European Geriatric Medicine最新文献

Purpose: To examine the prognostic accuracy of the Clinical Frailty Scale (CFS) and Braden Scale (BS) separately and combined for 90-day mortality. Furthermore, to examine the effect of frailty on mortality depending on different levels of the Braden score.

Methods: The study included acutely admitted medical patients ≥ 65 years. We used an optimum cutoff for CSF and BS at ≥ 4 and ≤ 19, respectively. CFS categorized frailty as Non-frail (< 4), Frail (4-5), and Severely frail (> 5). Prognostic accuracy was estimated by the area under the receiver operating characteristic curves (AUROC) with 95% confidence intervals (CI). Cox regression analysis was used to compute the adjusted hazard ratio (aHR) for mortality.

Results: The mean age among 901 patients (54% female) was 79 years. The AUROC for CFS and BS was 0.65 (CI95% 0.60-0.71) and 0.71 (CI95% 0.66-0.76), respectively. aHR for mortality of CFS ≥ 4, BS ≤ 19, and combined were 2.3 (CI95% 1.2-4.2), 1.9 (CI95% 1.3-2.9), and 1.9 (CI95% 1.3-2.8), respectively. For BS > 19, the aHR for mortality was 2.2 (CI95% 1.0-4.8) and 3.5 (CI95% 1.4-8.6) for 'frail' and 'severely frail', respectively. aHR for BS ≤ 19 was 1.1 (CI95% 0.4-3.2) and 1.3 (CI95% 0.5-3.7) for 'frail' and 'severely frail', respectively.

Conclusion: Although CFS and BS were associated with 90-day mortality among older acutely admitted medical patients, the prognostic accuracy was poor-to-moderate, and the combination of CFS and BS did not improve the prognostic accuracy. However, the hazard of mortality across different levels of frailty groups were particularly increased among patients with high BS scores.

Background: Muscle ultrasound is increasingly popular thanks to its advantages over other techniques. However, its usefulness in the diagnosis of sarcopenia in older adults with aortic stenosis (AS) has not been studied to date.

Objectives: to analyze the prevalence of sarcopenia using muscle ultrasound and its impact on the health outcomes in older patients with AS.

Methods: The single-center FRESAS (FRailty-Evaluation-in-Severe-Aortic-Stenosis) registry was used to study patients over 75 years with severe AS susceptible to valve replacement. Sarcopenia was suspected in those individuals with diminished grip strength, and the diagnosis was confirmed in the presence of reduced ultrasound quadriceps muscle thickness, following the recommendations of the EWGSOP2 (European-Working-Group-on-Sarcopenia-in-Older-People). The primary composite endpoint was urgent hospital admission and mortality of cardiac cause 6 months after the diagnosis.

Results: Of the 150 patients studied, 55.3% were females, and only 17.3% were frail; the mean age was 83.4 years. Sarcopenia was diagnosed in 42 patients (28%). The overall survival rate at 6 months was 92%. The primary endpoint was recorded in 23.2% of the cases and was more frequent in the sarcopenic patients (33.3%) than in the non-sarcopenic individuals (17.6%) (p = 0.01). The regression analysis found that sarcopenia was associated with an increased risk of the primary endpoint (HR: 2.25; 95% CI 1.19-4.45; p = 0.02), adjusting for potential confounding factors.

Conclusions: The incidence of serious cardiac complications in older patients with sarcopenia and severe AS is significant. The present study describes a noninvasive, ultrasound-guided diagnostic technique that may prove efficient in its predictive capacity.

Purpose: Numerous epidemiological studies have suggested a possible association between dysphagia and the risk of decline in Activities of daily living (ADL) among older adults. This systematic review and meta-analysis aimed to elucidate the relationship between dysphagia and ADL in older adults.

Methods: PubMed, Web of Science, Cochrane Library, Embase, Ebsco, MEDLINE, Wiley, CINAHL, and Ovid databases were comprehensively examined for relevant studies published up to October 31, 2022. Quantitative studies published in English were included to explore the relationship between dysphagia and ADL in people aged 65 years and older. The NIH Quality Assessment Tool was used to assess the study quality. R software was used to draw forest plots and I² was employed to indicate study heterogeneity. Sensitivity analysis was performed using the one-by-one exclusion method. Publication bias was measured using funnel plots and Egger's test.

Results: A total of 3,498 studies were retrieved from the database, 22 of which were eventually included in the systematic evaluation, and 14 of which were subjected to meta-analysis. Data from nine studies were categorical variables, and meta-analysis results showed that swallowing disorders in older adults were associated with a lower ability to perform ADL (OR = 3.39, 95% CI: 2.55-4.50, p < 0.001), with moderate heterogeneity (I² = 62%, p = 0.006). Data from seven studies were continuous variables, resulting in a negative association between the prevalence of dysphagia and ADLs in older adults (SMD = -0.80, 95% CI: -1.08 to -0.51, p < 0.001), with high heterogeneity (I² = 94%, p < 0.001). Sensitivity analysis showed robust results, funnel plots and Egger's test indicated no publication bias.

