European Geriatric Medicine最新文献

Purpose: The aim of this study was to evaluate the effects of combining self-management strategies (SMS) for reducing sedentary behavior (SB) with multicomponent exercise (ME) compared to ME alone on SB patterns and physical function among community-dwelling older adults.

Methods: A randomized, blinded, clinical trial was conducted with 46 older adults (73.5 ± 6.71 years, 73.9% female) allocated to two groups: receiving ME program + SMS (ME + SMS = 23) or receiving only the ME program (ME = 23). ME lasted 40 weeks and SMS was incorporated in the first 16 weeks. SB patterns (via accelerometry) and physical function (30-s sit-to-stand test, handgrip strength, and Timed Up and Go test) were assessed at baseline, 16 weeks, and at 40 weeks (24 weeks after SMS withdrawal). Effects of the interventions were analyzed using a generalized linear mixed model.

Results: Both groups significantly reduced mean % of daily time spent in SB, time spent in SB, and sitting time after 16 weeks (p < 0.05), returning to baseline levels after 40 weeks. Interaction effect was identified only in handgrip strength after 40 weeks in favor of the ME + SMS group compared to the ME group (Mean difference = 1.94 [0.92], 95%CI = 0.13 to 3.74, p = 0.035).

Conclusion: The inclusion of SMS in a ME program was not more effective than the ME program alone in reducing SB patterns among community-dwelling older adults after 16 weeks. Both groups initially reduced SB; however, the effects were not maintained after 40-week follow-up period.

Trial registration: Brazilian Registry of Clinical Trials RBR-10zs97gk. Registered 17 June 2021, https://ensaiosclinicos.gov.br/rg/RBR-10zs97gk .

Background: Loneliness is an increasingly recognised determinant of health in older adults, associated with adverse outcomes and higher healthcare utilisation.

Purpose: This study aimed to evaluate the relationship between loneliness and healthcare use in an ageing rural population in southern Portugal.

Methods: A cross-sectional survey was conducted amongst community-dwelling individuals aged ≥ 65 years, randomly selected from primary care records in the Baixo Alentejo region. Data collection included the validated Portuguese version of the UCLA Loneliness Scale and self-reported use of healthcare services over the previous year (primary care and emergency visits, and the number of daily prescribed medicines).

Results: A total of 318 participants were included (58.8% female), with a mean age of 75.5 years, 28.9% over 80. Mild loneliness was reported by 52.2% and severe loneliness by 14.8%. Severe loneliness was significantly associated with increased primary care visits (OR = 6.8; 95%CI: 5.8-7.7; p < 0.001), emergency department use (OR = 5.8; 95%CI: 4.4-7.1; p < 0.001), and polypharmacy (OR = 2.0; 95%CI: 1.3-2.6; p < 0.001). Depression, poor perceived health, family dysfunction, and urinary tract disease were associated with severe loneliness, whilst strong neighbourhood relationships appeared protective.

Conclusion: Loneliness is a measurable and clinically relevant determinant of healthcare use in older adults. These findings support the integration of loneliness screening and intervention into routine clinical care, regardless of geographic setting.

Purpose: Current opinions on endoscopic retrograde cholangiopancreatography (ERCP) safety in older patients are contentious. This study aimed to assess emergency one-stage endoscopic treatment for choledocholithiasis-related cholangitis in older adults.

Methods: Patients with choledocholithiasis related cholangitis from January 2019 to July 2023 were recruited. A propensity score (PS) framework was then used to evaluate clinical outcomes after ERCP in patients over 80 years of age.

Results: Inclusion criteria yielded 374 patients, with 120 pairs matched via PS (median age: 85.1 years; 49.2% male in the older group). There was no significant difference in in-hospital mortality between the older adult ERCP group and the control group (2.5% vs. 0%, P = 0.081), whereas intensive care unit (ICU) admissions were higher (38.3% vs. 17.5%, P < 0.001) and length of hospital stay (LOHS) were longer (10 days vs. 8.5 days, P < 0.001). Multivariate analysis revealed that factors affecting LOHS included procalcitonin (PCT), creatinine (Cr), age, and adverse events related to post-ERCP. The independent factor rising ICU admission was age. Subgroup analysis revealed early ERCP reduced antibiotic use and hospitalization in older patients. Severe acute cholangitis (SAC) increased antibiotic use duration and 30-day mortality, while comorbidities raised ICU admission rates, ICU duration, and antibiotic use.

