Clinical Interventions in Aging最新文献

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.

Background: There are presently limited clinical studies of endoscopic retrograde cholangiopancreatography (ERCP) in the longevous (elders aged no less than 90 years old). This study aimed to evaluate the efficacy and safety of ERCP in longevous patients.

Methods: A total of 113 longevous patients who underwent ERCP for the first time at our center from January 8^th, 2009 to December 20^th, 2023 were enrolled. Correspondingly, the control groups included the old-old (75-89 years) patient group and the young-old (60-74 years) patient group. Each of the control group was matched in a 1:2 ratio to the longevous patient group based on the gender, presence of choledocholithiasis, endoscopic sphincterotomy, endoscopic papillary balloon dilatation, periampullary diverticulum, the placement of biliary stent, and guidewire entry into the pancreatic ducts, ultimately including 226 patients in each control group. Baseline characteristics, clinical and endoscopic data were compared among the three groups, and risk factors for post-ERCP pancreatitis in elderly patients were analyzed.

Results: Except for the higher incidence of acute cholangitis and atrial fibrillation (AF) in longevous patients, the three elderly patient groups were comparable in baseline characteristics. The technical success rate of ERCP in longevous patients was 95.6%, which has no significant difference from that of old-old patients (95.1%) and young-old patients (96.9%) during the same period. The overall incidence of post-ERCP adverse events was 12.9%, and there was no significant difference in the incidence and mortality of adverse events among the three groups. PEP was the most common adverse event after ERCP in elderly patients. Multivariable logistic regression analysis showed endoscopic metal biliary endoprothesis (OR=2.351, 95% CI 1.144-4.832, P=0.020), pancreatic duct opacification (OR=5.774, 95% CI 1.062-31.383, P=0.042) were independent risk factors for PEP in elderly patients.

Conclusion: ERCP is safe and effective in the longevous population, and advanced age did not increase the incidence of adverse events after ERCP.

Background: The Kihon Checklist (KCL) is widely used in Japan to assess robustness, pre-frailty, and frailty. However, the specific KCL items that predict the maintenance of robustness or transitions between frailty states remain unclear. Identifying these predictors could guide preventive strategies in older adults. This study examined item-level predictors of frailty transitions in a community-dwelling population over 6 years.

Methods: This longitudinal non-interventional study followed residents aged 70 years in 2016 and 76 years in 2022 in Agano City, Japan. Health status was evaluated using the 25-item KCL, and frailty states (robust, pre-frail, frail) were classified by total scores. Changes in responses to each item (yes-to-yes, yes-to-no, no-to-yes, no-to-no) were analyzed. Multivariate logistic regression identified independent predictors of maintaining robustness, transitioning to pre-frailty or frailty, and improving from frailty.

Results: Among the 358 participants that completed both surveys, robustness decreased from 60.9% to 48.6%. Maintaining robustness was independently associated with visiting friends and absence of fear of falling. Transition to pre-frailty was linked with loss of stair-climbing ability, difficulty eating tough foods, and impaired date orientation. Transition to frailty was associated with persistently low body mass index, reduced outings, memory loss recognized by others, and difficulty performing routine tasks. Improvement from frailty was predicted by initiating weekly outings.

Conclusion: Key protective factors included social engagement, absence of fear of falling, oral function, cognitive health, and maintaining body weight. Regular outings prevented frailty and facilitated recovery, highlighting practical community-level intervention targets. Future research should test whether programs targeting these predictors reduce frailty incidence and improve recovery.

Purpose: Perioperative hypothermia is a common complication of general anesthesia, especially in older patients undergoing transurethral resection of the prostate (TURP) or bladder tumors (TURB). Age-related thermoregulatory impairment increases vulnerability to hypothermia, and large-volume irrigation during these procedures further elevates the risk. Preclinical and clinical studies suggest that remimazolam may reduce perioperative hypothermia and shivering compared with volatile anesthetics. This study compared remimazolam and sevoflurane on perioperative body temperature (BT) changes in older patients undergoing TURP or TURB.

Patients and methods: This prospective, randomized clinical trial enrolled 84 patients aged 65-85 years undergoing TURP or TURB under general anesthesia. Patients were randomized to receive either remimazolam (n = 42) or sevoflurane (n = 42). Preoperative tympanic temperature was measured immediately before induction, and intraoperative core BT was monitored with an esophageal temperature probe. Postoperative BT was recorded using tympanic thermometry. The primary outcome was the incidence of perioperative hypothermia (BT < 36.0°C). Secondary outcomes included intraoperative decrease in BT, incidence of profound hypothermia (BT < 35.0°C), need for active warming in the PACU, postoperative nausea, vomiting and shivering, pain scores, and perioperative hemodynamic variables.

