European Geriatric Medicine最新文献

Background: Sarcopenia, defined by a decline in muscle strength, muscle mass and physical performance, is associated with poorer health-related quality of life (HRQoL) in older adults. However, longitudinal studies investigating this relationship using sarcopenia-specific HRQoL instruments remain scarce.

Objective: To investigate the association between changes in sarcopenia components and changes in HRQoL over four years using the SarQoL questionnaire, a tool specifically designed for individuals with sarcopenia.

Methods: This study included 333 community-dwelling older adults from the SarcoPhAge cohort, followed annually for four years. HRQoL was evaluated using the SarQoL questionnaire. Sarcopenia components were measured using a handgrip dynamometer to assess muscle strength, dual-energy X-ray absorptiometry (DEXA) to assess muscle mass and the Short Physical Performance Battery (SPPB) test to assess physical performance. Associations between changes in sarcopenia components and changes in global and domain-specific SarQoL scores were assessed using linear mixed models, with random effects to account for within-subject variation.

Results: 333 community-dwelling older adults were included in this study (age: 72.6 years (68.7-77.5), 58.9% women). Over four years, despite an overall age-related decline in sarcopenia components and HRQoL, the increases in physical performance (β = 1.04; p < .0001), grip strength (β = 0.195; p = .0001), and muscle mass (β = 2.47; p < .0001) were independently associated with higher global SarQoL scores. Analyses of the seven SarQoL domains yielded consistent findings.

Conclusion: The results support the use of the SarQoL questionnaire as a specific and sensitive instrument for monitoring HRQoL in older adults as it appears responsive to changes in muscle mass, strength, and physical performance.

Purpose: Functional independence measure (FIM) is a detailed assessment of activities of daily living in patients with stroke. To confirm that the FIM is useful in clinical practice and clinical research, the minimal important change (MIC), which is an aspect of interpretability of the FIM, must be clarified in addition to validity and reliability. This study aimed to estimate the MIC of the FIM in older patients with subacute stroke, with the goal of enhancing the interpretability of rehabilitation outcomes in geriatric care.

Methods: Data from patients admitted to a single convalescent rehabilitation ward (CRW) in Japan between January 2020 and December 2022 were analyzed. This study included patients aged 65 years or older with subacute stroke who were originally living at home. Those who died or were transferred to other hospitals during hospitalization were excluded. FIM was assessed on admission and discharge. The MIC for the FIM was calculated using the place of discharge as an anchor (i.e., anchor-based adjusted predictive modeling method [MIC_adj]).

Results: Of the 1401 patients admitted to the CRW, 277 were eligible (mean age [SD], 78.9 [7.6] years). The motor, cognitive, and total FIM scores on CRW admission were 39.1 (21.2), 19.7 (8.5), and 58.8 (27.7) and those at CRW discharge were 60.9 (23.9), 23.9 (8.4), and 84.8 (30.7), respectively. The estimated MIC_adj for the motor, cognitive, and total FIM scores were 18.6, 3.9, and 22.8, respectively.

Conclusions: The MIC for the FIM in older patients with subacute stroke were 19, 4, and 23 points for the motor, cognitive, and total FIM, respectively, which may aid in interpreting the effects of rehabilitation in older patients with subacute stroke.

Purpose: With the ageing population, more older persons require rehabilitation following (sub)acute functional decline. The International Classification of Functioning, Disability and Health (ICF) model offers a biopsychosocial framework to address complexities of rehabilitation in this population. This systematic review investigates which ICF components have been reported in rehabilitation research involving older persons, which rehabilitation outcomes have been reported, and whether, and how associations between ICF components and rehabilitation outcomes have been described.

Methods: A comprehensive search was conducted in three databases. Studies involving older persons (mean or median age ≥ 70 years) undergoing post-acute rehabilitation, with health data linked to the ICF model and rehabilitation outcomes, were included. Study quality was assessed using the Methodological Index for Non-Randomized Studies (MINORS) by two independent reviewers.

Results: Seven studies involving 896 patients were included. Associations were found between ICF components, particularly body functions and activities and participation, and improved functional independence and quality of life. Environmental factors also contributed to outcomes, whereas personal factors did not appear, reflecting their absence from the formal ICF coding structure.

