European Geriatric Medicine最新文献

Purpose: To assess and compare, through a retrospective cohort study, the relationships between frailty, comorbidity, multimorbidity, and levels of adherence to lipid-lowering drugs (LLDs), antihypertensives and antidepressants.

Methods: In a primary care database, we selected a cohort of patients aged 60 or older on December 31, 2022. The date of the first prescription of the aforementioned medications was the study index date. Patients with Variable Medication Possession Ratio (VMPR) > = 80% were classified as properly adherent. Frailty (i.e. Primary Care-Frailty Index), comorbidity (i.e. Charlson Index) and multimorbidity (i.e. disease counts) alternatively entered multivariate logistic regressions along with age and sex. Models' performances in prediction of medications adherence were compared in terms of information (AIC; BIC) and discrimination values (AUC).

Results: Incident users of LLDs, antihypertensives or antidepressants were 4310 (mean age: 67.9 (SD: 6.9); 56.0% females), 5969 (mean age: 69.1 (SD: 7.6); 58.0% females), and 3834 (mean age: 68.7 (SD: 6.9); 66.5% females), respectively. Among users of LLDs (46% adherent) and antidepressants (22% adherent), those who were moderately or severely frail showed a significant 30-32% decrease in adherence. In contrast, users of antihypertensives (46% adherent) showed a 41% increase in adherence when multimorbid. As a whole, the three multivariate models were equally effective in informing on medication adherence, as per AIC and BIC. They also displayed similar discriminatory ability, with AUC scores ranging from 53 to 58%. Regarding the workload of GPs, the number of elderly patients classified as moderately/high frail was less than those with co-morbidities or multimorbidities. For instance, there were approximately 35 users of antihypertensive medications per GP for the moderately frail group, compared to 46 and 66 for the co-morbid and multi-morbid groups, respectively.

Conclusions: These findings showed similar capacity for frailty, comorbidity, and multimorbidity in capturing medications adherence. Given the existence of a validated tool in primary care that aligns well with GPs' workload, frailty seems the most suitable measure for assessing the complexity of older adults in relation to their adherence to long-term medications.

Background: Concerns about falling (CaF) are common in older adults. They can lead to various negative outcomes, including an increased risk for future falls. The Worlds Falls Guidelines recently published recommendations for assessing and treating CaF. However, the extent to which these guidelines have been adopted into falls prevention practice (in addition to the barriers preventing implementation) are currently unknown.

Methods: A cross-sectional survey was completed by 114 healthcare professionals working in falls prevention and rehabilitation services in the UK and Ireland. The survey explored their experiences and perceptions regarding the management and assessment of CaF.

Results: Only 39% of respondents reported using the Falls Efficacy Scale-International (FES-I), a tool recommended by the World Falls Guidelines for assessing CaF. Healthcare professionals in hospital settings were significantly less likely to use the FES-I compared to those working in the community (X² = 6.324, p = 0.043). While there was no significant difference between settings regarding the type of intervention used to manage CaF, only about 50% of participants adopted a holistic approach combining physical and psychological strategies as recommended by the World Falls Guidelines. The most commonly identified barriers to clinical management of CaF were a lack of both time and perceived effective interventions, particularly for those working within hospital settings (X² = 6.209, p = 0.013 and X² = 3.752, p = 0.053, respectively).

Conclusion: These findings indicate low levels of adoption of the World Falls Guidelines recommendations for assessing and managing CaF, especially in hospital settings. Future work should focus on addressing these barriers to maximise the clinical adoption of these recommendations.

Purpose: The purpose of this study was to determine the effects of peri and postoperative intravenous vitamin C administration on severity of postoperative pain and intraoperative blood loss in patients with trochanteric fracture treated with intramedullary nailing.

Methods: A prospective, single-blinded, controlled, randomised clinical study was conducted. It included 60 patients who were randomly divided into the Vitamin C and Control groups. Baseline characteristics, haemoglobin levels, number of Red Blood Cell (RBC) units transfusion, and metamizole consumption were noted in each group. Visual Analogue Scale (VAS) score was evaluated at 24 and 48 h postoperatively.

