American Journal of Geriatric Psychiatry最新文献

英文中文

Long-Term Impact of Delirium on the Risk of Dementia in Hospitalized Older Patients: A Real-World Multicenter Study 谵妄对住院老年患者痴呆风险的长期影响：一项真实世界多中心研究

IF 4.4 2区医学 Q1 GERIATRICS & GERONTOLOGY

American Journal of Geriatric Psychiatry

Pub Date : 2025-02-01 DOI: 10.1016/j.jagp.2024.08.004

Gyubeom Hwang M.D. , ChulHyoung Park M.D. , Sang Joon Son M.D., Ph.D. , Hyun Woong Roh M.D., Ph.D. , Jae Yeon Hwang M.D., Ph.D. , Jae-Won Jang M.D., Ph.D. , Young Tak Jo M.D., Ph.D. , Gihwan Byeon M.D. , HyunChul Youn M.D., Ph.D. , Rae Woong Park M.D., Ph.D.

Background

The association between delirium and dementia has been suggested, but mostly in the postoperative setting. This study aims to explore this relationship in a broader inpatient population, leveraging extensive real-world data to provide a more generalized understanding.

Methods

In this retrospective cohort study, electronic health records of 11,970,475 hospitalized patients aged over 60 from nine institutions in South Korea were analyzed. Patients with and without delirium were identified, and propensity score matching (PSM) was used to create comparable groups. A 10-year longitudinal analysis was conducted using the Cox proportional hazards model, which calculated the hazard ratio (HR) and 95% confidence interval (CI). Additionally, a meta-analysis was performed, aggregating results from all nine medical institutions. Lastly, we conducted various subgroup and sensitivity analyses to demonstrate the consistency of our study results across diverse conditions.

Results

After 1:1 PSM, a total of 47,306 patients were matched in both the delirium and nondelirium groups. Both groups had a median age group of 75–79 years, with 43.1% being female. The delirium group showed a significantly higher risk of all dementia compared with the nondelirium group (HR: 2.70 [95% CI: 2.27–3.20]). The incidence risk for different types of dementia was also notably higher in the delirium group (all dementia or mild cognitive impairment, HR: 2.46 [95% CI: 2.10–2.88]; Alzheimer's disease, HR: 2.74 [95% CI: 2.40–3.13]; vascular dementia, HR: 2.55 [95% CI: 2.07–3.13]). This pattern was consistent across all subgroup and sensitivity analyses.

Conclusions

Delirium significantly increases the risk of onset for all types of dementia. These findings highlight the importance of early detection of delirium and prompt intervention. Further research studies are warranted to investigate the mechanisms linking delirium and dementia.

背景：谵妄与痴呆之间的关系已被提出，但主要是在术后环境中。本研究旨在利用广泛的真实世界数据，在更广泛的住院人群中探讨这种关系，以提供更普遍的认识：在这项回顾性队列研究中，分析了韩国九家医疗机构的 11970475 名 60 岁以上住院患者的电子健康记录。确定了有谵妄和无谵妄的患者，并使用倾向得分匹配法（PSM）创建了可比组别。采用考克斯比例危险模型进行了为期10年的纵向分析，计算出了危险比（HR）和95%置信区间（CI）。此外，我们还进行了一项荟萃分析，汇总了所有九家医疗机构的结果。最后，我们还进行了各种亚组和敏感性分析，以证明我们的研究结果在不同情况下的一致性：经过 1:1 PSM，谵妄组和非谵妄组共匹配了 47,306 名患者。两组患者的年龄中位数均为 75-79 岁，女性占 43.1%。与非谵妄组相比，谵妄组患所有痴呆症的风险明显更高（HR：2.70 [95% CI：2.27-3.20]）。不同类型痴呆的发病风险在谵妄组也明显较高（所有痴呆或轻度认知障碍，HR：2.46 [95% CI：2.10-2.88]；阿尔茨海默病，HR：2.74 [95% CI：2.40-3.13]；血管性痴呆，HR：2.55 [95% CI：2.07-3.13]）。这一模式在所有亚组和敏感性分析中都是一致的：结论：谵妄会大大增加所有类型痴呆症的发病风险。这些发现强调了早期发现谵妄和及时干预的重要性。有必要开展进一步研究，探讨谵妄与痴呆症之间的关联机制。

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引用次数: 0

How should Null Findings be Interpreted? 如何解读无效结论？

IF 4.4 2区医学 Q1 GERIATRICS & GERONTOLOGY

American Journal of Geriatric Psychiatry

Pub Date : 2025-02-01 DOI: 10.1016/j.jagp.2024.08.006

Jeannie-Marie Leoutsakos Ph.D.

