European Geriatric Medicine最新文献

Background: Depression is known to be associated with a greater risk of developing cardiovascular disease (CVD) in middle-aged people. However, it is not certain how depression would influence incident CVD in older people aged ≥ 75 years. We investigated the association between depression and CVD in older people.

Methods: We analyzed 146,085 individuals aged ≥ 75 years including 7581 individuals (5.2%) with depression registered in the DeSC database from April 2014 to November 2022. We excluded those with a prior history of CVD. The incidence of composite CVD events, comprising ischemic heart disease (IHD), heart failure, and stroke was documented. A Cox proportional hazard regression analysis was conducted to estimate hazard ratios (HR) associated with the presence of depression.

Results: The median age was 79 years and 41.0% were men. During the mean follow-up period of 3.4 ± 1.5 years, 39,552 composite CVD events (IHD: n = 10,916; heart failure: n = 26,719; stroke: n = 13,090) were recorded. Multivariable Cox regression analyses showed that older individuals with depression had a greater risk of composite CVD events than those without (hazard ratio [HR] 1.29, 95% confidence interval [CI] 1.24-1.34). The HR (95% CI) of depression was 1.26 (1.17-1.37) for IHD, 1.25 (1.19-1.31) for heart failure, and 1.30 (1.21-1.39) for stroke, respectively. While considering the limitations of real-world data, we conducted multiple sensitivity analyses, which confirmed the results of the primary analysis.

Conclusions: The presence of depression was independently associated with a greater risk of developing CVD even in older individuals.

Methods: We conducted a single-center, retrospective cohort study of French older adults. Participants with Mini-Mental State Examination (MMSE) ≥ 24 were recruited from a fall clinic in a geriatrics department. We recorded history of falls in the preceding 6 months, as well as Timed Up and Go test and mobility assessment at baseline and at 6- and 12-month follow-up.

Results: We included 199 participants at baseline (mean age 83.1 years; 70.3% of females), of which 50.8% (101) had abnormal FAB scores (indicating executive impairment). Participants with executive impairment were more likely to have a history of falls. 125 and 96 participants completed 6- and 12-month follow-up visits, respectively. There was no association between abnormal FAB score at baseline and any or serious falls. Abnormal baseline FAB score was only associated with repeated (≥ 2) falls at 6 months, after adjusting for age, education, and polypharmacy (OR = 3.1 95% CI [1.0, 9.9]). Moreover, participants with abnormal FAB scores had significantly lower Timed Up and Go test scores.

Conclusion: Abnormal FAB score was associated with repeated falls at 6 months, but not with total incident falls during the follow-up period. Our results highlight the potential utility of FAB in fall risk assessment, particularly for repeated falls, but further studies are needed to clarify this association.

Purpose: Older people are at an increased risk of developing adverse drug reactions (ADR) and adverse drug events (ADE). This study aimed to develop and validate a risk prediction model (ADAPTiP) for ADR/ADE in older populations.

Methods: We used the adverse drug reactions in an Ageing PopulaTion (ADAPT) cohort (N = 798; 361 ADR-related admissions; 437 non-ADR-related admissions), a cross-sectional study designed to examine the prevalence and risk factors for ADR-related hospital admissions in patients aged ≥ 65 years. Twenty predictors (categorised as sociodemographic-related, functional ability-related, disease-related, and medication-related) were considered in the development of the model. The model was developed using multivariable logistic regression and was internally validated by fivefold cross-validation. The model was externally validated in a separate prospective cohort from the Centre for Primary Care Research (CPCR) study of ADES. The cross-validated and externally validated model performance was evaluated by discrimination and calibration.

Results: The final prediction model, ADAPTiP, included nine predictors: age, chronic lung disease, the primary presenting complaints of respiratory, bleeding and gastrointestinal disorders and syncope on hospital admission and antithrombotics, diuretics, and renin-angiotensin-aldosterone system drug classes. ADAPTiP demonstrated good performance with cross-validated area under the curve of 0.75 [95% CI 0.72;79] and 0.83 [95% CI 0.80;0.87] in the external validation.

Conclusion: Using accessible information from medical records, ADAPTiP can help clinicians to identify those older people at risk of an ADR/ADE who should be monitored and/or have their medications reviewed to avoid potentially harmful prescribing.

Aim: Frailty is an important risk factor for a wide range of chronic diseases and for mortality risk. This study aims to explore the relationship between frailty and incidence of chronic kidney disease (CKD), particularly on the change and accumulation of frailty.

