Aging and health research最新文献_第3页

Increased white matter hyperintensities on MRI in autosomal dominant familial compared to sporadic Alzheimer’s disease 常染色体显性家族性阿尔茨海默病与散发性阿尔茨海默病相比，MRI上白质高强度增加

IF 2

Aging and health research

Pub Date : 2025-07-18 DOI: 10.1016/j.ahr.2025.100255

Alice Accorroni , Maggie R Fraser , Phoebe Walsh , Antoinette O’Connor , M Jorge Cardoso , Llwyd Prosser , Nick C Fox , Carole H Sudre , Natalie S Ryan

Background

White matter hyperintensities (WMH) on MRI may be observed in autosomal dominant familial Alzheimer’s disease (FAD) and sporadic AD (SAD), however, studies comparing WMH burden between these two groups are lacking.

Methods

In this cross-sectional study, we evaluated global and local differences in WMH severity on MRI in 19 individuals with symptomatic FAD due to Presenilin 1 mutations, 20 individuals with young-onset SAD and 19 healthy individuals, controlling for age, cerebrovascular risk factors (CVR) and APOEε4 carrier status. Relationships between WMH, grey matter (GM) volumes and neuropsychological tests (NPT) were also investigated.

Results

Despite their young age and minimal CVR, the FAD group had higher WMH load in all areas considered, apart from juxta-cortical and periventricular layers when compared to the SAD group. The increased lobar WMH load observed in FAD was not influenced by APOEε4 genotype or CVR. No significant associations were found between WMH and GM volumes or NPT in either AD group.

Conclusions

Our findings suggest that WMH may reflect aspects of AD pathology that are particularly prominent in FAD. Notably, in our study, WMH were not simply attributable to CVR, APOEε4 carrier status, or GM atrophy, but may instead represent independent features of the disease.

背景在常染色体显性家族性阿尔茨海默病（FAD）和散发性阿尔茨海默病（SAD）中可以观察到MRI上的白质高强度（WMH），然而，比较这两组之间白质高强度负担的研究缺乏。方法在本横断面研究中，我们在控制年龄、脑血管危险因素（CVR）和APOEε4携带者状态的情况下，评估了19例早老素1突变引起的有症状性FAD患者、20例年轻发病SAD患者和19例健康人的MRI WMH严重程度的全球和局部差异。WMH、灰质（GM）体积与神经心理测试（NPT）之间的关系也进行了研究。结果：与SAD组相比，FAD组尽管年龄小，CVR最小，但除了皮质旁和心室周围层外，所有考虑的区域的WMH负荷都更高。在FAD中观察到的大叶WMH负荷增加不受APOEε4基因型或CVR的影响。在任何AD组中，WMH与GM体积或NPT之间均未发现显著关联。结论WMH可能反映了AD病理的某些方面，这些方面在FAD中尤为突出。值得注意的是，在我们的研究中，WMH不是简单地归因于CVR、APOEε4载体状态或GM萎缩，而是可能代表疾病的独立特征。

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引用次数: 0

Practical approaches to lifestyle interventions for enhancing brain health in older adults: A selective narrative review 生活方式干预增强老年人大脑健康的实用方法：选择性叙述回顾

Aging and health research

Pub Date : 2025-07-17 DOI: 10.1016/j.ahr.2025.100258

Raymond L Ownby , Joshua Caballero

Background

As the prevalence of Alzheimer’s disease and other dementias increases worldwide, it is increasingly important to help middle-aged and older adults develop brain health lifestyles.

Method

We conducted a selective review of studies on the use of shared decision-making, psychoeducation, and behavior change techniques to promote healthy behaviors in adults. We then synthesized results into a model that can be implemented in clinical practice to promote brain healthy lifestyles.

Results

Selected research supports the usefulness of these techniques in promoting health behaviors. The integrative model allows us to generate specific hypotheses about implementation strategies, testing of which could help in the development of a practical intervention.

