Gerontology and Geriatric Medicine最新文献

Introduction: The gerontological literature suggests that external housing-related control beliefs (HCB) influence activities of daily living (ADL) among older people, but knowledge is scarce for people with Parkinson's disease (PD). This longitudinal study aimed to explore the directions of the relationship between external HCB and ADL among people with PD.

Methods: Baseline (T1) and 3-year follow-up data (T2) were collected from 154 people with PD (mean age = 68 years, T1). Two regression analyses were applied, where dependent (T2 values) and independent (T1 values) variables-external HCB score and PD specific ADL (PADLS)-were switched, adjusting for age, disease severity, cognitive functioning, and accessibility problems.

Results: There was a significant effect of ADL on external HCB (β = 3.07, p < .001, CI [1.28, 4.85]), but no effect in the reverse direction. The proportion with moderate-extreme ADL difficulties increased over time (from 20.8% to 32.5%, p = .006).

Discussion: ADL difficulties seem to lead to higher external HCB, but not the other way around, which contradicts assumptions in environmental gerontology theories. This new knowledge can promote theory development. While additional studies are required to verify whether this is a disease-specific finding, this indicates the importance of targeting ADL if the purpose is to influence external HCB among people with PD.

Behavioral activation therapy is presented as a promising psychological intervention to enhance depression management and related symptoms by increasing engagement in rewarding activities. This study reviews three research endeavors, including randomized controlled trials and a case study. Variability in intervention duration and training approaches is noted, although typically, eight sessions per week were conducted. Therapy components range from participating in pleasurable activities to ongoing support outside sessions. The process of evidence source selection relied on identifying 327 articles across four databases, with three selected for review, utilizing the PRISMA extension for scoping reviews. This ensured rigorous eligibility criteria and a structured methodology for data collection. Overall, these findings support the effectiveness and applicability of behavioral activation therapy in treating depression in older adults. Training non-specialized healthcare personnel would improve the overall quality of medical care and facilitate the dissemination of evidence-based therapies. This, in turn, could be crucial in closing the psychotherapeutic care gap that exists in low and middle-income countries.

Objective: We aimed to assess seasonal and age-related variations in sleep quality using Fitbit data and offer lifestyle recommendations for enhancing winter sleep quality. Methods: Fitbit sleep and activity data of 51 participants randomly recruited from members of the Association for Research in Supporting System of Chronic Disease, a nonprofit organization in the Yamanashi Prefecture of Japan, were collected and retrospectively analyzed from July to December 2022. Sleep stage targets were set at 10% to 25% for deep sleep, 50% to 60% for shallow sleep, and 20% to 25% for REM sleep. Participants were categorized into improved, unchanged, and worsened groups based on sleep stage unit changes between August and December. Results: The median (interquartile range) age was 71 (68-74) years old. There were eight participants in the improved group, 23 in the unchanged group, and nine in the worsened group. The improved group showed significantly more steps (990 ± 1,102 steps/day, p = .039) in December than in August, while the worsened group showed fewer steps (-507 ± 1,638 steps/day, p = .38). Conclusion: Increasing step count in winter may improve sleep quality, as assessed by sleep stage. Further research considering potential confounders and factors affecting winter sleep is needed to support and extend these findings.

The COVID-19 pandemic has significantly impacted the daily lives of older adults. Three case reports illustrate how individuals have coped with loss, maintained routines, and faced emotional challenges. Understanding these experiences can guide efforts to promote the well-being and resilience of older adults during this time. Interview questions included "What was your daily routine and any leisure activities you participated in before COVID-19? During the height of social distancing?" to explore the impact of this pandemic on older adults' daily routines and the effects on their mental and physical health.

One dementia prevention strategy that is effective for older adults is frequent participation in leisure time physical activity. However, research gaps exist in our understanding of the longitudinal relationship between different levels of leisure time physical activity participation and the cognitive function of older adults with mild cognitive impairment. Thus, we investigated this relationship using Health and Retirement Study data from 2012 to 2020. Results from Repeated Measures Multivariate Analysis of Covariance indicated that both the mid (Mean Difference = -0.45) and high level (Mean Difference = -0.82) leisure time physical activity groups showed higher levels of memory function compared to the low-level leisure time physical activity group. Additionally, the mid (Mean Difference = -0.21) and high level (Mean Difference = -0.37) leisure time physical activity groups reported better working memory function, and the mid (Mean Difference = -0.02) and high level (Mean Difference = -0.02) leisure time physical activity groups showed higher levels of attention and processing speed than the low-level leisure time physical activity group. These findings suggest that older adults with mild cognitive impairment who engage either vigorously or moderately in leisure time physical activity (more than three times a week) experience improvements in cognitive function compared to those who do not. This study provides valuable insights for clinicians on the optimal level of leisure time physical activity required to mitigate cognitive decline in older adults with mild cognitive impairment.