Methods: Frailty status was assessed using the frailty index (FI, constructed by 31 items) and categorized as robust, pre-frail, and frail. The accumulation and change in frailty were assessed on the basis of frailty status at baseline and a second survey 4 years after baseline. Logistic regression was used to estimate the association between frailty and developing CKD.

Results: A total of 3597 participants (mean age: 59.08 ± 8.94 years old, male: 49.9%) from CHARLS were included. Participants with pre-frailty or frailty status had a higher risk of developing CKD compared with robust participants (pre-frail vs robust, OR 1.78, 95% CI 1.37-2.32, p < 0.001; frail vs robust, OR 2.52, 95% CI 1.67-3.79, p < 0.001). Participants who had a robust status in the two surveys had a significantly lower risk of developing CKD (OR 0.51, 95% CI 0.36-0.75, p < 0.001) compared with those who never had a robust status.

Conclusion: Frailty status is significantly associated with the incidence of CKD. The risk of CKD was lower in those who ever had a robust status than in participants who never had a robust status.

Objective: Many risk factors affect dementia and all-cause mortality. However, whether falls are a risk factor for dementia and all-cause mortality is unclear. The study examines the association of falls with the risk of dementia and all-cause mortality, and whether dementia mediates the association of falls with all-cause mortality.

Methods: Data were taken from the Japanese Gerontological Evaluation Study (JAGES) with a 9-year follow-up. Falls information was collected through a questionnaire and categorized into no falls, single and multiple falls. Dementia and all-cause mortality data were obtained from the long-term care insurance (LTCI) system. The Cox proportional hazard models were used to calculate the hazard ratios (HRs) and 95% confidence intervals (95% CIs), and causal mediation analysis (CMA) was used to assess the mediating effects of dementia.

Results: A total of 52,076 participants were included in the study. Compared to participants with no falls, participants with single and multiple falls had an increased risk of dementia (single fall, HRs = 1.18, 95% CIs 1.12-1.24; multiple falls, HRs = 1.66, 95% CIs 1.56-1.77) and all-cause mortality (single fall, HRs = 1.09, 95% CIs 1.04-1.15; multiple falls, HRs = 1.34, 95% CIs 1.26-1.43), and the risk increased with the number of falls (P for trend < 0.01). In addition, dementia significantly mediated the association between falls and risk of all-cause mortality (NIE: HRs = 1.02, 95% CIs 1.00-1.04, PM = 15.0%).

Conclusion: Falls are associated with the risk of dementia and all-cause mortality. Dementia has important mediating effects in the association between falls and the risk of all-cause mortality.

Introduction: The European Working Group on Sarcopenia in Older People (EWGSOP2) defines sarcopenia as a muscle disease (muscle failure) rooted in adverse muscle changes that accrue across a lifetime; sarcopenia is common among adults of older age. New findings on the hormonal and metabolic characteristics of patients with sarcopenia have aided in developing more targeted therapeutic strategies. However, treating older patients with sarcopenia still poses a number of challenges. Despite numerous studies on sarcopenia, no comprehensive phenotyping of older sarcopenic patients has yet to be offered. Cluster analysis has been successfully used to study various diseases. It may be extremely advantageous for collecting data on specific sarcopenia progressions based on a simultaneous assessment of a whole range of factors.

Aim: To identify disease progression specific to older patients based on cluster analysis of blood biomarkers and lifestyle.

Methods:  This study included 1709 participants aged 90 and older. The median age was 92. Seventy-one percent of participants were female. Participants underwent a comprehensive geriatric assessment and had their metabolic, hormonal, and inflammatory blood biomarkers measured. The data were analyzed and clustered using the R programming language.

Results:  Seven sarcopenia clusters were identified. The most significant variables, in descending order, were malnutrition, physical activity, body mass index, handgrip strength, testosterone, albumin, sex, adiponectin, total protein, vitamin D, hemoglobin, estradiol, C-reactive protein, glucose, monocytes, and insulin. Handgrip strength measurements and free T3 levels increased linearly between the cluster with the lowest measurements and the cluster with the highest measurements.

Conclusion: The findings of this study may greatly aid in understanding the relationship between blood biomarkers, lifestyle and sarcopenia progression in older adults, and may help in developing better prevention and diagnostic strategies as well as more personalized therapeutic interventions.

Purpose: Sarcopenia is an age-related disease that is related to nutritional intake and chronic low-grade inflammation. The aim of this study was to investigate the association of dietary intake, inflammatory markers and sarcopenia among the community-dwelling older adults.