引用次数: 0

Navigating the Last Leg of the Sail 航行最后一段航程。

IF 4.4 2区医学 Q1 GERIATRICS & GERONTOLOGY

American Journal of Geriatric Psychiatry

Pub Date : 2025-02-01 DOI: 10.1016/j.jagp.2024.11.004

George S. Alexopoulos M.D.

引用次数: 0

Commentary: “How should Null Findings be Interpreted?” 评论："如何解读无效结论？

IF 4.4 2区医学 Q1 GERIATRICS & GERONTOLOGY

American Journal of Geriatric Psychiatry

Pub Date : 2025-02-01 DOI: 10.1016/j.jagp.2024.09.004

Charles South Ph.D. , Stephan Arndt Ph.D.

引用次数: 0

Delirium and dementia: Two of a kind? 谵妄和痴呆：同类？评论：谵妄对住院老年患者痴呆风险的长期影响：真实世界多中心研究 Gyubeom hwang，医学博士 ChulHyoung Park，医学博士 Rae Woong Park Sang Joon Son，医学博士 Hyun Woong Roh，医学博士 Jae Yeon Hwang，医学博士 Jae-Won Jang，医学博士 Young Tak, Jo，医学博士 Gihwan Byeon，医学博士 HyunChul Youn，医学博士。美国老年精神病学杂志》。

IF 4.4 2区医学 Q1 GERIATRICS & GERONTOLOGY

American Journal of Geriatric Psychiatry

Pub Date : 2025-02-01 DOI: 10.1016/j.jagp.2024.08.007

Aartjan TF Beekman M.D., Ph.D.

引用次数: 0

Association of Cognitive Frailty With Subsequent All-Cause Mortality Among Middle-Aged and Older Adults in 17 Countries 17 个国家的中老年人认知能力衰弱与后续全因死亡率的关系。

IF 4.4 2区医学 Q1 GERIATRICS & GERONTOLOGY

American Journal of Geriatric Psychiatry

Pub Date : 2025-02-01 DOI: 10.1016/j.jagp.2024.08.009

Yemin Yuan Ph.D. , Huaxin Si Ph.D. , Zhenyu Shi Ph.D. , Yanshang Wang Ph.D. , Yiqi Xia Ph.D. , Xiaolong Guan Ph.D. , Ping He Ph.D.

Objectives

Cognitive frailty refers to the co-occurrence of cognitive impairment and frailty without concurrent Alzheimer's disease or dementia. Studies of cognitive frailty and mortality have been limited to single country or older people. However, frailty and cognitive decline may occur much earlier. We aimed to examine the association between different cognitive frailty status and subsequent all-cause mortality among middle-aged and older people in 17 countries.

Methods

Participants aged 50 and over were drawn from six prospective cohorts of aging. We classified participants according to their cognitive impairment and frailty status into the following groups: none, only cognitive impairment, only frailty and cognitive frailty. Competing-risks regression models were used to evaluate the association of different cognitive frailty status at baseline with subsequent all-cause mortality.

Results

The cognitive frailty group had a higher mortality risk compared to those without cognitive impairment and frailty groups. Meta-analysis results showed participants with cognitive frailty (pooled subhazard ratio [SHR] = 2.34, 95% confidence interval [CI]: 2.01–2.72, I² = 68.0%) had a higher mortality risk compared with those with only cognitive impairment status (pooled SHR = 1.36, 95% CI: 1.25–1.48, I² = 3.0%) or only frailty status (pooled SHR = 1.83, 95% CI: 1.72–1.95, I² = 31.0%). The association between cognitive frailty and mortality were stronger among those who were aged 70 years and older, males, single and nonconsumers of alcohol.

Conclusions

Cognitive frailty, frailty or cognitive impairment alone, is associated with an increased risk of all-cause mortality in Asian, European and American countries. Physical and cognitive function screening should be conducted as early as possible in middle-aged and older people, and targeted intervention approaches should be developed to reduce the incidence of adverse health outcomes.

