European Geriatric Medicine最新文献

Purpose: To gather information from clinicians on how geriatric oncology models of care have emerged in different European countries and describe current practice in this clinical area.

Methods: A semi-structured online interview was performed, exploring aspects related to implementation, perceived quality of care, and professional satisfaction.

Results: The centers participating in this interview showed significant differences in terms of resource allocation, team members, components of the comprehensive geriatric assessment (CGA), and CGA-driven interventions. High levels of professional satisfaction were expressed by all participants. This was deemed a consequence of a perception of increased quality in the provision of care and enhanced educational and academic opportunities.

Conclusion: Interdisciplinary models of care in geriatric oncology, regardless of implementation details, seem to provide grounds for increased professional satisfaction and perception of better provision of quality of care. These characteristics could support promoting and further developing similar collaborations on a wider scale.

Purpose: Polymorphisms (rs1815739; R577X) in the gene encoding alpha-actinin-3 (ACTN3) are thought to be associated with body composition and physical function in older people and athletes. RR homozygotes are associated with greater expression of ACTN3 protein in muscle than the X-allele carriers. We aimed to investigate the association between ACTN3 R577X polymorphism and appendicular skeletal muscle mass, walking speed, and muscle strength in older adults.

Methods: A cross-sectional analysis was performed on 265 community-dwelling older adults (mean age 74.0 ± 5.8 years, 63.4% female) who provided data on ACTN3 gene polymorphisms and completed surveys in the Tarumizu study conducted between 2018 and 2019. Genetic polymorphisms were categorized as RR homozygous and X allele. Muscle mass was assessed using the appendicular skeletal muscle mass index (ASMI), and physical function was assessed based on walking speed and relative muscle strength. Those in the bottom 25% for each sex were considered "low" and the association with ACTN3 genotype was examined.

Results: Considering ACTN3 polymorphism, 72 participants were RR homozygotes (27.2%) and 193 were X-allele carriers (72.8%). After adjusting for potential confounders, RR homozygosity was associated with not having low muscle mass (odds ratio 0.39, 95% confidence interval 0.19-0.82, p = 0.013) but not with low walking speed and muscle strength.

Conclusion: The association between ACTN3 genotype and physical function in community-dwelling older adults is not clear; however, it is considered to be associated with muscle mass.

Objectives: This study aims to determine the availability of geriatrics-friendly protocols, pieces of equipment, and physical environments alongside potential opportunities of improvement in the emergency departments of our country.

Methods: This prospective, cross-sectional study was conducted between the 1^st and 29^th of February, in the year 2024, within the AI, AII, B group- and university hospitals in Turkey. A questionnaire form consisting of three subdivisions in which general pieces of information, information regarding appropriate personnel/management for geriatrics-friendly emergency departments, equipment/materials, and the presence of physical environments was presented online to the participants and the responses that were provided online were evaluated.

Results: The study was conducted with a total of 175 participants from hospital emergency departments. The number of hospitals with monthly older patient application amounts of 500 and above was 133 (76.0%). It was observed that personnel/management knowledge was, relative to guideline suggestions, at low levels. When the appropriateness of personnel/management knowledge and total equipment/materials were compared to hospital roles, it was determined that university hospitals adhered closest to the guideline and that inter-group differences were significant (p < 0.001).

Conclusions: It was determined that the compliance of emergency departments in Turkey with the criteria specified in the geriatric emergency department guidelines is at very low levels.

Purpose: The objective of this systematic literature review was to: (1) estimate the prevalence of (symptoms of) rheumatic and musculoskeletal diseases (RMDs) and (2) explore how (symptoms of) RMDs are identified and documented in studies among nursing home residents.

Methods: Prevalence data of (symptoms of) RMDs in permanently admitted nursing home residents ≥ 60 years were included. Data extraction, data synthesis and risk of bias assessment were performed by two reviewers independently. Included studies were categorized based on case ascertainment and case definition comprising: (location of) musculoskeletal pain, general terms for RMDs or a specific type of RMD. Results were summarized descriptively.

Results: Out of 6900 records, 53 studies were included. Case ascertainment comprised databases (n = 5), physical examination (n = 1), self-report questionnaires (n = 14), review of medical charts (n = 23) and self-report questionnaires combined with review of medical charts (n = 10). Prevalence ranged between 0.9 and 77.0% for (localized) musculoskeletal pain (n = 19) and between 0.6 and 67.5% for RMDs in general (n = 39). Prevalence rates of specific type of RMDs ranged between 0.7 and 47.5% for gout, between 3.3 and 11.0% for rheumatoid arthritis and between 2.8 and 75.4% for osteo-arthritis (n = 14). Heterogeneity with regard to documentation of (symptoms of) RMDs in medical data of nursing home residents was high.

