Journals of Gerontology Series A-Biological Sciences and Medical Sciences最新文献

Background: Several hip fracture clinical prediction models have been developed. We conducted this study to (i) map outcomes used in clinical prediction models for hip fracture, (ii) identify the domains and instruments of predictors, and (iii) assess the risk of bias.

Methods: We performed systematic searches of studies published from June 2002 to June 2023 in the PubMed, Cochrane Library, CINAHL, CiNii, and Ichushi databases. After the relevant articles were identified, we performed the data extraction and bias risk assessment. We used the Prediction Study Risk Of Bias Assessment Tool (PROBAST) to assess each study's risk of bias. Outcome mapping was performed for the core outcome set of hip fractures. Qualitative synthesis and the PROBAST evaluation were performed on other-than-mortality core outcomes, which are difficult to target in rehabilitation.

Results: We screened 3 206 studies for eligibility; 45 studies were included in the outcome mapping, and 10 studies were included in the qualitative synthesis. Outcomes included mortality (n = 35), mobility (n = 8), and activities of daily living (n = 2). No clinical prediction models had pain or health-related quality of life as an outcome. Predictors were reported in 8 domains and 38 measures. The PROBAST evaluation showed a high risk of bias in all 10 studies that were eligible for a qualitative synthesis.

Conclusions: The clinical prediction models had only mortality, mobility, and activities of daily living as outcomes. The development of clinical prediction models with pain and health-related quality of life as outcomes is necessary. Clinical prediction models overcoming the risk of bias identified in this study are also needed.

Background: Long-term care facilities (LTCFs) are constantly working to reduce sources of infectious pathogens to improve resident care. LTCF residents are particularly susceptible to health care-associated infections (HAIs), many of which originate from the air. An advanced air purification technology (AAPT) was designed to comprehensively remediate volatile organic compounds (VOCs) and all airborne pathogens including all airborne bacteria, fungi, and viruses. The AAPT contains a unique combination of proprietary filter media, high-dose ultraviolet germicidal irradiation, and high-efficiency particulate air (HEPA) filtration.

Methods: The AAPT was installed in an LTCF's heating, ventilation, and air-conditioning ductwork and 2 floors were studied: the study floor with comprehensive AAPT remediation and HEPA filtration and the control floor with only HEPA filtration. VOC loading and airborne and surface pathogen loading were measured in 5 locations on both floors. Clinical metrics such as HAI rates were also studied.

Results: There was a statistically significant 98.83% reduction in airborne pathogens, which are responsible for illness and infection, an 89.88% reduction in VOCs, and a 39.6% reduction in HAIs. Surface pathogen loading was reduced in all locations except 1 resident room where the detected pathogens were linked to direct touch.

Conclusions: The removal of airborne and surface pathogens by the AAPT led to a dramatic reduction in HAIs. The comprehensive removal of airborne contaminants has a direct positive impact on resident wellness and quality of life. It is critical that LTCFs incorporate aggressive airborne purification methods with their current infection control protocols.

Background: Several studies have reported the association between blood neurofilament light chain (NfL) levels and all-cause mortality. However, the generalizability of these findings in general adults remains unclear. The study aimed to examine the association between serum NfL and all-cause mortality in a nationally representative population.

Methods: Longitudinal data were obtained from 2 071 participants aged 20-75 years in the National Health and Nutrition Examination Survey 2013-14 cycle. Serum NfL levels were measured by using a novel, high-throughput acridinium-ester immunoassay. Kaplan-Meier curves, multivariate Cox regression analysis, and restricted cubic spline regression were employed to investigate the association between serum NfL and all-cause mortality.

Results: Over a median follow-up of 73 (interquartile range = 12) months, 85 (3.50%) participants died. After adjustment for sociodemographic characteristics, lifestyle variables, comorbidity, body mass index, and estimated glomerular filtration rate, elevated serum NfL levels were still significantly associated with a higher risk of all-cause mortality (hazard ratio = 2.45, 95% confidence interval = 1.89-3.18 for per lnNfL increase) in a linear manner.

Conclusions: Our findings suggest that circulating levels of NfL may serve as a biomarker of mortality risk in a nationally representative population.

Background: Hip fracture is a disabling event experienced disproportionately by older adults with Alzheimer's disease or related dementias (ADRD). Claims information recorded prior to a hip fracture could provide valuable insights into recovery potential for these patients. Thus, our objective was to identify distinct trajectories of claims-based days at home (DAH) before a hip fracture among older adults with ADRD and evaluate associations with postfracture DAH and 1-year mortality.

Methods: We conducted a cohort study of 16 576 Medicare beneficiaries living with ADRD who experienced hip fracture between 2010 and 2017. Growth mixture modeling was used to estimate trajectories of DAH assessed from 180 days prior to fracture until index fracture admission, and their joint associations with postfracture DAH trajectories and 1-year mortality.