Purpose: Medication-related osteonecrosis of the jaw (MRONJ) caused by bisphosphonates (BPs) and denosumab (Dmab) is still a major oral adverse event caused by cancer treatment and may be under-recognized by private dental services. With the aim of reducing the prevalence of MRONJ, this study, which is a pilot study for a planned future large-scale survey, compared knowledge about MRONJ between dental hygienists (DHs) in private dental clinics and those in cancer center hospitals. Methods: We conducted a questionnaire-based survey regarding MRONJ between 1 November 2023 and 31 January 2024 on DHs at a cancer base hospital and a private clinic in Saitama, Japan. We statistically analyzed the data collected using the χ² test or Fisher's exact test with the level of significance set at 5%. Results: This study included 10 in-hospital and 53 private clinic DHs. The in-hospital DHs had appropriate knowledge of MRONJ. However, compared with the in-hospital DHs, although the private clinic DHs knew that BPs are used for osteoporosis, significantly fewer had knowledge of Dmab (p < .001) or knew that BPs and Dmab could also be used to treat cancer (both p < .001). In addition, few private clinic DHs were aware of MRONJ cases refractory to antibiotic treatment alone (p = .012). Conclusion: These findings suggest that private clinic DHs have less knowledge of MRONJ than those in cancer base hospitals.

Objective: Previous studies suggest older patients with multiple health conditions and medications may experience adverse interactions, leading to negative outcomes. However, there's limited research on this in older adults receiving home medical care. This study assesses whether polypharmacy is linked to falls or other clinical outcomes. Methods: The study population included 217 participants, aged ≥65 years, receiving home medical care, who consented to participate in the Osaka Home Care Registry (OHCARE) study in Japan. The survey examined the association between polypharmacy and clinical outcomes. We defined "polypharmacy" as six or more medications taken regularly. Results: Of the participants, 135 (62.6%) had polypharmacy and were significantly more likely to have hypertension or diabetes. Common medications included those for hypertension, diabetes, and mental disorders. Participants with polypharmacy experienced significantly more falls. Multivariate analysis showed an association between polypharmacy and falls (odds ratio: 2.81, 95% confidence interval [1.34, 5.92]). Conclusion: Even in older patients receiving home health care, the use of six or more medications poses a risk of falls. Careful observations and life support by medical stuffs are necessary to prevent falls in older patients with polypharmacy receiving home medical care.

The most adverse outcomes of the COVID-19 pandemic include high post-infection mortality among long-term care (LTC) home residents. Research about mortality over a longer period after contracting COVID-19 and in different pandemic years is limited. In the current study, we examined outcomes for 1,596 LTC residents from the day of a positive COVID-19 test until January 31, 2023. We reported all-cause mortality 30 days after contracting COVID-19 and monthly throughout the follow-up, up to 35 months after the pandemic start. We also examined mortality among 2,724 residents residing in the same LTC homes, with no history of COVID-19 during the same period. The results underscored a large number of deaths in the first month post-infection, with 30-day mortality substantially decreasing over the years-from 28% (95% CI [24.3, 31.8]) among residents contracting COVID-19 in 2020, to 8.3% (95% CI [7.4, 9.2]) in the 2022 cohort. Observed over longer periods, monthly mortality among residents with a COVID-19 history was similar to mortality in the No-COVID residents, and no evidence was found of increased mortality risk in the COVID group beyond the first post-infection month. We discuss mortality in LTC during the pandemic and a continuing need to reduce mortality in the acute phase of COVID-19.

The occurrence rate of frailty is high among patients with chronic diseases. However, the assessment of frailty among these patients is still far from being a routine part of clinical practice. The aim of this study is to develop a validated predictive model for assessing frailty risk in patients with chronic illnesses. This study recruited 543 patients with chronic diseases, and 237 were included in the development and validation of the predictive model. A total of 57 frailty related indicators were analyzed, encompassing sociodemographic variables, health status, physical measurements, nutritional assessment, physical activity levels, and blood biomarkers. There were 100 cases (42.2%) presenting frailty symptoms. Multivariate logistic regression analysis revealed that gender, age, chronic diseases, Mini Nutritional Assessment score, and Clinical Frailty Scale score were predictive factors for frailty in chronic disease patients. Utilizing these factors, a nomogram model demonstrated good consistency and accuracy. The AUC values for the predictive model and validation set were 0.946 and 0.945, respectively. Calibration curves, ROC, and DCA indicated the nomogram had favorable predictive performance. Altogether, the comprehensive nomogram developed here is a promising and convenient tool for assessing frailty risk in patients with chronic diseases, aiding clinical practitioners in screening high-risk populations.

Hyponatremia, characterized by serum sodium <135 mEq/L, poses a significant health concern, particularly among the elderly. This case report explores chronic hyponatremia, with a focus on the Tea and Toast Syndrome, prevalent in individuals with atypical dietary habits. We present a 69-year-old female presenting with chronic hyponatremia, revealing dietary factors as key contributors. Thorough diagnostic workup ruled out common causes, emphasizing the importance of meticulous approaches. The patient's adherence to recommended dietary changes resulted in significant improvement, showcasing the pivotal role of targeted nutritional interventions. Pathogenetic mechanisms, such as reduced water-excretory capacity and solute excretion, were explored, with differentiation between AVP-mediated and non-AVP-mediated hyponatremia highlighted. The case underscores the intricate interplay between dietary habits, aging, and chronic hyponatremia, emphasizing the need for adjusted interventions in this vulnerable population. Addressing the nutritional aspects of chronic hyponatremia emerges as a crucial aspect, offering an opportunity for targeted management and improved patient care, especially in the aging demographic.