Clinical Interventions in Aging最新文献

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.

Purpose: Postoperative delirium affects up to 65% of elderly surgical patients, leading to increased mortality and cognitive decline. Current prevention strategies face implementation barriers, necessitating accessible, non-pharmacological interventions. Transcutaneous auricular vagus nerve stimulation (taVNS), a non-invasive neuromodulation technique, reduces neuroinflammation and regulates autonomic function, offering potential for delirium prevention. This multicenter, randomized, double-blind, sham-controlled trial evaluates whether taVNS can prevent postoperative delirium in older adults undergoing total knee arthroplasty.

Patients and methods: We will enroll 1448 patients aged 65-80 years undergoing elective knee replacement under general anesthesia at four hospitals in Fujian Province, China. Participants will be randomized equally to receive active taVNS (25 Hz, 250 μs targeting the cymba conchae and tragus) or sham stimulation (25 Hz, 250 μs targeting the earlobe and antihelix). Both groups will receive interventions at two timepoints: the afternoon before surgery and the morning of surgery before anesthesia. The primary outcome is delirium incidence within 72 hours postoperatively, assessed using the Confusion Assessment Method. Secondary outcomes include inflammatory markers (interleukin-1, interleukin-6, tumor necrosis factor-alpha), autonomic function (heart rate variability), cognitive trajectories, psychological status, sleep quality, pain scores, and recovery parameters. Safety monitoring will follow standardized adverse event reporting guidelines.

Conclusion: If effective, taVNS could provide a practical, non-invasive method to reduce delirium incidence in elderly patients undergoing knee replacement, potentially improving postoperative outcomes and reducing healthcare costs.

Purpose: Perioperative neurocognitive disorder (PND) is common in elderly surgical patients and severely affects postoperative recovery. However, effective prevention is still lacking. Potential perioperative cerebral stressors (including inappropriate sedative/analgesic depth and imbalanced cerebral oxygen supply/demand) may be important contributing factors. We developed an anesthesia management protocol based on multimodal brain monitoring to achieve standardized, individualized, and real-time regulation of sedative/analgesic depth and cerebral oxygen saturation and investigated whether it could reduce the incidence of PND and its underlying mechanisms.

Patients and methods: Patients (aged ≥65 years) were randomized into Groups C (n=88) and E (n=93). Patients in Group E received multimodal brain monitoring-guided anesthesia management, and those in Group C received BIS-guided anesthesia management. The Montreal Cognitive Assessment (MoCA) was performed both before and seven days after surgery. The postoperative pain scores were recorded. Resting-state functional MRI data were analyzed to examine functional connectivity (FC).

Results: Group E demonstrated a numerically lower incidence of PND (15.50% vs 21.59% in Group C), but this difference was not statistically significant. Patients in Group E had increased FC within the right pulvinar, right sub-gyral region, and right inferior parietal lobule (P < 0.05). Significantly lower pain scores were observed in Group E at rest (1h: P=0.04; 24h: P=0.04) and during movement (1h: P=0.03).

Conclusion: These results suggest that multimodal brain monitoring-guided anesthesia management may protect neurocognition by enhancing FC within cognition-associated brain regions and attenuating postoperative acute pain. And multimodal brain monitoring-guided anesthesia management may confer a clinically relevant reduction in PND incidence compared to BIS-guided management in elderly surgical patients.

Background: Frailty is a common geriatric syndrome, and its occurrence in elderly stroke patients may further worsen clinical outcomes, yet the influencing factors and potential causal relationship remain unclear.

Objective: This study aimed to identify the influencing factors of frailty in elderly hospitalized stroke patients and to analyze the potential causal relationship between stroke and frailty.

Methods: A multicenter cross-sectional survey including 210 elderly stroke patients was conducted, and bidirectional Mendelian randomization analysis was applied to examine the causal relationship between stroke and frailty. Univariate and multivariate logistic regression analyses were used to explore the impact of physiological, psychological, and clinical symptom factors on frailty.

Results: The frailty index was positively correlated with stroke, and Mendelian randomization confirmed a bidirectional causal relationship. Univariate analysis showed significant associations between frailty and diabetes, lesion site, lesion location, and brain atrophy. Multivariate logistic regression further identified Fugl-Meyer score, Berg score, and MoCA score as independent risk factors for frailty in elderly hospitalized stroke patients.

Conclusion: Frailty is strongly associated with stroke, and elderly stroke patients face an increased risk of frailty during hospitalization. These findings provide a basis for early identification of high-risk patients and the development of targeted intervention strategies in clinical practice, with important implications for stroke rehabilitation and elderly care.

Aging is a complex, multifactorial process driven by interconnected biological mechanisms collectively known as the hallmarks of aging, which contribute to functional decline and the onset of age-related diseases. High-mobility group box 1 (HMGB1), a nuclear DNA chaperone and damage-associated molecular pattern (DAMP), plays a pivotal role in regulating these hallmarks through its dual functions: preserving genomic stability within the nucleus and promoting inflammatory responses when released extracellularly. This review examines the multifaceted involvement of HMGB1 in key aging hallmarks, such as genomic instability, telomere attrition, mitochondrial dysfunction, and chronic inflammation among others. Preclinical studies demonstrate that nuclear HMGB1 supports chromatin integrity and DNA repair, whereas its extracellular release triggers TLR4/RAGE signaling pathways, thereby intensifying inflammaging and senescence-associated secretory phenotypes (SASP). Emerging therapeutic approaches-such as HMGB1 inhibitors, neutralizing antibodies, and epigenetic modulators-show potential in restoring genomic homeostasis and mitigating age-related pathologies. Nevertheless, significant challenges remain, including elucidating HMGB1's roles in nutrient sensing and psychosocial stress, fine-tuning interventions to preserve its nuclear functions while minimizing extracellular toxicity, and establishing efficacy in human clinical settings. Addressing these gaps may position HMGB1 as a promising multifunctional target for delaying aging and translating preclinical findings into clinical applications.