Conclusion: One-stage endoscopic treatment is safe and effective for older patients, with higher age linked to increased ICU admissions. Early ERCP benefits hospital outcomes, feasible even in severe SAC or comorbid conditions.

Purpose: Delirium is a frequent and critical condition in long-term care (LTC) settings. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) states that delirium requires three key elements: acute onset, fluctuating course, and disturbances in attention and awareness. As the Hydra, a mythological monster with multiple heads that doubles when cut down, delirium is multifactorial in nature. Understanding the multicomponents of delirium is decisive for effective prevention, early detection, and management.

Method: This paper aimed to outline etiologies of delirium in LTC settings. A comprehensive literature search was conducted using the Cochrane Database and MEDLINE to identify relevant studies on the etiology and diagnosis of delirium, particularly in LTC settings. Two geriatricians selected papers based on five criteria and one researcher extracted data. A narrative review was conducted to produce this article.

Results: The results were organized and compared to known literature. The three Ps model of delirium was elaborated, consisting of predisposing, precipitating and perpetuating factors. A multicomponent model of delirium in LTC was developed, likened to the mythological multiheaded Hydra. Predisposing factors identified comprise dementia, mild cognitive impairment, and depressive symptoms. Precipitating factors include infections (urinary, cellulitis, respiratory), medication (antipsychotics, anticholinergics, benzodiazepines), pain, sensory loss or deprivation, environmental stressors, malnutrition, cardiovascular conditions (such as stroke and myocardial infarction), and dehydration.

Conclusion: This work allowed the conceptualization of a model for delirium in LTC settings. More studies, as well as more comprehensive systematic reviews, might help to further develop and validate this model.

Purpose: Delirium remains underdiagnosed in hospitalized older patients. The Single Question in Delirium (SQiD) has emerged as a promising screening tool with a high negative predictive value in previous studies, but only a few have investigated the SQiD in geriatric patients. This study aimed to investigate the added value of combining the 4AT and SQiD for detecting delirium in hospitalized older patients. Secondary objectives included determining the point prevalence of delirium and healthcare professionals' awareness of delirium.

Methods: On World Delirium Awareness Day 2024, all patients aged 70 years and older in three German hospitals were screened for delirium using the 4AT and SQiD. To assess delirium awareness among healthcare professionals, both nurses and physicians were asked which patients they perceived as delirious, and discharge documentation was reviewed for mentions of delirium.

Results: 403 patients (mean age 81.3 ± 6.3 years, 55.3% female) were included. In 75.3% of cases, the results from SQiD alone and the 4AT alone were consistent. Combining both tools increased the detection rate of possible delirium from 20.3 to 31.3%. Delirium awareness was low: nurses and physicians correctly perceived patients as delirious in only 34.9% and 32.4%, respectively. Orientation deficits and altered alertness were associated with increased odds of staff awareness, attention deficits and a positive SQiD alone were not.

Conclusion: Combining the SQiD with the 4AT enhances the detection of possible delirium in older inpatients. Delirium awareness among healthcare professionals remains low and must be increased to ensure better detection, management, and ultimately patient outcomes.

Background: The detection of delirium among residents in nursing homes (NH) and long-term care (LTC) facilities remains challenging due to overlapping symptoms with dementia, limited staff training, and variability in assessment tools. This scoping review aimed to identify delirium detection tools and their properties as used for research purposes in these settings.

Methods: The methodology was guided by Arksey and O'Malley and Levac et al. Medline, Embase, CINAHL, PsycINFO, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials were searched for original research studies.