目的：认知虚弱指的是在没有并发阿尔茨海默病或痴呆症的情况下同时出现认知障碍和虚弱。有关认知虚弱和死亡率的研究仅限于单一国家或老年人。然而，虚弱和认知衰退可能发生得更早。我们旨在研究 17 个国家的中老年人不同的认知虚弱状况与随后的全因死亡率之间的关系：我们从六个老龄化前瞻性队列中抽取了 50 岁及以上的参与者。我们根据参与者的认知障碍和虚弱状态将其分为以下几组：无、仅认知障碍、仅虚弱和认知虚弱。我们使用竞争风险回归模型来评估不同基线认知虚弱状态与后续全因死亡率的关系：结果：与无认知障碍组和认知虚弱组相比，认知虚弱组的死亡风险更高。元分析结果显示，与仅有认知功能障碍状态（汇总子危险比 [SHR] = 1.36，95% 置信区间 [CI]：1.25-1.48，I2 = 3.0%）或仅有虚弱状态（汇总子危险比 [SHR] = 1.83，95% 置信区间 [CI]：1.72-1.95，I2 = 31.0%）的参与者相比，认知功能虚弱参与者的死亡风险更高（汇总子危险比 [SHR] = 2.34，95% 置信区间 [CI]：2.01-2.72，I2 = 68.0%）。认知虚弱与死亡率之间的关系在 70 岁及以上、男性、单身和不饮酒者中更为密切：结论：在亚洲、欧洲和美洲国家，认知虚弱、虚弱或认知障碍与全因死亡风险增加有关。应尽早对中老年人进行身体和认知功能筛查，并制定有针对性的干预方法，以降低不良健康后果的发生率。

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引用次数: 0

Responding to the Growing Need for Medical Experts in Testamentary and Estate Related Capacities: A Course for Physicians 应对在遗嘱和遗产相关能力方面对医学专家日益增长的需求：医生课程。

IF 4.4 2区医学 Q1 GERIATRICS & GERONTOLOGY

American Journal of Geriatric Psychiatry

Pub Date : 2025-02-01 DOI: 10.1016/j.jagp.2024.08.013

J. Kirkham M.D., M.Sc. , S.B. Mitchell M.D., MPH , C. Cohen M.D. , C. Hao M.Sc. , K. Shulman M.D., S.M.

Objectives

The objective of this continuing medical education course was to improve the knowledge and skills of physicians in the assessment of testamentary and related capacities.

Methods

We developed, conducted, and evaluated an accredited medical education course focusing on the role and responsibilities of medical experts in estate litigation and held in Toronto, Ontario, Canada in June 2022.

Results

Participants reported a 65% and 35% improvement in confidence in conducting retrospective and contemporaneous assessments of testamentary capacity, respectively. The overall mean score in the 9 key competencies for medical experts in estate litigation improved by 1.2-points from 3.02 (SD 1.33) to 4.22 (SD 0.74) from pre to postcourse (p <0.05, 95% CI [−1.66, −0.67]).

Conclusions

This course addresses a significant gap in training and formal education opportunities in testamentary and other related capacities that may contribute to increasing the pool of available and qualified medical experts in estate litigation.

目的本继续医学教育课程旨在提高医生在评估遗嘱能力和相关能力方面的知识和技能：我们于 2022 年 6 月在加拿大安大略省多伦多市开发、实施并评估了一个经认可的医学教育课程，该课程侧重于医学专家在遗产诉讼中的角色和责任：参加者表示，在对遗嘱能力进行回顾性评估和同期评估时，信心分别提高了65%和35%。从课程前到课程后，遗产诉讼中医学专家 9 项关键能力的总平均分从 3.02（标准差 1.33）提高到 4.22（标准差 0.74），提高了 1.2 分（P 结论：该课程解决了培训领域的重大空白：本课程弥补了遗嘱及其他相关能力培训和正规教育机会方面的重大空白，有助于增加遗产诉讼中可用的合格医学专家的数量。

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引用次数: 0

Forever The Wind 永远的风

IF 4.4 2区医学 Q1 GERIATRICS & GERONTOLOGY

American Journal of Geriatric Psychiatry

Pub Date : 2025-02-01 DOI: 10.1016/j.jagp.2024.11.005

Mark Steven Aster

引用次数: 0

Discontinuing the Term “Stakeholder” From the NIA IMPACT Collaboratory Engaging Partners Team: An Example of the Process of Language Change in an Organization 从 NIA IMPACT 协作参与伙伴团队中取消 "利益相关者 "一词：一个组织语言变化过程的实例。

IF 4.4 2区医学 Q1 GERIATRICS & GERONTOLOGY

American Journal of Geriatric Psychiatry

Pub Date : 2025-02-01 DOI: 10.1016/j.jagp.2024.08.016

Evan Plys Ph.D. , Karen O. Moss Ph.D. , Kristen Jacklin Ph.D. , Molita Yazzie M.S. , Ellen Tambor M.A. , Erin Luers M.S. , Linda Elam Ph.D. , Nina Ahmad B.S. , Zachary J. Kunicki Ph.D. , Carolyn Malone M.P.H. , Gary Epstein-Lubow M.D.