Results: There were no differences between the groups concerning age, gender, length of hospitalisation, fracture type distribution, preoperative and postoperative haemoglobin levels. Postoperative metamizole consumption was higher in the Control group than in the Vitamin C group, with statistically significant difference (p = 0.003). The median VAS scores were higher in the Control group compared to the Vitamin C group at 24 and 48 h postoperatively with significant differences (p = 0.001 and p < 0.0005, respectively). Multivariate logistic regression analysis revealed two independent predictors of postoperative blood transfusion: unstable fracture pattern (OR = 0.065, 95% CI 0.007-0.571, p = 0.014), and preoperative haemoglobin level (OR = 903, 95% CI 0.846-0.965, p = 0.003).

Conclusion: The results showed significant reduction of subjective pain levels and lower analgesic consumption in patients who received intravenous vitamin C, suggesting that it could be considered as an adjuvant agent for analgesia in older patients with hip fracture. Unstable fracture pattern and preoperative haemoglobin levels significantly contributed to postoperative blood transfusion requirement.

Purpose: The increasing burden of out-of-pocket expenses borne by older adults with frailty can be a considerable challenge in efforts toward improving societal health. This study estimated the cost of frailty for older adults by employing cost of illness theory.

Methods: Five electronic databases were searched (without any language or year restriction) for relevant articles from their inception to April 2024. Studies investigating the cost of frailty and prefrailty for older adults (aged ≥ 60 years) were included.

Results: A total of 51 studies were included. The findings revealed that frailty significantly increased mean total costs by US$3286 and US$4653 compared with the costs for individuals with prefrailty and robustness, respectively. The cost difference between the prefrailty and robust groups was US$2729. The increases in indirect costs did not significantly differ between the prefrailty and robust groups or between the frailty and robust groups. The total cost by setting was significantly increased in the frailty group relative to the prefrailty and robust groups. The results stratified by continent or region revealed that only the frailty and prefrailty groups in North America experienced significant increases in total costs relative to the robust group. However, in the Asia-Pacific region and Europe, no significant results were noted.

Conclusions: This is the first meta-analysis to employ cost of illness theory to investigate the cost of frailty. Our findings can help providers of health-care services and professional workers develop effective and comprehensive intervention plans and services that can be provided for older adults with frailty.

Purpose: This cross-sectional study examined the gut microbiota species associated with skeletal muscle mass reduction in a community-based sample of older Japanese adults.

Methods: The study included 744 participants (320 men and 424 women) aged 65-89 years (mean age: 73 years) with no history of treatment for colorectal, chronic kidney, or liver diseases. Bioelectrical impedance analysis was performed to estimate the appendicular skeletal muscle mass (ASM) of each participant. The gut microbiota composition was assessed using next-generation sequencing targeting the V3-V4 regions of the prokaryotic 16S rRNA genes. A self-administered questionnaire was used to evaluate daily living habits, including food intake associated with maintaining the gut microbiota.

Results: Among the participants, those with reduced muscle mass (defined as an ASM index of less than 4.4 kg/m² for men and 3.7 kg/m² for women) had significantly higher levels of the genus Blautia when compared with those with normal muscle mass (P = 0.009). Logistic regression analysis revealed that the association between the genus Blautia and skeletal muscle mass remained significant even after adjusting for multiple confounding factors (P = 0.012). Additionally, an increase in the genus Blautia was positively associated with excessive alcohol consumption (≥ 20 g/day, β = 0.125, P = 0.002) and negatively associated with regular yogurt intake (≥ 1 time/week, β = -0.101, P = 0.010), independent of other lifestyle and dietary factors.

Conclusion: Elevated levels of the genus Blautia were associated with reduced skeletal muscle mass in older Japanese adults, suggesting that improving the gut microbiota may be a potential approach to preserving muscle mass among this population.