Conclusion: Dysphagia is significantly associated with the capacity to perform ADL. Prevention and screening of dysphagia in older patients dependent on others for daily care are needed. Further long-term studies are needed in the future to prove causality.

Purpose: Sarcopenia is diagnosed on the basis of low muscle strength, with low muscle mass used to confirm diagnosis. The added value of measuring muscle mass is unclear. We undertook a systematic review to assess whether muscle mass measurement in patients with hip fracture was acceptable, feasible and independently associated with adverse outcomes.

Methods: Electronic databases (MEDLINE, EMBASE, CENTRAL, CINAHL, Clinicaltrials.gov) were searched for studies of patients with hip fracture aged ≥ 60 with perioperative muscle mass or strength assessments. Associations with postoperative outcomes including death, length of stay and activities of daily living were extracted. Risk-of-bias was assessed using the AXIS and ROBINS-I tools. Due to the degree of study heterogeneity, data were analysed by narrative synthesis.

Results: The search strategy identified 3317 records. 36 studies were included with 7860 participants. Acceptability of muscle mass measurement was not assessed, but measurement appeared feasible using biompedance, dual energy x-ray absorptiometry and computed tomography. Univariate analyses indicated that lower muscle mass was associated with higher death rates at 30 days, worse mobility, worse activity of daily living metrics and worse physical performance but there was no significant association with length of stay or postoperative complications. Four studies included both muscle mass and strength in multivariable analyses; muscle mass was a significant independent predictor of only one adverse outcome in a single study after adjustment for muscle strength and other predictor variables.

Conclusion: Current data suggest that muscle mass assessment offers no additional prognostic information to muscle strength measures in patients with hip fracture.

Purpose: This study assessed the characteristics, management, and outcomes of dysphagia rehabilitation in older patients with CVD in a super-aged society, highlighting the need for comprehensive management strategies in community hospital settings. It aimed to uncover valuable insights into the benefits of integrating dysphagia rehabilitation with cardiac care in patient management.

Methods: We conducted a retrospective review of patients with CVD aged ≥ 65 years who were admitted to Niigata Minami Hospital between January 2019 and December 2021. We focused on patients requiring dysphagia rehabilitation and assessing the effects of these interventions on recovery.

Results: The study included 732 participants with an average age of 86.0 ± 7.8 years, of whom 41.9% were male. Approximately 55.1% required dysphagia rehabilitation. Dysphagia rehabilitation significantly improved oral caloric intake and BMI in patients who underwent rehabilitation, and these improvements were comparable to those in patients who did not require dysphagia rehabilitation. Significant enhancement in the ADL of patients was observed at discharge. Patients who required dysphagia rehabilitation also had longer hospital stays and were more likely to be discharged to nursing facilities.

Conclusion: Dysphagia is common in older patients with CVD, and dysphagia rehabilitation positively affects the maintenance of nutritional status and helps patients achieve ADL independence at discharge. This study highlights the importance of integrating dysphagia rehabilitation into ordinary cardiac rehabilitation programs for older patients with CVD to improve their QOL.

Purpose: Gastric cancer (GC) is mostly a disease of aging, and older patients with GC are generally frailer. This study aimed to describe the characteristics and in-hospital outcomes, both overall and stratified by gender and resection, and to explore factors associated with outcomes of first hospitalization, in older GC patients.

Methods: Data on GC patients ≥ 65 years hospitalized from January 2016 until December 2020 were retrieved from the electronic medical records of a large tertiary hospital. Patient and tumor characteristics, duration and fee of hospitalization, and in-hospital mortality were described for overall patients and compared by gender and resection. Factors associated with outcomes of first hospitalization were explored using multivariable-adjusted logistic regression.

Results: 3238 eligible patients were analyzed, with a mean age of 71 years and a male proportion of 74%. The median duration and fee of first hospitalization were 13 days and 40,000 RMB, respectively, with a median fee of 17,000 RMB not covered by insurance. 16 (< 1%) and 32 (1%) deaths occurred during first and any hospitalization, respectively, with only 4 (< 1%) perioperative deaths. Compared to male patients, female cases had more often signet-ring-cell carcinoma, reduced food intake, resection, and history of major abdominal surgery. Compared to unresected cases, resected patients had higher body-mass-index and Barthel index, less often reduced food intake, weight loss, and risk of malnutrition, and more often common diet, longer hospital stay, and higher fee. Through multivariable-adjusted analysis, longer first hospital-stay was associated with earlier year of diagnosis, older ages, emergency admission, signet-ring-cell carcinoma, resection, history of anticoagulant intake, larger body-mass-index, non-common diet, and non-low-salt and non-diabetes diets; higher fee of first hospitalization was associated with later year of diagnosis, male gender, older ages, emergency admission, signet-ring-cell carcinoma, and resection.

Conclusions: In this large institution-based study, older GC patients had low in-hospital mortality rates; the insurance coverage needs to be improved. Several characteristics and in-hospital outcomes significantly differed by gender and resection status, and various factors associated with duration and fee of first hospitalization were identified, providing important hints for individualized and stratified geriatric GC care.