Conclusion: This review shows that body functions and activities and participation are most consistently linked to clinical outcomes in older persons, reflecting their central role in functional independence and quality of life. Environmental factors were examined less often, yet contextual factors (including personal factors) remain important for understanding recovery and personalized care. These findings clarify which ICF-based functional profiles are routinely captured and support more structured, person-centred assessment across the rehabilitation trajectory. Further research should include personal factors and longer-term outcomes.

Purpose: Little is known about the expectations of patients with hip fracture regarding geriatric rehabilitation. We aimed to identify goals and expectations of older people regarding geriatric rehabilitation after a hip fracture in geriatric rehabilitation facilities.

Methods: A qualitative study of 20 community-dwelling older adults, who all underwent rehabilitation after hip fracture in skilled nursing facilities, was conducted using semi-structured interviews by phone. Data were analyzed using thematic content analysis. The themes were additionally arranged using the International Classification of Functioning, Disability and Health (ICF).

Results: The goals focused on the ICF key components of activity and participation and were described as returning to pre-fracture mobility, regaining independence in (I)ADL, returning to pre-fracture residence, and social and meaningful interactions. Expectations were related to environmental and personal factors. Environmental factors included aspects related to the care provided in rehabilitation facilities as well as the influence of informal caregivers. Personal factors focused on coping, adaptation skills, and self-efficacy.

Conclusion: Patients undergoing rehabilitation have clear goals and expectations for their successful recovery. Meaningful interactions and support from the rehabilitation facility are important factors that can influence the recovery process. A patient-centered approach can be developed during goal setting by involving the patient and integrating their goals and expectations within the ICF model. This strategy maximizes the effectiveness in achieving these goals. Trial register and date of registration NL7491 04-02-2019.

Purpose: Supine hypertension is prevalent but underdiagnosed among older adults, and its relationship with cardiovascular risk in adults aged ≥ 65 years remains unclear. This study aims to investigate the association between major adverse cardiovascular events (MACEs) and supine hypertension, stratified by hypertension treatment status.

Methods: Community-dwelling adults aged 65 years and older were enrolled. Supine hypertension was defined as supine systolic blood pressure (SBP) ≥ 140 or diastolic blood pressure (DBP) ≥ 90 mm Hg, while seated hypertension was defined as seated SBP ≥ 140 or DBP ≥ 90 mm Hg. The primary outcomes were MACEs, including nonfatal stroke, nonfatal myocardial infarction, and all-cause death.

Results: Among 3290 participants (mean age 71.4 years, 43.5% male), 345 MACEs occurred over a median follow-up of 6.4 years. Supine hypertension was present in 49.9% of participants, and 16.7% of participants had isolated supine hypertension. 73.2% of the participants with seated hypertension had supine hypertension. Supine hypertension was associated with an increased risk of MACEs (hazard ratio [HR], 1.43; 95%CI 1.14-1.80). Results remained consistent even after stratification by antihypertensive medication use. Participants with isolated supine hypertension exhibited a significantly higher risk of MACEs (HR, 1.39 vs. 1.18) and stroke (HR, 1.92 vs. 1.83) compared to those with isolated seated hypertension. Additionally, SBP change between supine and seated positions was associated with increased mortality risk (HR,1.01; 95%CI 1.00-1.02).

Conclusion: Isolated supine hypertension demonstrated a higher HR for MACEs and stroke than isolated seated hypertension. The postural SBP difference was associated with increased mortality risk in older adults.

Purpose: To investigate whether hemoglobin two days after discharge and transferrin saturation two months after discharge for hip fracture (HF) were associated with mobility and functional outcomes.

Methods: We included patients ≥ 65 years, surgically treated for a hip fracture at Copenhagen University Hospital, Bispebjerg and Frederiksberg. Iron deficiency was defined as transferrin saturation (TSAT) below 20%. Mobility and physical function were measured two months after discharge in an orthogeriatric outpatient clinic using new mobility score (0-9 points, 9 best functional mobility), six-minute walk test, usual walking speed (10-m), 30-s Sit-to-Stand test, and handgrip strength. Associations between hemoglobin, transferrin saturation (per units of 10%) and outcomes were evaluated by multivariable linear regression, with age, sex, and type of fracture (intra- versus extracapsular) as covariates.