Purpose: Hospital surgical services that utilise the approach of the perioperative medicine for older people undergoing surgery (POPS) model of care improve outcomes for older people contemplating and undergoing surgery. Complex models of care like POPS may be difficult to implement without understanding the elements that comprise that model of care. Logic models can be used to aid implementation by visually depicting theoretical relationships between the elements of the model of care. Our objective was to understand the core elements of the POPS model of care at health services other than where it was first developed.

Methods: A qualitative case study at three contextually different health services in England with POPS models of care of varying implementation maturity was undertaken. We conducted semi-structured interviews with clinicians and managers involved in POPS (n = 56). The interviews were analysed using inductive and deductive methods.

Results: We developed a logic model with seven domains and themes that described the core elements of the POPS model of care compared and contrasted across the three health services. We found POPS could be adapted to 'fit' the local contexts of our study and still achieve its desired outcomes if it remained true to the principles of comprehensive geriatric assessment and optimisation and was delivered by staff with expert skills and attitudes.

Conclusion: Our logic model provides potentially generalisable information about the core elements of the POPS service in three health services. This information can be used to aid the implementation of the POPS model of care in healthcare settings similar to our study. Further research may be required to test the logic model in other healthcare contexts.

Purpose: We aimed to assess differences among older patients demonstrating low STS performance in the 30 s-STS and/or the 5r-STS.

Methods: 30 s-STS and 5r-STS were used to assess lower limb muscle strength and function in older adults. Analysis involved 376 patients (≥ 65 years) from a geriatric outpatient clinic for fall assessment.

Results: The mean age of patients was 79.8 (± 6.1) years (67% female). In total, 40.6% had low STS performance with 9.3% presenting only low 30 s-STS, 9.8% only low 5r-STS, and 21.5% low STS performance in both tests. Patients with low STS performance in both tests had lower gait speed, were more often frail, and had more prior falls compared to patients with low STS performance in one test only.

Conclusion: The two STS tests are not interchangeable, and the use of both STS tests capture a wider range of physical abilities in mobility-limited older adults.

Clinical trial registration: NCT05795556.

Objective: To conduct a meta-analysis to explore the optimal dosage of Tai chi exercise that positively influences the sleep quality of the older people.

Methods: A literature search was conducted from 2004 to October 2024 in PubMed, Embase, Web of Science, Google Scholar, Cochrane Library, and Chinese databases (CNKI and Wanfang) for randomised controlled trials in Chinese and English on Tai chi improving sleep quality in the older people. Data extraction and verification were performed by two independent researchers. Additionally, a meta-analysis of the mean difference (MD) and 95% confidence interval (CI) was conducted using RevMan 5.4.

Results: A total of nine randomised controlled trials involving 1,166 older participants were included. Compared with the control group, Tai chi significantly reduced the total Pittsburgh Sleep Quality Index (PSQI) scores in the older people [MD =  - 1.53, 95% CI (- 2.18, - 0.89), p < 0.001], with heterogeneity results Q = 53.63, df = 12, and I² of 78% (p < 0.001); Total weekly duration of Tai chi exercise: Less than 150 min reduced PSQI scores, but the difference was not statistically significant [MD =  - 1.47, 95% CI (- 3.89, 0.95), p = 0.23]. Between 150-300 min significantly reduced PSQI scores [MD =  - 1.54, 95% CI (- 2.00, - 1.08), p < 0.001]; Duration of Tai chi exercise programme: 8-12 weeks significantly reduced PSQI scores [MD =  - 1.93, 95% CI (- 2.60, - 1.25), p < 0.001]; 16-24 weeks significantly reduced PSQI scores [MD =  - 1.27, 95% CI (- 2.27, - 0.26), p = 0.01]; Single session duration of Tai chi exercise: 60 min significantly reduced PSQI scores [MD =  - 2.17, 95% CI (- 3.15, - 1.18), p < 0.001]; Less than 60 min (25-45 min) significantly reduced PSQI scores [MD =  - 0.92, 95% CI (- 1.63, - 0.20), p = 0.01].

Conclusion: Older individuals engaging in at least 150 min per week of Tai chi practice can improve sleep quality. Beyond this threshold, extending the duration of individual practice sessions or the exercise programme does not yield additional benefits for sleep quality.