Objectives: The present study aimed to explore the association between oral frailty and glycated hemoglobin (HbA1c), and the chain mediating role of nutritional status and physical frailty among older adults with type 2 diabetes mellitus (T2DM).

Methods: Patients with T2DM aged > 60 years were recruited from the endocrinology department of a national metabolic center from October 2023 to March 2024. Oral frailty, nutritional status, and physical frailty were assessed with Oral Frailty Index-8 (OFI-8), the Nutrition Risk Screening 2002 (NRS2002), Fatigue, Resistance, Ambulation, Illness and Loss of Weight Index (FRAIL), respectively. Their HbA1c were collected at the same time. In order to reveal the interaction and influence between multiple variables, chain mediation analyses were conducted using the "Process" macro in SPSS 26.0 to estimate the direct and indirect effects of oral frailty on nutritional status, physical frailty and HbA1c.

Results: A total of 292 participants (50.7% male) were enrolled in this study at a median age of 70.0 (65.2, 76.0) years and a T2DM disease duration of (16.5 ± 9.4) years. After adjustment for age, oral frailty of older people with T2DM significantly positively predicted their HbA1c (β = 0.198, P < 0.001). In addition, oral frailty affect HbA1c through two indirect pathways, including an independent mediating effect of physical frailty (effect = 0.046) and a chain-mediating effect of nutritional status and physical frailty (effect = 0.004).

Conclusions: Our findings suggest that less oral frailty of older adults with T2DM could optimize their nutritional status and physical frailty and, thus, their HbA1c. Consequently, improving oral health is expected to be a promising intervention target for reaching optimal glycaemic control in older adults with T2DM.

Background: Global aging is leading to an increase in frailty patients, and physical activity (PA) may have an impact on frail in middle-aged and older population. This study aimed to explore the relationship between the frequency of different PA intensities and the incidence and prevalence of frailty in middle-aged and older adults based on the Survey of Health, Ageing, and Retirement in Europe (SHARE).

Method: Self-reported questionnaires were used to obtain information on demographics and PA, and frailty was assessed using the SHARE Frailty Instrument (SHARE-FI). Cox regression and logistic regression models were used to explore the association between PA and frailty and stratified according to middle or old age.

Results: Among 6315 baseline non-frail participants aged 44-96 years, 16.1% developed frailty over 4 years, with higher incidence and prevalence in women (P < 0.05). Women accounting for 55.80% of the sample. The frequency of participants participating in sports decreased over 4 years (P < 0.05). Compared with participants who engaged in PA more than once a week, participants who engaged in moderated PA less frequently had a higher risk of new-onset frailty (HR: 3.174-6.115), and participants who engaged in vigorous PA 1-3 times a month had a higher risk of new-onset frailty (HR: 1.335). Participation in low-frequency moderate PA and vigorous PA 1-3 times per month were positively associated with the prevalence of frailty (P < 0.05).

Conclusion: Physical activity frequency decreases with age in middle-aged and older adults. Those adults who engage in moderate PA more than once a week have a lower risk of incidence of frailty, compared to those with more sedentary life-styles. Additionally, women need to pay more attention to frailty management.

Aim: The present study aimed to investigate the relationship between delirium and tryptophan and its metabolites in critically ill older patients.

Methods: This prospective and observational study was conducted on patients who were > 60 years of age and hospitalized for at least 24 h at the internal medicine ICU in the tertiary health care unit (n = 120). All consecutively selected patients were evaluated for delirium at the baseline and follow-up period at the bedside by an intensive care specialist. At the end of the 24 h follow up, the patients were divided into two groups (with and without delirium). Clinical properties and tryptophan (TRP) and its metabolites [kynurenine (KYN), kynurenic acid (KYNA), quinolinic acid (QA), 3-hydroxykynurenine (3-HK), 3-hydroxyanthranilic acid (3HAA)] were compared between groups.

Results: The median age of the patients was 79.5 (62-95) years and 53.3% were female. The median age and CCI score were significantly higher among patients with delirium than in those without delirium (P = 0.001 and 0.031, respectively). The level of TRP was significantly (borderline) decreased among patients with delirium (P = 0.056). The KYN/TRP and QA/TRP ratios were statistically and significantly higher in patients with delirium than those without (P < 0.001 and P = 0.016, respectively). The best predictive values for detecting delirium were calculated as ≤ 14,100 ng/mL for TRP (AUC: 0.601, P = 0.052), > 1.12 for KYN/TRP ratio (AUC: 0.704, P < 0.001), and > 0.75 for QA/TRP ratio (AUC: 0.627, P = 0.013). The QA/TRP ratio showed independent and borderline significant association with being delirium in multivariable regression analysis (Odds ratio: 2.007, P = 0.066).

Conclusion: This study demonstrated that tryptophan and its metabolites obtained within the first 24 h of ICU admission might have predictive value for determining high-risk older patients for delirium.