Conclusion: The overall prevalence of (symptoms of) RMDs varied to a great extent. This was mainly due to large heterogeneity in documentation of (symptoms of) RMDs. Establishing agreement on a useful and practical classification may ultimately increase identification of RMDs in the nursing home setting.

Background: Proponents argue that a high waist-to-calf ratio (WCR) may indicate an imbalance between muscle and fat in the body, making it a potential predictor for sarcopenic obesity (SO). The WCR is a new index incorporating both measurements, providing a reliable approach for assessing the imbalance between abdominal fat and leg muscle mass. The present study aimed to examine the association of WCR with SO and reveal the predictive effect of SO in community-dwelling older adults.

Methods: The study population was composed of 234 geriatric outpatients with obesity. WCR was calculated by dividing the waist circumference (in cm) by the calf circumference (in cm). SO was defined according to the ESPEN and EASO Consensus Statement.

Results: The mean age was 72.7 ± 5.8 years, and 78.7% (n = 175) were female. Eighty-one patients (34.6%) were considered as sarcopenic obese. The WCR was 3.04 [Interquartile range (IQR), 2.88-3.32] in the sarcopenic obese group, and in the nonsarcopenic obese group, it was 2.82 [IQR, 2.7-3.0] (p < 0.001). Independent of age, sex, nutritional and frailty status WCR was associated with SO (OR 12.7, 95% CI 4.0-40.1 and p < 0.001). The cut-off value of WCR for SO was calculated as 2.94 with 72.8% sensitivity and 67.3% specificity (Area Under Curve: 0.72 and Positive likelihood ratio: 2.23, p < 0.001).

Conclusions: WCR, a simple and accessible method, indicates promise as a possible and potential diagnostic tool for SO in community-dwelling older adults.

Background: With population aging and advances in surgical and anesthetic procedures, the incidence of surgery in patients over the age of 65 years is increasing. One post-operative complication often encountered by older surgical patients is post-operative cognitive dysfunction (POCD). Preoperative exercise training can improve the overall physiological resilience of older surgical patients, yet its impact on post-operative cognition is less well-established.

Methods: Six databases (Medline (OVID); EMBASE (OVID); EMCARE (OVID); CINAHL (EBSCOHost), the Cochrane Library, and PubMed) were searched for studies reporting the effect of pre-operative physical training on post-operative cognition. The quality of evidence was assessed using the Mixed Methods Assessment Tool.

Results: A total of 3983 studies were initially identified, three of which met the inclusion criteria for this review. Two studies were pilot randomized trials, and one was a prospective randomized trial. Two of the studies were high-quality. Each study used a different type of physical exercise and cognition assessment tool. Across the studies, post-operative cognition (p = 0.005) and attention (p = 0.04) were found to be better in the intervention groups compared to control, with one study reporting no difference between the groups.

Conclusion: Preoperative physical training may improve post-operative cognitive function, although more research with a consistent endpoint is required. Future studies should focus on patients at high risk of POCD, such as older adults, and explore the impact of different exercise regimes, including frequency, intensity, time, and type.

Purpose: The purpose of the present study was to comprehensively examine the association between inadequate physical activity (PA), cognitive activity (CA), and social activity (SA) and the development of sarcopenia.

Methods: We conducted a two-wave survey. In the first-wave survey, we asked participants five questions for each of the three categories-PA, CA, and SA. The low-activity group was defined as those who fell into the decline category for one or more of the five questions. In both Wave 1 and Wave 2, we assessed the sarcopenia status of our participants. The revised definition of the European Working Group on Sarcopenia in Older People 2 was used to determine sarcopenia, and the Asian Working Group for Sarcopenia criteria were used for cut-off points for muscle mass, grip strength, and walking speed.

Results: In the second wave, we were able to follow 2,530 participants (mean age 75.0 ± 4.7 years, 47.8% men). A multivariable logistic regression showed that low-PA participants face a higher risk of incident sarcopenia, both before and after multiple imputations (odds ratio [OR] 1.62, 95% confidence interval (CI) 1.22-2.15 before imputation; OR 1.62, 95% CI 1.21-2.18 after imputation); the low-SA group also showed a higher risk of incident sarcopenia both before and after multiple imputations (OR 1.31, 95% CI 1.05-1.64 before imputation; OR 1.33, 95% CI 1.07-1.65 after imputation).

Conclusion: Each low PA and SA independently led to incident sarcopenia late in life. Encouraging not only PA, but also SA, may be effective to prevent sarcopenia among older adults.

Purpose: Our objective was to perform an external validity study of the clinical frailty scale (CFS) classification tree by determining the agreement of the CFS when attributed by a senior geriatrician, a junior geriatrician, or using the classification tree. Additionally, we evaluated the predictive value of the CFS for 6-month mortality after admission to an acute geriatric unit.