Results: A total of 58 studies met the inclusion criteria, with most conducted in the USA (37.9%) and Europe. We identified 25 delirium detection tools, with the Confusion Assessment Method long form (43.1%), the Neelon and Champagne Confusion Scale (10.3%), the Nursing Home Confusion Assessment Method (10.3%), the short Confusion Assessment Method and its modifications (8.6%), the Delirium Index (6.8%), the Delirium Rating Scale-Revised-98 (6.8%), and the 4A's Test (5.1%) as the most frequently used. Only 14 tools have undergone validity and reliability testing in NH/LTC settings, with the Delirium Observation Screening Scale showing the highest diagnostic accuracy. Ten tools showed full concordance regarding the three delirium domains: cognitive domain, higher-level thinking domain, and circadian domain. The Delirium Diagnostic Tool-Provisional (DDT-Pro) required no more than three items.

Discussion: This review highlights the lack of standardized delirium detection in NH/LTC settings. Future research should focus on providing evidence based on validity and reliability of existing tools, integrating delirium screening and assessment into routine care as part of delirium prevention and management, and training NH/LTC staff.

Purpose: People living with dementia are vulnerable to adverse outcomes of hospitalisation, such as functional decline and deconditioning. The aim of this review was to examine the effectiveness of hospital-based interventions involving physical activity on deconditioning outcomes in people living with dementia.

Methods: Five databases (MEDLINE, CENTRAL, Embase, PsycINFO, and CINAHL) were searched to January 2025 to identify eligible studies. Two researchers independently carried out screening, data extraction and quality assessment.

Inclusion criteria: adults with a diagnosis of dementia, acute hospital admission, and interventions involving physical activity during hospitalisation. Data were pooled for strength, balance, functional outcomes, readmission, falls, length of stay, and delirium. We used GRADE to assess the certainty of evidence.

Results: 2179 records were identified and six studies (n = 576 with dementia) included: one randomised-controlled trial, five non-randomised or quasi-randomised. Studies were conducted in an "acute care for elders unit" (n = 2), acute psychogeriatric ward (n = 2), general medical unit (n = 1), and geriatric rehabilitation ward (n = 1) across six countries. In meta-analyses, there was less decline in basic activities of daily living at 3 months in the physical activity group (change from pre-admission status); two studies, mean difference 1.27 (95% CI 0.36-2.18) but there were no differences found in all other outcomes at discharge or 3 months, compared to usual care. Certainty of the evidence is low/very low.

Conclusion: Due to the limited available evidence, there is uncertainty about the effect of physical activity interventions above usual care. More high-quality research is needed to improve outcomes for people living with dementia in hospital.

Purpose: Dementia represents an increasing challenge to health systems globally, with a notable impact on health-related quality of life (HRQoL). Nevertheless, the potential effect of sex on the relation between individuals' characteristics and HRQoL, particularly in the early stages of this disease, remains unclear. Therefore, the present study aims to evaluate the association between sociodemographic, lifestyle and health-related factors with HRQoL among individuals at high risk of dementia, according to sex.

Methods: This cross-sectional study was based on baseline data from the MIND-Matosinhos randomized controlled trial, targeting Portuguese adults at high risk of dementia [n = 207; 59.9% female; median age = 70.0 (interquartile range: 11)]. HRQoL was measured using the EQ-5D-5L. The associations between explanatory variables and HRQoL scores (dichotomized by the median) were quantified through odds ratios (OR) and 95% confidence intervals (CI), stratified by sex.

Results: Overall, females reported lower HRQoL when compared with males [median (interquartile range): 0.875 (0.190) vs. 0.923 (0.129); p = 0.004]. Problems in mobility (43.6% vs. 27.7%; p = 0.021), pain/discomfort (71.8% vs. 44.6%; p < 0.001) and anxiety/depression (66.9% vs. 45.8%; p = 0.002), as well as the existence of any problem in five dimensions (7.3% vs. 3.6%; p = 0.004), were more frequently referred by females than males. A stronger association between poorer self-perceived health status and lower HRQoL was observed among females (OR = 8.75, 95% CI:3.64-21.03) compared to males (OR = 1.88, 95% CI:0.72-4.89; p for interaction = 0.020).

Conclusion: Health status is associated with HRQoL, distinctively amongst males and females. These findings emphasize the need for sex-specific public health strategies to improve HRQoL in a vulnerable population of individuals at high risk of dementia.