Conclusions

Shared decision-making, psychoeducation, and behavior change techniques each could provide valuable support for individuals’ efforts at developing brain health lifestyles. The integrative model proposed here may be useful in generating specific hypotheses that can be tested in the process of developing an intervention that could be clinically implemented.

随着阿尔茨海默病和其他痴呆症在世界范围内的患病率上升，帮助中老年人培养大脑健康的生活方式变得越来越重要。方法我们对使用共同决策、心理教育和行为改变技术促进成人健康行为的研究进行了选择性回顾。然后，我们将结果综合到一个可以在临床实践中实施的模型中，以促进大脑健康的生活方式。结果选定的研究支持这些技术在促进健康行为方面的有用性。综合模型使我们能够产生关于实施策略的具体假设，对其进行测试可以帮助制定实际干预措施。结论：共同决策、心理教育和行为改变技术都可以为个人努力发展大脑健康的生活方式提供有价值的支持。这里提出的综合模型可能有助于产生特定的假设，这些假设可以在开发可临床实施的干预措施的过程中进行测试。

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引用次数: 0

Polypharmacy and deprescribing among geriatric patients 老年患者的综合用药和处方化

Aging and health research

Pub Date : 2025-07-17 DOI: 10.1016/j.ahr.2025.100256

Nokwanda Nhlanzeko Ngcobo

Background

Polypharmacy is increasingly common among middle-aged and geriatric patients, raising concerns about overprescribing, adverse outcomes, and healthcare costs. While appropriate polypharmacy can improve clinical outcomes when tailored to individual needs, inappropriate use heightens risks such as adverse drug reactions, falls, frailty, non-adherence, and increased mortality.

Methods

This review synthesises current literature examining the impact of polypharmacy in older adults. It highlights evidence-based strategies aimed at promoting appropriate prescribing practices and mitigating the risks associated with multiple medication use.

Results

Evidence indicates that polypharmacy in the aging population contributes to treatment non-adherence, higher incidence of adverse events, and increased healthcare expenditures. The risk of harm escalates with the number of prescribed medications and underlying comorbidities. Interventions such as medication reviews, clinician education, patient counselling, deprescribing protocols, and adherence support have shown promise in reducing medication-related harm.

Conclusion

Addressing polypharmacy requires a multifaceted approach, including raising clinician awareness, promoting rational prescribing, and implementing patient-centred interventions. Emphasising appropriate polypharmacy and deprescribing can significantly reduce adverse outcomes and improve overall quality of care in geriatric populations.

多种用药在中老年患者中越来越普遍，这引起了人们对过度用药、不良后果和医疗费用的担忧。虽然适当的多种用药可以根据个人需要改善临床结果，但不当使用会增加药物不良反应、跌倒、虚弱、不依从性和死亡率增加等风险。方法本综述综合了目前研究多种药物对老年人影响的文献。它强调以证据为基础的战略，旨在促进适当的处方做法和减轻与多种药物使用相关的风险。结果有证据表明，老年人群中使用多种药物会导致治疗不依从、不良事件发生率升高和医疗支出增加。危害的风险随着处方药物和潜在合并症的数量而增加。诸如药物审查、临床医生教育、患者咨询、处方解除方案和依从性支持等干预措施在减少药物相关危害方面显示出希望。结论解决多重用药问题需要采取多方面的措施，包括提高临床医生的认识，促进合理处方，实施以患者为中心的干预措施。强调适当的综合用药和处方化可以显著减少不良后果，提高老年人群的整体护理质量。

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引用次数: 0

Addressing disparities in caregiver training for dementia in the philippines and beyond 解决菲律宾及其他国家在痴呆症护理人员培训方面的差异

Aging and health research

Pub Date : 2025-07-16 DOI: 10.1016/j.ahr.2025.100257

John Patrick C. Toledo

引用次数: 0

Health security across the spectrum: Exploring the impact of socioeconomic factors on health insurance uptake in India 全面的卫生安全：探索社会经济因素对印度医疗保险吸收的影响

Aging and health research

Pub Date : 2025-06-27 DOI: 10.1016/j.ahr.2025.100244

Madhubrota Chatterjee , Alok Aditya , Prashant Kumar Choudhary

Background

To ensure that healthcare services are accessible, health insurance is receiving increased amounts of attention in debates among health experts. The current disease pattern has increased the need for people to rely on intensive care, increasing both the cost of treatment and the frequency of accessing healthcare facilities. This paper aimed to examine the demographic, socio-economic, and health-related determinants of the choice to be insured with various types of health insurance schemes among older people in India.

