fall risk testing and cognitive function assessment.

Conclusion: This study developed a structured physical activity program rooted in Tai Chi culture. This multimodal exercise approach may have significant benefits for older adults in maintaining balance, enhancing mobility, and preserving cognitive function.

With aging, compensatory mechanisms and physiological reserve may become insufficient to maintain balance and gait (BG), particularly when associated with stroke, Alzheimer's disease, diabetes, osteoarticular diease, vestibular disorders, orthostatic hypotension (OH), heart rhythm disorders, or drug side effects. This leads to poorer postural-motor function and increased risk of falling (RoF). This review aims to highlight recent scientific advancements relative to BG disorders (BGDs) for gerontology professionals. When assessing older adults (OAs) with BGDs, a thorough assessment of patient history is needed to identify the origins. This should include the history of falls, an inventory of medications, and an analysis of the home environment. A comprehensive clinical examination is also required to guide etiological diagnoses. A clinical suspicion of cardiac arrhythmia/conduction disorders, for example, will be confirmed by electrocardiogram (ECG)/Holter ECG, whereas suspected OH (on questioning) will be confirmed by an OH test, and, in the presence of confusion, epilepsy will be confirmed by the electroencephalogram. Several tools, ranging from simple and quick to more complex and thorough, have been validated to evaluate BGDs in OAs. These tests involve activities of daily living tasks required to preserve independence. Emerging technologies for RoF assessment (ie, surface electromyography, force platforms, three-dimensional motion capture systems) while not yet used in routine geriatric practice, can improve early detection, monitoring, and rehabilitation. Optimal BGD management requires the implication of several health professionals. Rehabilitation programs such as the "Otago exercise programme" and "falls management exercise" have been validated. Assistive technologies (canes, walkers, grab bars, and orthopedic footwear or automated alert systems), and new technologies (virtual reality) can also be used. Additional steps include medication review and deprescribing, occupational therapy and home environment adaptations. Understanding and managing BGDs in OAs remains a major public health issue, and is vital for preserving independence in later life.

Background: The Otago Exercise Program (OEP) is suitable for frail older adults but has limited effect on sarcopenia. Resistance training (RT) is commonly used for sarcopenia. This study evaluated the effects of 12 weeks of OEP combined with RT on body composition, physical function, quality of life, and frailty in older adults with pre-sarcopenia in nursing homes.

Methods: Sixty-one pre-frail elderly (aged 65-89 years) with sarcopenia were randomly divided into experimental group (EG) and control group (CG). EG received OEP+RT training three times a week for 12 weeks, and CG maintained daily activities. The InBody 770 was used to assess body composition, Jamar Plus was used to measure grip strength, and international standard scales were used to assess physical function, quality of life and frailty.

Results: Compared to the CG, the EG showed significant improvements in Skeletal Muscle Index (SMI: 5.79 vs 5.43, p=0.037), Skeletal Muscle Mass (21.8 vs 19.5, p=0.017), hand grip strength (19.31 vs 16.92, p=0.029), gait speed (0.9 vs 0.81, p<0.001), and the Five-Times-Sit-to-Stand Test (13 vs 14.35, p<0.001). Within the EG, both SMI and hand grip strength increased significantly compared to baseline levels (p<0.001), whereas in the CG, they decreased significantly (p<0.05). There was no significant improvement in frailty status observed in either group.

Conclusion: OEP combined with RT can improve the sarcopenia-related parameters of the elderly in nursing homes. Short-term unreversed frailty may be related to insufficient intervention intensity or single dimension. Improved muscle and physical function may contribute to future improvements in quality of life and frailty.

Background: Contezolid is a new oxazolidinone antibacterial agent, and its pharmacokinetic (PK) characteristics and safety in super-elderly patients remain poorly understood.

Methods: Contezolid PK parameters were analyzed in enrolled super-elderly patients (≥ 80 years), with systematic assessment of steady-state profiles and adverse events.

Results: Thirteen super-elderly patients (mean age: 94.9 ± 4.8 years) were included in the study. The plasma concentrations of contezolid peaked at 2-3h post administration. Both C_max and AUC_0-t exhibited dose-dependent increases across regimens (400 mg q24h, 400 mg q12h, and 800 mg q12h). When receiving a dosage of 800 mg q12h, super-elderly patients demonstrated comparable C_max (20.32 vs 26.45 mg/L), AUC_0-t (97.80 vs 90.38 h·mg/L), and clearance (9.08 vs 10.20 L/h) values to those of healthy adults but prolonged T_max (2.67 vs 0.57 h) and shorter t_1/2 values (2.33 vs 4.84 h). For pathogens with a minimum inhibitory concentration (MIC) ≤1 mg/L, 400 mg of contezolid q12h resulted in a > 90% probability of target attainment (PTA), whereas doubling the dose to 800 mg q12h resulted in a PTA > 90% against pathogens with MICs of 2-4 mg/L. Contezolid was well tolerated, with mild gastrointestinal adverse reactions (vomiting, n=2) and elevated AST (n=1), γ-GT (n=2), and lipase (n=1) levels. According to a self-controlled analysis of 9 patients who switched from linezolid to contezolid, the incidence of thrombocytopenia was significantly lower when taking contezolid (11.1% vs 77.8%).

Conclusion: Contezolid has comparable PKs in super-elderly and healthy adults. While a dosage of 400 mg q12h is sufficient for pathogens with MICs ≤ 1 mg/L, a higher dosage of 800 mg q12h is recommended for higher MICs (2-4 mg/L), with both doses demonstrating favorable safety.

Clinical trial registration number: ChiCTR2200056377; 4/2/2022.

Objective: The glucose-to-potassium ratio (GPR) has been proven to be an early predictor of central nervous system injury. Meanwhile, it has a potential interaction with the inflammatory response. Therefore, we aimed to comprehensively analyze the prognostic value of GPR for thrombolytic acute ischemic stroke (AIS) patients and its synergistic effect with the neutrophil-to-lymphocyte ratio (NLR).

Methods: AIS patients treated with thrombolysis were retrospectively enrolled at the First Affiliated Hospital of Wenzhou Medical University between February 1st, 2018, and December 31st, 2021. Cox and Logistic regression were used for evaluating the predictive value of GPR for the prognosis of AIS patients. Patients were grouped according to GPR and NLR levels to study the synergistic effect of GPR and NLR.

Results: In a cohort of 606 patients, after adjusting for significant confounding factors in a multivariate regression analysis, GPR was able to independently predict adverse outcomes such as 6-mRS [odds ratio (OR) = 1.743, 95% confidence interval (CI): 1.271-2.389, p = 0.001]. The synergistic analysis of GPR and NLR showed that for 6-mRS, GPR-H/NLR-L (OR = 2.888, 95% CI: 1.213-6.874, p = 0.017), GPR-H/NLR-M (OR = 2.757, 95% CI: 1.179-6.447, p = 0.019) and GPR-H/NLR-H (OR = 5.195, 95% CI: 2.320-11.634, p < 0.001) were significantly associated with adverse outcomes.

Conclusion: GPR independently predicts adverse outcomes in AIS patients, and its addition to the prediction model improves predictive accuracy. There's a synergistic effect between GPR and NLR on adverse outcomes.