Methods: This prospective study was conducted in two acute geriatric units in Belgium. The premorbid CFS was determined by a senior and a junior geriatrician based on clinical judgment within the first 72 h of admission. Another junior geriatrician, who did not have a treatment relationship with the patient, scored the CFS using the classification tree. Intra-class correlation coefficient (ICC) was calculated to assess agreement. A ROC curve and Cox regression model determined prognostic value.

Results: In total, 97 patients were included (mean age 86 ± 5.2; 66% female). Agreement of the CFS, when determined by the senior geriatrician and the classification tree, was moderate (ICC 0.526, 95% CI [0.366-0.656]). This is similar to the agreement between the senior and junior geriatricians' CFS (ICC 0.643, 95% CI [0.510-0.746]). The AUC for 6-month mortality based on the CFS by respectively the classification tree, the senior and junior geriatrician was 0.719, 95% CI [0.592-0.846]; 0.774, 95% CI [0.673-0.875]; 0.774, 95% CI [0.665-0.882]. Cox regression analysis indicated that severe or very severe frailty was associated with a higher risk of mortality compared to mild or moderate frailty (hazard ratio respectively 6.274, 95% CI [2.613-15.062] by the classification tree; 3.476, 95% CI [1.531-7.888] by the senior geriatrician; 4.851, 95% CI [1.891-12.442] by the junior geriatrician).

Conclusion: Interrater agreement in CFS scoring on clinical judgment without Comprehensive Geriatric Assessment is moderate. The CFS classification tree can help standardize CFS scoring.

Purpose: The present study aimed to investigate the influence of preoperative TTE on postoperative short-term mortality, surgery delay, as well as other economic and clinical outcomes in Chinese geriatric hip fracture patients.

Methods: This retrospective, matched-cohort study enrolled geriatric hip fracture patients (≥ 60 years) who underwent surgical interventions at our center between 2015 and 2020. The primary exposure was inpatient preoperative TTE. Demographic and clinical data that were reported as risk factors for postoperative mortality were retrieved from the medical data center as the covariates. The primary clinical outcomes were all-cause mortality at 30 days, 90 days, 180 days, and 1 year. Time from hospital presentation to surgery, length of stay (LOS), inpatient cost, frequency of cardiology consultation and coronary angiography (CAG) were also assessed. The propensity score matching (PSM) was performed in a ratio of 1:1.

Results: 447 patients were identified and 216 of them received a preoperative TTE (48.3%). After successfully matching 390 patients (87.2%), patients receiving TTE showed significantly higher 30-day mortality (6.6% vs 2.0%, P = 0.044). But no significant difference was found in 90-day, 180-day, and 365-day mortality as well as the 1-year accumulated survival rate. Receipt of TTE was also associated with significant increases in LOS (13.6 days vs 11.4 days, P = 0.017), waiting time for surgery (5.9 days vs 4.3 days, P < 0.001), and lower proportion of receiving surgery within 48 h (7.2% vs. 26.2%, P < 0.001). According to the multivariable logistic analysis, only ejection fraction (30 days, 90 days), aorta diameter (30 days, 90 days, 180 days, 365 days), left ventricular posterior wall diameter (90 days, 180 days, 365 days), aortic valve velocity (90 days) and mitral valve A-peak (90 days, 180 days) were association with postoperative mortality among the 17 parameters in the TTE reports. Besides, TTE has no influence on the frequency of preoperative cardiology consultation.

Conclusion: Preoperative TTE does not lead to decreased postoperative mortality but with increased time to surgery and length of stay in Chinese geriatric hip fracture patients. The predictive ability of TTE parameters is limited for postoperative mortality.

Purpose: Feeding assistance should be safe and improve the assisted individual's ability to feed, yet objective tools for evaluating these skills are lacking. This study focuses on developing a tool for assessing feeding assistance skills.

Methods: A group consisting of 25 experts employed the Delphi method to achieve a consensus on the essential items necessary for assessing feeding assistance skills. Subsequently, a draft score using a three-point scale was developed. To test the reliability of the draft scores, a group of 20 patients and 20 nurses was matched to record a meal assistance scene, which were independently evaluated by three raters. We computed the AC₁ statistic to assess both intra- and inter-rater reliability, and further examined correlations between the Feeding Assistance Skill Score (FASS) scores and outcome items to verify validity.

Results: Initially, an 18-item draft score was generated using the Delphi method. Subsequently, seven items were omitted from the intra- or inter-rater reliability analysis. Furthermore, after discussion, researchers removed one item that assessed food cognition, because the agreement score between the two items was 91%. Finally, the 10-item FASS was developed, showing a correlation with dietary intake upon validation.

Conclusions: We successfully developed a scoring system for peer evaluation of feeding assistance skills. Future studies should aim to validate the FASS. The implementation of the FASS aims to assess the effectiveness of feeding assistance training and care quality, potentially improving safety and satisfaction for those receiving feeding assistance.