Advances in geriatric medicine and research最新文献

Aim: To assess the prevalence of older adults with AF and multimorbidity expressing a need for greater involvement in SDM for stroke prevention and associated patient characteristics.

Methods: A prospective cohort study (2016-2018) enrolled patients aged 65 years and older with AF from clinics in MA and Georgia. Participants with one or more chronic conditions were included in this study. To assess patient preferences for greater engagement in SDM, participants on oral anticoagulants were asked at the one-year follow-up if they would like to be more involved in deciding to take an anticoagulant and which oral anticoagulant to use for stroke prevention. Multivariable logistic regression analysis was used to identify patient characteristics associated with preference for more SDM engagement.

Results: Among participants (n = 532; mean age: 75 years; 48% women, 87% White), 41% had 1-4 chronic conditions, 40% had 5-7, and 19% had 8 or more. Approximately one-third expressed a preference for both engaging in SDM on anticoagulation initiation and choosing the type of anticoagulant for stroke prevention. After multivariable adjustment, participants who were younger (aged 65-74 years), women, non-White, had less than high school education, higher perceived burden from anticoagulation use, or had fewer comorbidities, were more likely to report the need for greater SDM engagement for stroke prevention.

Conclusions: Clinicians should recognize the specific needs of older patients with AF and multimorbidity that seek greater involvement in SDM for stroke prevention. Providing tailored interventions can enhance stroke prevention decision-making in this vulnerable population.

Background: Degenerative diseases such as Alzheimer's disease and dementia are significant health concerns among older adults in the United States, contributing substantially to the high incidence of falls in this population. This study aims to investigate the incidence and prevalence of falls among older adults diagnosed with Alzheimer's disease and dementia and explore the association between these conditions and the occurrence of traumatic brain injuries (TBIs).

Methods: A retrospective cohort study was conducted using data from 17,000 older adults aged 65 and above, arrived at the hospital with fall related injuries, obtained from the TriNetX network at Virginia Commonwealth University Health System (VCUHS) between January 1, 2019, and December 31, 2023. Data included demographic information, diagnosis codes (ICD-10), and details on falls, Alzheimer's disease, dementia, and TBIs. Descriptive statistics and logistic regression analyses were performed using TriNetX analytical tools.

Results: Older adults with Alzheimer's disease (incidence proportion: 3.11%, prevalence: 4.81%) and dementia (incidence proportion: 12.46%, prevalence: 17.06%) had a significantly higher incidence of falls compared to those without these conditions. Females showed a slightly higher incidence of falls than males. Logistic regression analysis indicated that patients with Alzheimer's disease had a reduced risk of TBIs (OR = 0.765, 95% CI: 0.588-0.996, p = 0.047), while those with unspecified dementia had an increased risk (OR = 1.161, 95% CI: 1.002-1.346, p = 0.047).

Conclusions: Our study reveals a higher risk of falls and traumatic brain injuries (TBIs) in older adults with dementia compared to those with Alzheimer's disease. These findings underscore the need for targeted fall prevention strategies and educational programs for caregivers.

Background: Falls are a primary cause of injuries and hospitalization in older adults. It has been reported that cognitive impairments and dementia can increase fall risk in the older population; however, it remains unknown if fall risk differs among subgroups of dementia. This meta-analysis summarized previous studies reporting the annual fall risk of people with Alzheimer's disease (AD) or mild cognitive impairment (MCI) and compared the fall risk between these two groups of people with dementia.

Methods: Thirty-five studies enrolling 7844 older adults with AD or MCI were included. The annual fall prevalence and average number of falls of the included studies were meta-analyzed and compared by random-effects models with inverse variance weights.

Results: The annual fall prevalence in people with AD (43.55%) was significantly higher than MCI (35.26%, p < 0.001). A χ² test indicated that the pooled fall prevalence is significantly higher in people with AD than MCI χ² = 158.403, p < 0.001). Additionally, the yearly average number of falls in AD was higher than in MCI (1.30 vs 0.77 falls/person).

Conclusions: The results showed that older people with AD experience a higher annual fall prevalence with a larger number of falls than older adults with MCI. The results suggested that the fall risk measurements should be reported separately between people with AD and MCI. The findings could provide preliminary guidance for the identification of individuals with dementia who experience a high fall risk.

Falls are a leading cause of morbidity and mortality in older adults, especially among nursing home residents. Falls occur more commonly among older adults with dementia than among those without dementia. Moreover, half of nursing home residents have moderate to severe cognitive impairment. While less than 5% of older adults live in nursing homes, they account for 20% of deaths from falls in this age group. In addition, 78% of older adults who fall need help in getting up from the floor. The consequences of falling, such as prolonged lying on the floor, can produce severe and prolonged health effects. The acute shortage of staff in nursing homes, especially during evening, night and weekend shifts, can delay the detection and response to falls. There are various systems designed to detect falls and alert staff, including those utilizing wearable devices, ambience sensors and cameras (vision) as well as fusion systems. They each have their advantages and drawbacks. In this NIA-funded SBIR grant, we are developing and testing the feasibility of a fall detection and prevention system that addresses the drawbacks of previous systems. We anchor our approach on the deployment of an autonomously navigating robot equipped with a mounted infrared camera and machine learning software designed to detect the risk of falls and falls themselves. The robot will patrol resident rooms during evening and night shifts and alert the staff, allowing them to evaluate the fall risk or fall alert presented by the robot video camera and determine whether indeed a resident has fallen or is at risk of falling, and take appropriate action.