Methods: A total of 1001 older adults aged 60 and above were recruited. According to the criteria established by the Asian Working Group for Sarcopenia 2019, this paper assessed the presence of sarcopenia and using a Food Frequency Questionnaire to evaluate daily dietary intake. Serum levels of inflammatory markers were measured using the ELISA method.

Results: A total of 1001 participants took part in the study (mean 70.6 years), comprising 396 males and 605 females, the prevalence of sarcopenia was 19.6%. Multivariate analysis revealed that high levels of leucine, methionine, threonine, histidine, aspartic acid, calcium, zinc, and vitamin C were associated with a lower risk of sarcopenia. Higher dietary inflammatory index scores were associated with a higher risk of sarcopenia (OR  1.67, 95% CI 1.12-2.47). Higher tumor necrosis factor-like weak inducer of apoptosis (TWEAK) (OR 1.04, 95% CI 1.02-1.07) was associated with a higher risk of sarcopenia, and a lower skeletal muscle mass, strength, and physical function. Conversely, higher insulin-like growth factor-1 (IGF-1) (OR 0.83, 95% CI 0.74-0.94) and glutathione S-transferase (GST) (OR 0.75, 95% CI 0.61-0.91) were associated with a lower risk of sarcopenia.

Conclusions: This cross-sectional study revealed alterations in amino acid and micronutrient intake among older adults with sarcopenia. The levels of TWEAK were associated with an increased risk of sarcopenia, whereas IGF-1 and GST were associated with a reduced risk of sarcopenia.

The aim of this study is to investigate the association between four phenotypes of sarcopenia/obesity in older individuals and functional disability, malnutrition, and all-cause mortality. This study is a cross-sectional study, survival is 3 years. A total of 487 Chinese older adults were included with 283 (58.1%) females, a median age of 77 (69, 99) years. Sarcopenia was diagnosed according to skeletal muscle mass index, grip strength (GS), 5-time chair stand test, and gait speed test; obesity was diagnosed according to waist circumference, body mass index (BMI), and the percentage of body fat (PBF). Nutritional status was estimated with the Mini Nutritional Assessment short-form (MNA-SF) and functional health status was assessed using the Barthel Index (BI). The binary logistic regression analysis and the multivariate Cox regression analysis were utilized to investigate the association between sarcopenic/obesity phenotype and functional impairment, nutritional deficiency, and all-cause mortality. In the final-adjusted model, compared to patients with non-sarcopenic non-obesity phenotype, sarcopenic obesity is significantly associated with functional dependence (odds ratio [OR]: 3.83, 95% CI 1.47-9.97; P = 0.006), malnutrition (OR: 0.48, 95% CI 0.24-0.99; P = 0.047), and all-cause mortality (hazard ratio[HR]: 2.78, 95% CI 1.57-4.94; P = 0.001); sarcopenia is significantly associated with malnutrition (OR: 2.48, 95% CI 1.09-5.65; P = 0.030), and all-cause mortality (HR:3.06, 95% CI 1.69-5.56; P < 0.001); obesity is significantly associated with malnutrition (OR:0.11, 95% CI 0.05-0.22; P < 0.001). Consequently, it is advisable to incorporate sarcopenia and sarcopenic obesity into the screening and treatment protocols for older adults in the community to effectively mitigate the adverse health consequences.

Purpose: Multidisciplinary care pathways for falls prevention, which include falls risk stratification, multifactorial falls risk assessment, and management of multidomain interventions, can reduce falls in older adults. However, efficient multidisciplinary falls prevention care is challenging due to issues such as poor communication and role allocation. This study aimed to identify and visualize the multidisciplinary care needs of primary care-based health care professionals (HCPs) for falls prevention in the Netherlands using the novel co-design approach of journey mapping.

Methods: Online focus groups and interviews (N = 45) were conducted with physical therapists (n = 15), district nurses (n = 9), occupational therapists (n = 7), pharmacists (n = 6), nurse practitioners (n = 5), podiatrists (n = 2), and one general practitioner. HCPs were asked about their interactions, experiences, needs, and barriers with regards to multidisciplinary falls prevention care in a primary care context. Insights were used to visualize a journey map depicting the desired future state of multidisciplinary care pathways for falls prevention.

Results: Journey mapping identified the following needs for effective multidisciplinary falls prevention care: a dedicated case manager after risk stratification, preparatory patient information before the assessment, small multidisciplinary care team for the assessment, patient involvement during intervention management, good communication between HCPs, and a reduction in workload for HCPs.

Conclusion: The inclusion of a case manager program for older adults and access to resources to facilitate good communication between HCPs are important to optimize the configuration of multidisciplinary care pathways for falls prevention in actual practice.