Results: Before a hip fracture, a model with 3 distinct latent DAH trajectories was the best fit. Trajectories were characterized based on their temporal patterns as Consistently High (n = 14 980, 90.3%), Low but Increasing (n = 809, 5.3%), or Low and Decreasing (n = 787, 4.7%). Membership in the Low and Decreasing prefracture DAH trajectory was associated with less favorable postfracture DAH trajectories, and a 65% higher 1-year mortality rate (hazard ratio 1.65, 95% confidence interval 1.45-1.87) as compared to those in the Consistently High trajectory. Similar albeit weaker associations with these outcomes were observed for hip fracture survivors in the Low but Improving prefracture DAH trajectory.

Conclusions: Distinct prefracture DAH trajectories among hip fracture survivors with ADRD are strongly linked to postfracture DAH and 1-year mortality, which could guide development of tailored interventions.

Background: Recent operational definitions of sarcopenia have not been replicated and compared in Australia and New Zealand (ANZ) populations. We aimed to identify sarcopenia measures that discriminate ANZ adults with slow walking speed (<0.8 m/s) and determine the agreement between the Sarcopenia Definitions and Outcomes Consortium (SDOC) and revised European Working Group for Sarcopenia in Older People (EWGSOP2) operational definitions of sarcopenia.

Methods: Eight studies comprising 8 100 ANZ community-dwelling adults (mean age ± standard deviation, 62.0 ± 14.4 years) with walking speed, grip strength (GR), and lean mass data were combined. Replicating the SDOC methodology, 15 candidate variables were included in sex-stratified classification and regression tree models and receiver operating characteristic curves on a pooled cohort with complete data to identify variables and cut points discriminating slow walking speed (<0.8 m/s). Agreement and prevalence estimates were compared using Cohen's Kappa (CK).

Results: Receiver operating characteristic curves identified GR as the strongest variable for discriminating slow from normal walking speed in women (GR <20.50 kg, area under curve [AUC] = 0.68) and men (GR <31.05 kg, AUC = 0.64). Near-perfect agreement was found between the derived ANZ cut points and SDOC cut points (CK 0.8-1.0). Sarcopenia prevalence ranged from 1.5% (EWGSOP2) to 37.2% (SDOC) in women and 1.0% (EWGSOP2) to 9.1% (SDOC) in men, with no agreement (CK <0.2) between EWGSOP2 and SDOC.

Conclusions: Grip strength is the primary discriminating characteristic for slow walking speed in ANZ women and men, consistent with findings from the SDOC. Sarcopenia Definitions and Outcomes Consortium and EWGSOP2 definitions showed no agreement suggesting these proposed definitions measure different characteristics and identify people with sarcopenia differently.

Background: The Pittsburgh Performance Fatigability Index (PPFI) quantifies the percent decline in cadence using accelerometry during standardized walking tasks. Although PPFI has shown strong correlations with physical performance, the developmental sample was relatively homogenous and small, necessitating further validation.

Methods: Participants from the Study of Muscle, Mobility and Aging (N = 805, age = 76.4 ± 5.0 years, 58% women, 85% White) wore an ActiGraph GT9X on the nondominant wrist during usual-paced 400 m walk. Tri-axial accelerations were analyzed to compute PPFI (higher score = greater fatigability). To evaluate construct and discriminant validity, Spearman correlations (rs) between PPFI and gait speed, Short Physical Performance Battery (SPPB), chair stand speed, leg peak power, VO2peak, perceived fatigability, and mood were examined. Sex-specific PPFI cut-points that optimally discriminated gait speed using classification and regression tree were then generated. Their discriminate power in relation to aforementioned physical performance were further evaluated.

Results: Median PPFI score was 1.4% (25th-75th percentile range: 0%-21.7%), higher among women than men (p < .001). PPFI score was moderate-to-strongly correlated with gait speed (rs = -0.75), SPPB score (rs = -0.38), chair stand speed (rs = -0.36), leg peak power (rs = -0.34) and VO2peak (rs = -0.40), and less strongly with perceived fatigability (rs = 0.28-0.29), all p < .001. PPFI score was not correlated with mood (|rs| < 0.08). Sex-specific PPFI cut-points (no performance fatigability: PPFI = 0%; mild performance fatigability: 0% < PPFI < 3.5% [women], 0% < PPFI < 5.4% [men]; moderate-to-severe performance fatigability: PPFI ≥ 3.5% [women], PPFI ≥ 5.4% [men]) discriminated physical performance (all p < .001), adjusted for demographics and smoking status.

Conclusion: Our work underscores the utility of PPFI as a valid measure to quantify performance fatigability in future longitudinal epidemiologic studies and clinical/pharmaceutical trials.

Background: Sarcopenia diagnosis is partly based on handgrip strength (HGS) assessment. The gold-standard dynamometer for this measurement is the Jamar. The electronic Gripwise is a smaller and lighter one, and its measurements are correlated with the Jamar's in laboratory tests. Our study aimed to confirm this correlation in aged patients.

Methods: This monocenter cross-sectional study was performed in patients of 65 years and older admitted at the University Hospital. Participants were assessed either in a seated or bedridden position, randomly allocated to begin the measurements with the Jamar or the Gripwise.