Falls are the leading cause of injury, disability, and injury-related mortality in the older adult population. Older adults with Alzheimer disease (AD) are over twice as likely to experience a fall compared to cognitively normal older adults. Intrinsic and extrinsic fall risk factors may influence falls during symptomatic AD; intrinsic factors include changes in cognition and impaired functional mobility, and extrinsic factors include polypharmacy and environmental fall hazards. Despite many known fall risk factors, the high prevalence of falls, and the presence of effective fall prevention interventions for older adults without cognitive impairment, effective fall prevention interventions for older adults with AD to date are limited and inconclusive. Falls may precede AD-related cognitive impairment during the preclinical phase of AD, though a narrow understanding of fall risk factors and fall prevention interventions for older adults with preclinical AD limits clinical treatment of falls among cognitively normal older adults with preclinical AD. This mini review explores fall risk factors in symptomatic AD, evidence for effective fall prevention interventions in symptomatic AD, and preclinical AD as an avenue for future falls research, including recommendations for future research directions to improve our understanding of falls and fall risk during preclinical AD. Early detection and tailored interventions to address these functional changes are needed to reduce the risk of falls for those at risk for developing AD. Concerted efforts should be dedicated to understanding falls to inform precision fall prevention strategies for this population.

Sarcopenia, defined as a loss of muscle mass and function, is a physiologic factor that has been implicated as a predictor of adverse postoperative outcomes in many older adult populations. However, data related to sarcopenia in older adults with inflammatory bowel disease (IBD) remain limited. Older adults with IBD are particularly vulnerable to adverse postoperative outcomes, in part, due to muscle depletion from systemic inflammation, malnutrition, and reduced physical activity. However, few patients undergo routine muscle evaluation as a part of preoperative assessment. Moreover, cut-off values for measures of sarcopenia in the literature are modeled after non-IBD populations. The lack of standardized measures and values for sarcopenia in the IBD patient population has led to heterogenous findings and a paucity of preoperative risk stratification tools. Therefore, we aim to explore the scope of sarcopenia as a preoperative risk stratification tool among older adults with IBD.

Background: Falls among older adults significantly increase the risk of physical injuries, loss of independence, and social isolation, contributing to psychological conditions such as depression.

Objective: This study explores the association between falls and the risk of developing depression among older adults, comparing psychological outcomes between those with initial and recurrent falls. It also examines demographic factors such as age, sex, and race that may influence depression risk.

Methods: We retrospectively analyzed electronic health records from the TriNetX network at Virginia Commonwealth University Health System (VCUHS) during 2023. Older adults aged 65 to 89 were classified into two cohorts: initial falls (n = 2710) and recurrent falls (n = 1050). Statistical analyses, including risk ratios, survival analysis, and proportional hazards models, were used to evaluate associations between falls and depression risk.

Results: Recurrent fallers exhibited a higher prevalence of depression (25.7%) compared to initial fallers (16.6%), with a significant association (p < 0.000). Recurrent fallers were 48.8% more likely to develop depression (HR = 1.488). Among younger adults aged 65 to 69, females had a higher prevalence of depression than males (30.5% vs. 20.1%). Anxiety disorders tripled the risk of depression following falls (HR = 3.036).

Conclusions: Recurrent falls are significantly associated with an increased likelihood of depression among older adults, highlighting the need for comprehensive interventions. Preventing falls not only reduces the risk of physical injuries but also alleviates associated mental health challenges, including depression and other comorbidities such as postoperative cognitive decline and dementia. Tailored prevention strategies, such as balance training, cognitive therapy, and home safety modifications, can foster better recovery and enhance the quality of life for this vulnerable population.

Background: Assisted walking exercise programs are widely recommended in rehabilitation guidelines for stroke survivors. However, most evidence supporting these programs primarily focuses on ambulatory stroke survivors or those dependent ambulatory in acute and subacute stages. There is a notable gap in the application of walking exercise programs for chronic dependent ambulatory stroke survivors despite potential benefits in reducing sedentary behavior and improving rehabilitation outcomes. Thus, this literature review aims to summarize the existing evidence on the feasibility and efficacy of assisted walking exercise programs for chronic stroke survivors who are dependent ambulators.

Methods: Six major databases were searched for clinical trials related to assisted walking exercise and chronic dependent ambulatory stroke.

Results: Seven studies (evidence with low- to moderate-quality) involving 91 chronic dependent ambulatory stroke subjects are included in this review.

Conclusions: These studies indicated that assisted walking exercise is feasible to perform by chronic dependent ambulatory stroke survivors and can induce continued motor recovery and functional improvement. However, the mixed and limited evidence from existing research underscores the need for future high-quality randomized controlled trials with standardized designs and outcome measures to establish evidence-based walking programs for this population.

Estrogen receptor alpha (ERα) plays a crucial role in reproductive function in both sexes. It also mediates cellular responses to estrogens in multiple nonreproductive organ systems, many of which regulate systemic metabolic homeostasis and inflammatory processes in mammals. The loss of estrogens and/or ERα agonism during aging is associated with the emergence of several comorbid conditions, particularly in females undergoing the menopausal transition. Emerging data also suggests that male mammals likely benefit from ERα agonism if done in a way that circumvents feminizing characteristics. This has led us, and others, to speculate that tissue-specific ERα agonism may hold therapeutic potential for curtailing aging and chronic disease burden in males and females that are at high-risk of cancer and/or cardiovascular events with traditional estrogen replacement therapies. In this mini-review, we emphasize the role of ERα in the brain and liver, summarizing recent evidence that indicates these two organs systems mediate the beneficial effects of estrogens on metabolism and inflammation during aging. We also discuss how 17α-estradiol administration elicits health benefits in an ERα-dependent manner, which provides proof-of-concept that ERα may be a druggable target for attenuating aging and age-related disease burden.