Results: The change over time in BT in operating room was significantly different between 2 groups (P = 0.010). The remimazolam group exhibited significantly smaller intraoperative reductions in core BT compared to the sevoflurane group (0.83 ± 0.38°C vs 1.08 ± 0.48°C, P=0.011). The incidence of profound hypothermia occurred in the sevoflurane group (17%) and was not observed in the remimazolam group (0%) (P = 0.029). Significantly fewer patients in the remimazolam group required active warming in the PACU (19% vs 40%, P = 0.032). Hemodynamic variables and postoperative shivering rates were comparable between the groups.

Conclusion: These findings suggest that remimazolam may offer thermoregulatory advantages in older surgical patients at high risk for hypothermia.

Background: Most adults aged ≥65 years live with multiple chronic conditions (MCC), and nearly one in four have recognized or unrecognized Alzheimer's disease and related dementias (ADRD), including an estimated 7.2 million Americans. Together, MCC and ADRD increase treatment complexity, medication burden, and the risk of adverse outcomes. Among patients who meet clinical criteria for mild cognitive impairment (MCI) or ADRD but lack a formal diagnosis, MCC burden remains unclear. This study examined the association between MCC burden and undiagnosed MCI and ADRD in a diverse cohort of older adults in primary care.

Methods: We conducted a cross-sectional analysis of 324 adults aged ≥65 from primary care clinics in Indiana and South Florida (2021-2023), as part of a larger ADRD detection study. Patients without documented MCI or ADRD completed standardized cognitive assessments. Cognitive status (normal, MCI, ADRD) was determined by interdisciplinary consensus. Chronic conditions and medications were extracted from electronic health records. Multinomial logistic regression was used to examine the association between MCC profiles and cognitive status.

Results: Among 324 older adults, 51.9% were determined to have MCI and 8% ADRD. Patients with MCI and ADRD had more chronic conditions (mean = 5-6) and medications (mean = 4-5) than those with normal cognition (p < 0.001). Anticholinergic use was more common in the MCI (23.8%) and ADRD (23.1%) groups than in those with normal cognition (10.8%). In adjusted models, MCI and ADRD were associated with higher odds of having more chronic conditions. Cerebrovascular disease was associated with both MCI and ADRD; diabetes, sleep apnea, and insomnia with MCI; and ischemic heart disease and insomnia with ADRD.

Conclusion: Older adults with unrecognized MCI and ADRD experience substantial MCC and medication burden. These findings highlight the need for targeted primary care interventions that integrate cognitive screening, support MCC management, optimize self-management capacity, and promote safer prescribing.

Background: The therapeutic effect of conventional therapies (eg, resistance training, nutritional support) for treating sarcopenia show limited efficacy in older individuals with multiple comorbidities. Therefore, this study aims to investigate whether electroacupuncture (EA) combined with standardized exercise therapy improves walking ability and other functional outcomes in older patients with sarcopenia compared to exercise-alone therapy.

Methods: This randomized, controlled, assessor-blinded trial will include 122 older adults diagnosed with sarcopenia. Participants are randomly allocated to either the EA plus exercise group or exercise-only group in a 1:1 ratio. Both groups will follow 12-week Otago Exercise Program, with the EA plus exercise group receiving additional EA treatment targeting lower limb muscle flaccidity. Primary outcome is the Appendicular Skeletal Muscle Mass (ASMM). Secondary outcomes include the Short Physical Performance Battery (SPPB), Timed Up and Go (TUG) Test, 6-minute walk test distance, calf circumference, grip strength, and knee flexion/extension strength. ASMM is selected as the primary endpoint due to its direct relevance as a core diagnostic criterion for sarcopenia and its objective measurement of muscle mass changes. All outcome measures will be evaluated before treatment, at week 6 and week 12 during the treatment course, and at the end of 12-week follow-up (week 24). Adverse events will be monitored during the trial.

Discussion: This trial will provide valuable insights into the combined use of electroacupuncture and exercise for improving walking ability and other functional outcomes in older individuals with sarcopenia. The results could potentially inform clinical practices and offer a new therapeutic option for managing sarcopenia.

Trial registration: Clinicaltrials.gov under the identifier NCT05431010.