Results: 235 patients were included (69% women, age 80 ± 8 years, 55% had intra-capsular fractures). The average ± SD hemoglobin two days after discharge was 10.4 ± 1.5 g/dL, 91% had anemia according to the WHO definition. The average transferrin saturation two months after surgery was 0.21 ± 0.09, 51% had iron deficiency. High hemoglobin was associated with high new mobility score (B = 0.46, 95% CI 0.25-0.66, p < 0.001). High transferrin saturation was associated with high new mobility score (B = 0.74, 95% CI 0.17-1.31, p = 0.01), six-minute walk test (B = 47, 95% CI 16-78, p = 0.004), walking speed (B = 0.12, 95% CI 0.06-0.19, p < 0.001), 30-s Sit-to-Stand test (B = 1.56, 95% CI 0.30-2.85, p = 0.01), and hand grip strength (B = 2.1, 95% CI 0.0-4.2, p = 0.049).

Conclusions: High hemoglobin two days after discharge was associated with high new mobility score two months after surgery. Transferrin saturation was associated with mobility and all measured functional outcomes two months after hip fractures.

Purpose: The association between antidementia drugs (ADDs) use and the risk of nursing home placement (NHP) remains inconclusive. This study aimed to investigate the effects of ADDs, including cholinesterase inhibitors (CEIs) and memantine, on NHP among individuals with dementia.

Methods: A systematic search of PubMed, Embase, Cochrane Library and ClinicalTrials.gov was conducted up to 16 March 2024 and updated on 25 August 2025. Randomized controlled trials (RCTs) or observational studies investigating the use of ADDs and NHP were included. Hazard ratios (HRs) with 95% confidence intervals (CI) were pooled using the DerSimonian-Laird random-effects model.

Results: Of 1,373 records, three RCTs and nine observational studies were included, encompassing different comparators. Meta-analyses were conducted separately by study design. In RCT, the single trial comparing any ADDs versus non-use (N = 1; donepezil vs placebo) showed no significant difference in NHP. In head-to-head RCT comparisons, one trial suggested a non-significant trend toward higher NHP risk with memantine versus donepezil. Among observational studies, a meta-analysis of five observational studies suggested a lower NHP risk with any ADDs in Alzheimer's disease (pooled HR = 0.43, 95% CI: 0.32-0.58, I² = 40.39%, p < 0.001) and mixed dementia (pooled HR = 0.84, 95% CI: 0.72-0.97, I² = 0.00%, p = 0.019). Pooled observational head-to-head comparisons likewise showed no significant differences between donepezil and rivastigmine (n = 3), donepezil and galantamine (n = 2), or CEIs + memantine versus CEIs monotherapy (n = 2). These observational estimates may be affected by residual confounding and other biases and should be interpreted with caution. By GRADE, certainty was low for the RCTs evidence and very low for the pooled observational studies of ADDs or CEIs versus non-use, and for head-to-head and combination therapy comparisons.

Conclusions: RCTs, rated as low-certainty evidence, suggest that ADDs may have no effect on NHP, whereas observational studies, rated as very low-certainty evidence, suggest that ADDs may be associated with a reduced risk of NHP among individuals with dementia. Given the overall uncertainty, high-quality, adequately powered prospective trials with longer follow-up are required to clarify these associations and to assess whether a causal relationship exists.

Background: Falls are a major public health concern among older adults in India. While earlier studies using LASI data have identified some risk factors, they did not account for key geriatric syndromes, physical performance, and functional status. This study aims to comprehensively examine the determinants of falls among older adults using nationally representative LASI Wave 1 data.

Methods: We analysed data from 26,780 community-dwelling individuals aged ≥ 60 years from LASI Wave 1. Falls were self-reported. Covariates included socio-demographics, comorbidities, ADL/IADL, cognition, depressive symptoms, grip strength, gait speed, physical activity, and sensory impairments. Associations were assessed using univariate and stepwise multivariable logistic regression.

Results: Among 28,285 community-dwelling older adults from the LASI dataset, the median age of the participants was 67 years (interquartile range: 63-73), 51% of the individuals were male and 49% female. 11.56% individuals reported a history of falls, with a higher prevalence among women (56.97%) and increasing age groups. In multivariate analysis, female sex, underweight BMI, tobacco and alcohol use, chronic joint disease, high cholesterol, prior injury or fracture, sensory impairments, ADL limitations, depression, and physical performance deficits were independently associated with increased fall risk. Functional limitations, such as difficulty climbing stairs and pushing/pulling objects, were also significant predictors. Conversely, urban residence and heart disease were associated with a lower risk.

Conclusion: Falls in older Indian adults are linked to a complex interplay of sociodemographic, clinical, and functional factors. These findings highlight the need for integrated, targeted fall prevention strategies addressing modifiable risk factors within this population.