Methods

We used data from the Longitudinal Ageing Study in India (LASI) Wave-1, 2017–2018, comprising individuals aged 45 years and above. Multinomial Logistic Regression was employed to examine the association between the socio-demographic, socio-economic, and health status of respondents and their choice of opting for different types of health insurance.

Results

The findings revealed that adults with multimorbid conditions were more likely to choose private insurance (RRR = 1.477, p < 0.01), while those currently working showed a higher preference for employer-based coverage (RRR = 2.184, p < 0.01). Individuals from poorer households were more inclined towards government insurance (RRR = 1.565, p < 0.01). Furthermore, higher education and urban residence increased the likelihood of employer and private insurance, while caste and regional differences reflected disparities in access and preference.

Conclusion

The findings indicated that health and economic conditions play a central role in shaping health insurance choices in India. It highlighted the importance of responsive and inclusive health policies that must address both medical needs and financial vulnerability in the ageing population.

背景：为了确保保健服务的可及性，健康保险在卫生专家的辩论中受到越来越多的关注。目前的疾病模式增加了人们对重症监护的依赖，增加了治疗费用和前往卫生保健设施的频率。本文旨在研究印度老年人选择参加各种类型的健康保险计划的人口、社会经济和健康相关决定因素。方法：我们使用了2017-2018年印度纵向老龄化研究（LASI） Wave-1的数据，包括45岁及以上的个体。采用多项逻辑回归来检验社会人口统计学、社会经济和健康状况与受访者选择不同类型健康保险之间的关系。结果调查结果显示，患有多种疾病的成年人更倾向于选择私人保险(rr = 1.477, p <；0.01)，而在职人士更倾向于以雇主为基础的保险(rr = 2.184, p <；0.01)。贫困家庭的个体更倾向于政府保险(rr = 1.565, p <；0.01)。此外，高等教育和城市居住增加了雇主和私人保险的可能性，而种姓和地区差异反映了获得和偏好的差异。结论研究结果表明，健康和经济条件在印度健康保险选择中起着核心作用。它强调了必须同时解决老龄化人口的医疗需求和财务脆弱性的响应性和包容性卫生政策的重要性。

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引用次数: 0

The effect of education and work on functional limitations in later life in cohorts affected by the Cultural Revolution and economic reform 教育和工作对受文化大革命和经济改革影响的人群晚年功能限制的影响

Aging and health research

Pub Date : 2025-06-26 DOI: 10.1016/j.ahr.2025.100243

Chengming Han

Background

This study examines the moderation effect of work on education level in terms of functional limitations across different People’s Republic of China (PRC) cohorts born around 1949, who experienced the Cultural Revolution and economic reform.

Methods

Data were obtained from the China Health and Retirement Longitudinal Study (CHARLS). Multilevel Tobit regression models were used to analyze the effects of education and work on functional limitations from 2011 to 2018 across cohorts. The interaction effects of education and work were used to examine how work moderates the effect of education level on functional limitations.

Results

Interrupted education during the Cultural Revolution decreased the proportion of PRC cohort members receiving college education. The protective effects of education were found only among those with rural jobs. In the late-PRC cohort, higher returns to education after the economic reform in China were associated with the effect of higher education level on functional limitations.

Conclusion

The Cultural Revolution and Economic Reform shaped the education and work for cohorts, which in turn, impact the functional limitations in later life.