Results: Among 649 aged inpatients assessed for eligibility, 348 were included (mean age: 79 ± 9; 52% females). The intraclass correlation coefficient was 0.93 (95% confidence interval [CI] 0.92-0.94, p < .001) for the maximum value measured with both devices and 0.94 (95% CI 0.93-0.95, p < .001) for the mean values. However, there was a significant difference in detecting low values (<16 kg in women, <27 kg in men), found in 48% of patients with Jamar, and 71% with Gripwise (p < .001). Thus, we determined alternate cutoffs for diagnosing HGS low values with the Gripwise (<12 kg in women, <22 kg in men), further validated in a supplementary validation population (n = 70). The diagnostic performances of these alternative cutoffs were high (93% sensitivity and 87% specificity in women; 94% sensitivity and 96% specificity in men).

Conclusions: The correlation of the Gripwise with the Jamar was confirmed in aged inpatients. However, lower values recorded with the Gripwise require alternate cutoffs for a relevant low HGS diagnosis.

Males and females rarely express the same length of life. Here, we studied how sociosexual exposure shapes male and female age-specific mortality rates in Drosophila melanogaster. We maintained focal females and males within large, replicated cohorts throughout life with individuals of the same or opposite sex. Consistent with previous works, we found that females kept throughout their lives with males had only half the lifespan of those maintained throughout life at the same density in same-sex cohorts. In contrast, only a small lifespan decrease was observed in the corresponding male treatments and the reduction in male lifespan following exposure throughout life to other males or females was similar. Deconvolution of underlying aging parameters revealed that changes in lifespan were underpinned by opposing effects on actuarial aging in males versus females. Exposure to the opposite or same sex increased initial mortality rate in both sexes. However, in females, increasing exposure to males increased the rate of aging, while increasing exposure to females actually decreased it. The effects were in the opposite direction in males and were much smaller in magnitude. Overall, the findings were consistent with reports suggesting that exposure to the same versus opposite sex can affect survival differently in males and females. However, they also reveal a new insight-that overall lifespan can be underpinned by key differences in actuarial senescence in each sex. The findings suggest that responses to same or opposite sex exposure may have fundamentally and qualitatively different physiological consequences for health in males and females.

Background: Assessing an older adult's fitness-to-drive is an important part of clinical decision making. However, most existing risk prediction tools only have a dichotomous design, which does not account for subtle differences in risk status for patients with complex medical conditions or changes over time. Our objective was to develop an older driver risk stratification tool (RST) to screen for medical fitness-to-drive in older adults.

Methods: Participants were active drivers aged 70 and older from 7 sites across 4 Canadian provinces. They underwent in-person assessments every 4 months with an annual comprehensive assessment. Participant vehicles were instrumented to provide vehicle and passive Global Positioning System (GPS) data. The primary outcome measure was police-reported, expert-validated, at-fault collision adjusted per annual kilometers driven. Predictor variables included physical, cognitive, and health assessment measures.

Results: A total of 928 older drivers were recruited for this study beginning in 2009. The average age at enrollment was 76.2 (standard deviation [SD] = 4.8) with 62.1% male participants. The mean duration for participation was 4.9 (SD = 1.6) years. The derived Candrive RST included 4 predictors. Out of 4 483 person-years of driving, 74.8% fell within the lowest risk category. Only 2.9% of person-years were in the highest risk category where the relative risk for at-fault collisions was 5.26 (95% confidence interval = 2.81-9.84) compared to the lowest risk group.

Conclusions: For older drivers whose medical conditions create uncertainty regarding their fitness-to-drive, the Candrive RST may assist primary health care providers when initiating a conversation about driving and to guide further evaluation.

Background: Few studies have compared gait speed and its correlates among different ethnogeographic regions. The goals of this study were to describe usual and rapid gait speed, and identify their correlates across Australian, Asian, and African countries.

Methods: We used data from 6 population-based cohorts of adults aged 65+ from 6 countries and 3 continents (N = 6 472), with samples ranging from 231 to 1 913. All cohorts are members of the Cohort Studies of Memory in an International Consortium collaboration. We investigated whether clinical (body mass index [BMI], hypertension, stroke, apolipoprotein status), psychological (cognition, mood, general health), and behavioral factors (smoking, drinking, physical activity) correlated with usual (N = 4 cohorts) and rapid gait speed (N = 3 cohorts) similarly across cohorts. Regression models were controlled for age, sex, and education, and were sex-stratified.

Results: Age- and sex-standardized usual gait speed means ranged from 0.61 to 1.06 m/s and rapid gait speed means ranged from 1.16 to 1.64 m/s. Lower BMI and better cognitive function consistently correlated with faster gait speed in all cohorts. Less consistently, not having hypertension and greater physical activity engagement were associated with faster gait speed. Associations with mood, smoking, and drinking were largely nonsignificant. These patterns were not attenuated by demographics. There was limited evidence that the associations differed by sex, except physical activity, where the greater intensity was associated with usual gait among men but not women.

Conclusions: This study is among the first to describe the usual and rapid gait speeds across older adults in Africa, Asia, and Australia.