In this paper, we describe our process of changing language of the National Institute on Aging Imbedded Pragmatic Alzheimer's disease and AD-related dementias Clinical Trials Collaboratory (NIA IMPACT Collaboratory) “Stakeholder Engagement Team” to “Engaging Partners Team” in response to feedback from community partners regarding the problematic connotations of the term “stakeholder.” We present a brief history of the term “stakeholder” and its use in clinical and community-engaged research. Then, we summarize critiques of this term, including its colonial history and potential to reinforce complacency with generational traumas, particularly among Indigenous peoples and communities. We conclude with a detailed overview of our team and organization's multi-step process to discontinue use of the term “stakeholder,” in alignment with a theoretical model of organizational behavior change. This paper highlights the importance of critically evaluating language and responding to community partners. We hope our process can guide other researchers and organizations.

在本文中，我们介绍了美国国家老龄化研究所嵌入式实用阿尔茨海默病和与阿尔茨海默病相关的痴呆症临床试验协作组（NIA IMPACT Collaboratory）将 "利益相关者参与团队 "改为 "参与合作伙伴团队 "的过程，以回应社区合作伙伴对 "利益相关者 "一词存在问题内涵的反馈意见。我们简要介绍了 "利益相关者 "一词的历史及其在临床和社区参与式研究中的使用。然后，我们总结了对这一术语的批评，包括其殖民历史以及对世代创伤的自满情绪，特别是在土著人民和社区中。最后，我们详细概述了我们团队和组织为停止使用 "利益相关者 "一词而采取的多步骤过程，该过程与组织行为改变的理论模型相一致。本文强调了批判性评估语言和回应社区合作伙伴的重要性。我们希望我们的过程能够为其他研究人员和组织提供指导。

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引用次数: 0

Life Fatigue: A Critical Analysis 生命疲劳：批判性分析》。

IF 4.4 2区医学 Q1 GERIATRICS & GERONTOLOGY

American Journal of Geriatric Psychiatry

Pub Date : 2025-02-01 DOI: 10.1016/j.jagp.2024.08.002

Margarita Bofarull MD, MA , Montse Esquerda MD, PhD , David Lorenzo PhD , Francesc Torralba PhD , Victoria Cusi PhD , José Antonio Suffo PhD , Juan Maria Velasco PhD , Jacinto Bátiz MD, PhD , Miguel Martin MA , Javier de la Torre PhD , Francisco José Cambra MD, PhD , Joan Bertran MD, PhD

Introduction

In recent years, euthanasia has been decriminalized or legalized in several countries. The debate on whether to legalize such a practice is open in many places and is a topic that arouses great controversy. Euthanasia has been presented as a response to situations of advanced, incurable, or irreversible disease, or situations that cause intolerable suffering to the person. However, in recent years, the claim has been asserted that this practice does not have to be associated with such situations. It may happen that a person wants to die and asks for help to do so, even if they are not in a specific clinical situation (pathology or condition) but are experiencing advanced age or present ‘vital fatigue’.

Aim

The objective of this article is to critically analyse the concept ‘vital fatigue’: define its meaning, its characteristics, its causes, and its consequences in the debate around euthanasia. To do this, a critical review of the main discussions and arguments present in the literature is made.

Conclusions

It is concluded that vital fatigue can be understood as a product or manifestation of an individualistic and productivistic vision of the human being, in which its relational nature and intrinsic value remain in the background. The loss of the meaning of life also influences him. Therefore, in the face of this phenomenon, the most guaranteeing and ethical option is –we believe–accompaniment and holistic care of the person that allows the causal factors to be modulated, without the need to resort to euthanasia.

导言：近年来，安乐死在一些国家已经非刑罪化或合法化。许多地方都在争论是否应将安乐死合法化，这也是一个引起巨大争议的话题。安乐死一直被认为是对晚期、无法治愈或不可逆转的疾病，或对人造成无法忍受的痛苦的一种回应。然而，近年来有人声称，这种做法不一定与这些情况有关。目的：本文旨在批判性地分析 "生命疲劳 "这一概念：界定其含义、特征、原因及其在安乐死辩论中的后果。为此，文章对文献中的主要讨论和论点进行了批判性回顾：结论：生命疲劳可被理解为个人主义和生产主义人类观的产物或表现，其关系性质和内在价值仍处于次要地位。生命意义的丧失也影响着他。因此，面对这种现象，最有保障和最符合伦理道德的选择是--我们认为--对人的陪护和整体护理，这样可以调节致病因素，而不必诉诸安乐死。

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