本研究考察了1949年前后出生、经历了文化大革命和经济改革的不同中华人民共和国（PRC）人群，在功能限制方面，工作对教育水平的调节作用。方法数据来源于中国健康与退休纵向研究（CHARLS）。采用多水平Tobit回归模型分析2011 - 2018年教育和工作对人群功能限制的影响。研究采用教育与工作的交互效应来考察工作如何调节教育水平对功能限制的影响。结果文化大革命期间中断的教育减少了中国同代人接受大学教育的比例。教育的保护作用只在有农村工作的人中被发现。在中华人民共和国后期队列中，中国经济改革后较高的教育回报与高等教育水平对功能限制的影响相关。结论文革和经济改革塑造了人群的教育和工作，进而影响了老年人的生活功能限制。

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引用次数: 0

Neighborhood physical environment satisfaction and aging attitudes in older Chinese adults: Differences by chronic condition status 中国老年人邻里自然环境满意度与老龄态度：慢性病状态的差异

Aging and health research

Pub Date : 2025-05-30 DOI: 10.1016/j.ahr.2025.100241

Zhijing Xu , Dan Zhao , Weiyu Mao , Jing Wang , Zhongfang Yang , Yaguang Zheng , Bei Wu

Background

With China’s aging population and rising prevalence of chronic conditions, it is crucial to understand the factors shaping aging attitudes. Satisfaction with the neighborhood physical environment may play an important role, particularly among those with chronic health issues. To examine the association between neighborhood physical environment satisfaction and aging attitudes among older Chinese adults, and to explore differences across groups with and without chronic conditions.

Methods

We analyzed data from 11,395 participants aged 60 and above from the 2020 China Longitudinal Aging Social Survey (CLASS). Stratified multiple regression analyses were conducted, comparing subgroups with chronic conditions (n = 8405, 73.76 %) and without chronic conditions.

Results

Among participants with chronic conditions, higher satisfaction with road conditions (β = 0.382, P = 0.001), environmental sanitation (β = 0.286, P = 0.007), and road/street lighting (β = 0.288, P = 0.005) was significantly associated with more positive attitudes toward aging. No significant associations were found among participants without chronic conditions.

Conclusions

Age-friendly neighborhood environments are important for promoting positive aging attitudes, particularly among older adults living with chronic conditions. These findings offer valuable insights for policymakers, researchers, and service providers aiming to support healthy aging in rapidly aging societies like China.

随着中国人口老龄化和慢性病患病率的上升，了解影响老龄化态度的因素至关重要。对社区自然环境的满意度可能起着重要作用，尤其是那些有慢性健康问题的人。研究中国老年人社区自然环境满意度与老龄化态度之间的关系，并探讨有无慢性疾病群体之间的差异。方法我们分析了2020年中国老龄化社会纵向调查（CLASS）中11395名60岁及以上的参与者的数据。进行分层多元回归分析，比较有慢性疾病亚组（n = 8405, 73.76%）和无慢性疾病亚组。结果慢性疾病被调查者对道路状况（β = 0.382, P = 0.001）、环境卫生（β = 0.286, P = 0.007）和道路/街道照明（β = 0.288, P = 0.005）的满意度与对衰老的积极态度显著相关。在没有慢性疾病的参与者中没有发现显著的关联。结论老年人友好型社区环境对促进老年人积极的老龄化态度具有重要意义，特别是对慢性病老年人。这些发现为政策制定者、研究人员和服务提供者提供了有价值的见解，旨在支持中国等快速老龄化社会的健康老龄化。

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引用次数: 0

The association between adverse childhood experiences and frailty among middle-aged and older adults in Rural South Africa 不良童年经历与南非农村中老年人身体虚弱之间的关系

Aging and health research

Pub Date : 2025-05-29 DOI: 10.1016/j.ahr.2025.100242

Shengruo Zhang , Markus J. Haapanen , Mengyao Wang , Hao Xiang , Hanzhang Xu , Chenkai Wu

Background

Adverse childhood experiences (ACEs) negatively impact later physical and mental health. However, evidence is lacking in low- and middle-income countries. We examined the association between ACEs and frailty among middle-aged and older adults in rural South Africa.

