Clinical Interventions in Aging最新文献

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.

Purpose: The frequency of acute heart failure (AHF) is relatively high in older adults undergoing hip fracture surgery. This study aims to explore the possible risk factors and create a nomogram predictive model for quantifying the level of risk.

Patients and methods: This study retrospectively analyzed older adults who underwent hip fracture surgery at the Orthopaedic Department of Chengdu Fifth People's Hospital affiliated with Chengdu University of Traditional Chinese Medicine between January 2022 and December 2023. Statistical analysis was performed using SPSS 25.0 and R software to develop a nomogram prediction model. The model's predictive precision was evaluated by examining the area under the curve (AUC) of the receiver operating characteristic (ROC) curve. Calibration curves and decision curve analysis (DCA) were also utilized to assess the model's calibration and clinical utility comprehensively.

Results: This study underwent rigorous screening and ultimately included 313 patients. These samples were then divided into two groups in a 7:3 ratio, with 220 cases serving as the training set and 93 cases serving as the validation set. After performing univariate analysis and multivariate logistic regression analysis, we developed a nomogram based on the training set model, with an AUC of 0.861 (95% CI: 0.796-0.925). In the validation set model, the AUC was 0.819 (95% CI: 0.692-0.946). According to the calibration curve, the model shows a good fit. The DCA results suggest that the model holds significant practical value.

Conclusion: Statistical data indicates that the incidence of AHF post-operative in older adults with hip fractures reaches up to 15.34%. Multiple regression analysis revealed that age, cerebrovascular disease, cirrhosis, malnutrition, intraoperative blood loss, and hypoproteinemia are significant risk factors. Based on these findings, this study developed a nomogram prediction model to accurately assess the risk of AHF following surgery in older adults with hip fractures.

Purpose: In clinical practice, non-steroidal anti-inflammatory drugs (NSAIDs) are widely prescribed to older adults patients for pain and inflammation. However, drug therapy in this population carries risks of polypharmacy and potential drug-drug interactions (pDDIs). This study aimed to evaluate prescribing trends of NSAIDs and examine the incidence of polypharmacy and pDDIs among older adults patients in the Outpatient Pharmacy Department of a secondary care hospital.

Patients and methods: A prospective observational study was conducted using electronic health records of older adults patients prescribed NSAIDs from January to June 2023. Data were screened for NSAID prescription patterns, polypharmacy, and pDDIs using the Micromedex database. Descriptive statistics and logistic regression assessed relationships between treatment-related factors and pDDIs, while Chi-square tested associations between NSAID prescriptions and gastro-protective drugs. A p-value <0.05 was considered statistically significant.

Results: The study was conducted in 174 older adults patients. Celecoxib (28.2%) and ketoprofen (27.6%) were the most often given oral and topical NSAIDs among the study populations, respectively. Aspirin and celecoxib were the most commonly involved NSAIDs causing pDDIs. A total of 340 potential pDDIs were found, with a mean of 1.95 ± 3.66 interactions for each prescription. The analysis of polypharmacy in relation to treatment factors revealed a significant correlation with comorbidities (p < 0.001). A robust positive association exists between the quantity of pDDIs and continuous treatment-related factors, including the Charlson comorbidity index (p = 0.004), the comorbidity burden (p < 0.001), and the overall number of medications being taken (p < 0.001).

Conclusion: The research elucidates the prescribing trends of NSAIDs and uncovers the occurrence of polypharmacy and pDDIs within the older adults population. Giving the right screening and intervention resources to maximize their medication regimen may ensure safer and more effective management of older adults patients.

Introduction: Osteoarthritis (OA) is a chronic degenerative disease characterized by progressive cartilage degeneration, most commonly affecting the knee. Clinical symptoms such as pain, stiffness, and functional limitations significantly impact quality of life. Although neuromuscular electrical stimulation (NMES) is considered a complementary treatment, evidence comparing different waveforms in clinical management remains limited.

Objective: To compare the effects of three different NMES waveforms versus a placebo, applied for four weeks, on pain intensity, disability, and other functional outcomes in individuals with knee osteoarthritis (KOA).

Methods: A randomized clinical trial with 100 participants equally assigned to four groups: transcutaneous electric nerve stimulation (TENS) (n=25), interferential current (IFC) (n=25), Aussie current (n=25), and placebo (n=25). Primary outcomes were pain intensity, disability, and pressure pain threshold and secondary outcomes included aerobic capacity, gait speed, lower limb strength, functional mobility, superficial knee temperature, stability, and fall risk. Primary and secondary outcomes were assessed before and after four weeks.

Results: A significant group x time interaction, with a moderate effect size, was found for the WOMAC index (P = 0.022; η² = 0.10). Participants of the IFC, Aussie, and Placebo groups presented less disability after the treatment. No significant group × time interactions were observed for the other outcomes (all P > 0.05); however, a main effect of time was identified, with positive changes at week 4 in most variables, except for superficial knee temperature, stability, and risk of falls.

Conclusion: Different NMES protocols did not provide additional benefits over placebo for pain intensity, disability or functional outcomes in people with KOA. These findings highlight the need for further research to refine stimulation protocols and identify patient subgroups that may benefit most from NMES in the management of knee osteoarthritis.

Background: Fatigue is highly prevalent in older adults receiving maintenance hemodialysis and seriously affects quality of life. However, evidence on the current status of fatigue and its determinants in this population remains scarce, especially in the unique socio-cultural context of China.

Aim: A multicenter cross-sectional study to investigate the current status of fatigue and analyze associated factors in Chinese older adults receiving maintenance hemodialysis to provide information for targeted interventions.

Methods: This multicenter cross-sectional study was conducted between July 2024 and February 2025. A convenience sampling method was used to recruit 279 older adults receiving maintenance hemodialysis from two tertiary hospitals in Wuxi City. The Revised Piper Fatigue Scale, the Self-Efficacy in Chronic Disease Scale, the Index of Family Caring Scale, the Medical Coping Scale, the Anxiety Self-Rating Scale, and the Depression Self-Rating Scale were used to assess fatigue and related factors. Influential factors were analyzed by t-test, Pearson correlation, and multiple linear regression.

Results: The prevalence of fatigue was 80.3%, and multiple linear regression showed: dialysis vintage ≥5 years (β=0.092, P<0.05), self-efficacy (β=-0.309, P<0.001), family care (β=-0.212, P<0.001), confrontation coping style (β=-0.194, P<0.001), avoidance coping style (β= 0.090, P<0.01), depression (β=0.104, P<0.05), hemoglobin (β=-0.083, P<0.05), and serum albumin (β=-0.075, P<0.05) were independent determinants on fatigue.

Conclusion: Fatigue is a prominent and serious problem in Chinese older adults receiving maintenance hemodialysis, which is influenced by a combination of physical, psychological, and social factors. Based on the determinants identified, targeted interventions should prioritize enhancing self-efficacy through structured education and skill-building programs, strengthening family support systems via family empowerment models, and promoting adaptive coping strategies through cognitive-behavioral techniques. There is an urgent need to incorporate fatigue into routine clinical monitoring and implement such individualized management to improve quality of life and prognosis.