Methods

We included 3825 respondents aged ≥40 years who participated in the survey, Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in rural South Africa (HAALSI). We included four ACEs: (1) parental unemployment for >6 months, (2) parents who argued or fought often, (3) parents who drank, did drugs, or had mental health problems, and (4) parental physical abuse. Frailty was measured by the Fried’s frailty phenotype approach using five criteria: slowness, weakness, exhaustion, inactivity, and shrinking. We assessed the independent association between each ACE and frailty using multinomial logistic regression.

Results

Having experienced parents arguing or fighting often was significantly associated with frailty (prevalence ratio [PR]=1.62, 95 %CI: 1.06–2.48). After adjusting for age and sex, we found a positive association between parents unemployed for 6 or more months and frailty (PR=1.48, 95 %CI: 1.00–2.19). People having two or more ACEs were positively associated with frailty in the unadjusted (PR=1.63, 95 %CI: 1.07–2.47) and adjusted models (PR=1.60, 95 %CI: 1.05–2.45) relative to those having only one ACE.

Conclusions

ACEs were associated with a higher burden of frailty among middle-aged and older adults in rural South Africa. Future studies utilizing individual-centered statistical techniques such as cluster analysis and latent class analysis might be considered to offer a more in-depth understanding of the relationships between ACEs and frailty.

童年不良经历会对以后的身心健康产生负面影响。然而，低收入和中等收入国家缺乏相关证据。我们研究了南非农村中老年人ace与虚弱之间的关系。方法我们纳入3825名年龄≥40岁的受访者，他们参加了“非洲健康与老龄化：南非农村一个INDEPTH社区（HAALSI）的纵向研究”调查。我们纳入了四种ace:(1)父母失业6个月；(2)父母经常争吵或打架；(3)父母酗酒、吸毒或有精神健康问题；(4)父母身体虐待。虚弱是通过弗里德虚弱表型方法测量的，使用五个标准：缓慢，虚弱，疲惫，不活动和萎缩。我们使用多项逻辑回归评估每个ACE和虚弱之间的独立关联。结果父母经常争吵或打架与身体虚弱有显著相关性（患病率[PR]=1.62, 95% CI: 1.06 ~ 2.48）。在调整了年龄和性别后，我们发现父母失业6个月或更长时间与身体虚弱呈正相关（PR=1.48, 95% CI: 1.00-2.19）。在未调整模型（PR=1.63, 95% CI: 1.07-2.47）和调整模型（PR=1.60, 95% CI: 1.05-2.45）中，与仅有一次ACE的人相比，有两次或两次以上ACE的人与虚弱呈正相关。结论：saces与南非农村中老年人较高的虚弱负担相关。未来的研究可以利用以个人为中心的统计技术，如聚类分析和潜在类分析，以更深入地了解ace与脆弱性之间的关系。

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引用次数: 0

Impact of regional inequalities in long-term care on health spending: evidence from dementia patients in France 长期护理方面的地区不平等对卫生支出的影响：来自法国痴呆症患者的证据

Aging and health research

Pub Date : 2025-05-28 DOI: 10.1016/j.ahr.2025.100239

Anne Penneau , Zeynep Or

Background

Unmet need for long-term care (LTC) could be associated with higher health care utilization and medical spending. In France funding of LTC is decentralised and there are significant disparities in accessibility of LTC. We analyse the impact of geographical variations in LTC funding and supply on healthcare expenditure focusing on dementia patients.

Methods

Healthcare spending of individuals is calculated from a national linked claims database. We run multilevel models exploiting the variations in spending across two geographical levels (residential areas nested in local authorities (LA)) to estimate the impact of local LTC supply and funding on health spending of patients with dementia. We estimated the generosity of LTC funding at LA with a stochastic frontier model and developed a taxonomy of LTC supply.

Results

Dementia patients living in LAs with most generous LTC funding have significantly lower acute (-11 %) and post-acute (-35 %) hospital spending while they have higher (+17 %) primary care spending. Moreover, people in areas with the highest LTC supply spend 3 % less on hospital care per year and per person compared to those in underserved areas.

Conclusions

Our results suggest that better accessibility of LTC with better funding and LTC supply can reduce hospital spending and improve overall health system efficiency.

长期护理需求低可能与较高的医疗保健利用率和医疗支出有关。在法国，LTC的资金是分散的，在LTC的可及性方面存在显著差异。我们分析了LTC资金和供应的地理差异对痴呆症患者医疗保健支出的影响。方法从国家关联索赔数据库中计算个人医疗保健支出。我们运行多层模型，利用两个地理水平（嵌套在地方当局（LA）的住宅区）的支出变化来估计当地LTC供应和资金对痴呆症患者医疗支出的影响。我们用随机前沿模型估计了洛杉矶大学LTC资金的慷慨程度，并开发了LTC供应的分类。结果：生活在LTC资助最慷慨的LAs的痴呆患者，其急性期（- 11%）和急性期后（- 35%）的医院支出显著降低，而其初级保健支出较高（+ 17%）。此外，长期医疗服务供应最多的地区的人们每年和每人在医院护理上的花费比服务不足地区的人少3%。结论改善长期门诊的可及性，改善长期门诊的资金和供应，可以减少医院的支出，提高卫生系统的整体效率。

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引用次数: 0

Commercially available products for the digital tracking of biomarkers in Parkinson's Disease 用于帕金森病生物标志物数字跟踪的市售产品

Aging and health research

Pub Date : 2025-05-28 DOI: 10.1016/j.ahr.2025.100240

Padraig Cronin , Lucy M. Collins , Aideen M. Sullivan

Background

Parkinson’s Disease (PD) is a debilitating neurological disorder which affects 8.5 million people globally. Diagnosis of PD is made upon presentation of motor symptoms. However, there is a well-recognised prodromal phase of PD, when patients experience non-motor symptoms, and subtle motor symptoms, before the onset of the cardinal motor symptoms. Biomarkers of this prodromal phase can provide a diagnostic window into early disease processes, assisting with the differential diagnosis of PD and enabling earlier treatment. Due to increased availability of commercially-available products, both wearable devices and smartphone applications are being explored for potential to identify PD biomarkers. Such products can provide clinicians with early warning of disease progression, and supply researchers with tools for monitoring PD outside of laboratory settings.

Methods

This systematic review critically examined the academic literature published in the English language to identify currently-available products designed to track biomarkers of PD across 6 databases between January 2000 and March 2025.

Results

27 papers were identified which captured physiological biomarkers in PD patients using commercially-available products. Current products emphasise the capture of early motor dysfunction through both upper limb and eye movements. There is a lack of literature on the validation of commercially-available products for the detection of PD, despite an increase in advanced data analysis algorithms.

Conclusion

There is a critical need for validation of devices for the tracking of biomarkers of PD, which may be utilised for detection during the prodromal phase.

帕金森氏病（PD）是一种使人衰弱的神经系统疾病，影响着全球850万人。PD的诊断是基于运动症状的表现。然而，PD有一个公认的前驱期，当患者经历非运动症状和轻微的运动症状时，在主要运动症状出现之前。这种前驱期的生物标志物可以提供一个早期疾病过程的诊断窗口，有助于PD的鉴别诊断和早期治疗。由于商用产品的可用性增加，人们正在探索可穿戴设备和智能手机应用程序识别PD生物标志物的潜力。这些产品可以为临床医生提供疾病进展的早期预警，并为研究人员提供在实验室环境之外监测PD的工具。方法：本系统综述严格审查了以英语发表的学术文献，以确定2000年1月至2025年3月期间6个数据库中目前可用的用于跟踪PD生物标志物的产品。结果27篇论文使用市售产品捕获了PD患者的生理生物标志物。目前的产品强调通过上肢和眼球运动捕捉早期运动功能障碍。尽管先进的数据分析算法有所增加，但缺乏关于PD检测的商业可用产品验证的文献。结论迫切需要验证PD生物标志物跟踪设备，这些设备可用于前驱期的检测。

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引用次数: 0